15040039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10581 WHITNEY WAY CONTRACTOR:SCLAR LESLIE J AND PERMIT NO:15040039
SUZANNE M
OWNER'S NAME:
CUPERTINO,CA 95014-4441 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
200 AMP PANEL UPGRADE
License Class Lie.#
Contractor Date
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:$1500
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:36938016.00 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 WITfIIN 180 DA 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 ST CALLED INSI`FfTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the (Q
Issued by: Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature Date 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:
tefollowing
by affirm that I am exempt from the Contractor's License Law for one of
two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
wner 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&Safe ode,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance h the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Cod ,Sectio 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionall ,shoul I use quipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as d rued y the y Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain complian
Date: /
rbecome
issued.
that in the performance of the work for which this permit is issued,I shall
loy any person in any manner so as to become subject to the Worker's
sation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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
h 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 ave re this application and state that the above information is
correct.I agre to com y with all city and county ordinances and state laws relating
to building co truction and ereby authorize presentatives of this city to enter
upon the above mentio ed erty for insp on purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and eep h le s he City of C ertino against liabilities,judgments,
costs,
Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10581 whitney was DATE: 04/06/2015 REVIEWED BY: Mendez
APN: BP#: EVALUATION: $1,500
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP2
USE: p PERMIT TYPE: i
WORK 200 amp panel upgrade
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 200 Amps $48
TOTALS: xa� ���H
$48.00
T .r
r
_ NO
Mech. Peru Check Plnmb.Plan Check Elec.Plan Check 0.0 hrs $0.00
;Lie,h.Permit fee; Plumb.Permit Pee: Elect.Permit Fee: IEPERMIT
F'I"'" Mech. tnsp. OrheY Ptumh Insp. Ll I Other Elea Insp. 0.0 hrs $48.00
.fngp. Fee: Plumb. hasp.fee: Elec.Imp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These&es are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 L . 711113) FEE QTY/FEE MISC ITEMS
Plan Check h*ee:
;S'uppl. P(..-Fee
PME Plan Check: $0.00
Perinit Fee.
Supp/. Insp I ee
PME Unit Fee: $48.00
PME Permit Fee: $48.00
Consiruction Tax:
Administrative Fee: IADMIN $45.00
Work Without Permit? ® Yes (E) No $0.00
Aclvaneecl Planning 147ees:
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
1010� $190.50 $0.00 , e FEE: $190.50
a. _ ;-.., "° �a%&
Revised: 02/14/2015