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15030158 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 810 ALDERBROOK LN CONTRACTOR"TB"--TO BE PERMIT NO: 15030158 DETM7MNEM', I) OWNER'S NAME: MISHRA VIKAS DATE ISSUED:03/25/2015 OWNER'S PHONE: 4086855219PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL M-6 Q 200 AMP PANEL UPGRADE C16 License Class pp'G�� Lic.# L6 M— ( NU Contractor Wt r1 PI jr.rw ate UF I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2100 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36917028.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITBIIN 180 PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter , CALLED INSP TI N. upon the above mentioned property for inspection purposes. (We)agree to save 180 D indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued b Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. ROOFS: Signature Date 7O(� All roofs shall be inspected prior to anyny roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 255059 25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuper' ' ' al Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' 505,25533,and 2 534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag t: Date:1Ny� 1 permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPEtiTtNQ (408):777-3228•FAX(408)_777-3333 (a� •buildingcupertino.org MISC ❑PLUMBING ❑MECHANICAL LECTRICAL ❑MISCELLANEOUS �O'O ADD SS APN# `_q 1-7 Q '0� \ OVINE co8-6s5-�2iq EMAIL v STREET ADDRESSCITY,STATE, 1 FAX Cv hO. Ck• 014 CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUJLDER ❑ OWNER AGENT 10,coNmAcToR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO T OR Nr LICENSE NUMBER LI�SEE TYPE BUS.LIC# 96 2.9,0 C V 1 VE E-MAIL ;l.,•cc FAX STREET ADDRESS CITY,STATE,ZIP PjiPNE r u ^ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑ NO DESCRIPTION OF WORK t© TOTAL VALUATION: L/�}U RECEIVEDBY �{, By my signature below,I certify to a the following: I am the pro erty owner or authorized agent to act on the p e o er's behalf. I have read this application and the informatio ave provided is co ect. I haver a Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws r ting to building cons tion. I au rite representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agen. Date: VWd SUPPLEMENTAL INFORMATION REQUIRED x oFFIc usE olv _„ f';' W °vk dHE COULTER' N �pau XPSS y rLARG3 � � '+ a 55 - :� MEPMiscApp_2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 810 alderbrook In DATE: 03/25/2015 REVIEWED BY: Mendez APN: BP#• `VALUATION: 1$2,100 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK 200 amp panel upgrade SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 200 Amps $48 TOTALS: - $48.00 x s wti z' m Wch. Plan Check Plumb. Plan Check Elec.Plan Check 0.0 1 hrs $0.00 Lle& Permit Fee: Plumb. Permit Fee: Elec.Permit Fee: 1EPERMIT Other;11ec°h. lrisp. Other Plumb Imp. EI-L-- Other Elec.Insp. EE hrs $48.00 t<teriz InsP. free: Plumb, Irish.Fee: I Isiec.Insla.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelintina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl, P(:`Fee PME Plan Check: $0.00 Permit Fie: Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 C'onslt�uction Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 ,4dvanced Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldp,Stds Commission Fee: ]BCBSC $1.00 x TO AL FEE: $190.50 $1 0.501 $0.00 , Revised: 02/14/2015