15030167CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22406 SALEM AVE
CONTRACTOR: CALIFORNIA POWER
PERMIT NO: 15030167
AND LIGHT
OWNER'S NAME:
MORGAN HILL, CA 95037
PHONE NO: 4088470520
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
❑ LICENSED CONTRACTOR'S DECLARATION
3 PLEX- REPLACE (E) MAIN PANEL TO 400 AMP; UNIT 3
�+
Class G' Lic. # 7�� 9 7—
INSTALL (2) EXHAUST FANS IN BATHROOMS, (6) NEW
License
� ` 3`ZC�-IS
Contracto�li��.?Id- �enreC4 (,�q �•t nate
RECEPTACLES; (3) SWITCHES.
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: $13800
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32615018.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
p i issued.
PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
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
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS F AS CALLED INSPECTION.
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 by Date: 3L//c---
granting of this permit. Additionally, the applicant understands and will comply
with all non -point so a regulations pe a Cupertino Municipal Code, Section
918.
c
Signature Date
RE -ROOFS -
All roofs shall be inspected prior to any 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
I, 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)
I, 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 25505, 25533, and 25534. I 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 Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 255 5, 25533, a 534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:--
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
�ST_RUC
not employ any person in any manner so as to become subject to the Worker's
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
918.
Signature Date
CITY OF CUPERTINO
IiIPIP F.CTIMSTnR — RITILDING DIVISION
Mech. Plan Check 1 0.0 1 hrs $0.00 1 Phraaab. 111a t (: /,Ec&
Mech. Permit Fee: IMPERMIT I I Piumb. Permii Fire:
Other Mech. Insp. 0.0 hrs 1 $48.00 (Other Plumb Insf).
Wech. Insp, tee:
Phiwb. hasp. Fee:
Elec. Plan Check 1 0.0 1 hrs $0.001
Elec. Permit Fee: IEPERMIT I
Other Elec. Insp. 0.0 hrs $48.00
Llec. Insxr. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public worxs, rere, aanuary,3ewer Lcstrnct, acnouc
TL,..... 1:.,. .. nContact the Dent for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113)
ADDRESS: 22406 salem ave
DATE: 03/26/2015
REVIEWED BY: Mendez
1;w
APN:
BP—
*VALUATION: 1$13,800
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
p
0.0
PENTAMATION 1 REAP2
USE:
PME Plan Check:
PERMIT TYPE:
WORK
3 lex- replace a main panel to 400 amp; unit 3 install 2 exhaust fans in bathrooms 6 new
SCOPE I
receptacles; (3) switches.
Mech. Plan Check 1 0.0 1 hrs $0.00 1 Phraaab. 111a t (: /,Ec&
Mech. Permit Fee: IMPERMIT I I Piumb. Permii Fire:
Other Mech. Insp. 0.0 hrs 1 $48.00 (Other Plumb Insf).
Wech. Insp, tee:
Phiwb. hasp. Fee:
Elec. Plan Check 1 0.0 1 hrs $0.001
Elec. Permit Fee: IEPERMIT I
Other Elec. Insp. 0.0 hrs $48.00
Llec. Insxr. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public worxs, rere, aanuary,3ewer Lcstrnct, acnouc
TL,..... 1:.,. .. nContact the Dent for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
400 amps Electrical
$72.00 1BELEC1000 Services
Suppl. PC Fee: Q Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F-1-0-0-1amps Electrical
$48.00 1 IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. ® OTo]
hrs
$0.00
0 Electrical
$48.00 1BREMRECEP Recep/Switch/Outlets
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
I�` J # Mechanical
$50.00 1BREMVENF Ventilation Fan
('otrstructl.on Tax:
Administrative Fee: ]ADMIN
$45.00
0
E)
Work Without Permit? ® Yes (j) No
$0.00
Advanced Plane Fee.-
$0.00
Select a Non -Residential
Building or Structure
0
i
Travel Documentation Fee: ITPA VDOC
$48.00
Strong Motion. Fee: IBSEISMICR
$1.79
Select an Administrative Item
B1dp, Stds Commission .Fee: 1BCBSC
$1.00
:y
$191.79
r
$218.00 TOLFEE:
$409.79
Revised: 02/14/2015