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15080082f CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10007 SPANISH OAK CT CONTRACTOR: SWITCHED ELECTRIC PERMIT NO: 15080082 OWNER'S NAME: ALAN KUTACH PO BOX 1092 DATE ISSUED: 08/10/2015 OWNER'S PHONE: 4155056798 LOS BANOS, CA 93635 PHONE NO: (209) 827-0125 ®' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ �SO REMOVE AND REPLACE 100 AMP MAIN ELECTRICAL License Class G' l Lic. # %Z O SERVICE Contractor b�lr t acr_,�CL 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 Sq. Ft Floor Area: Valuation: $3500 performance of the work for which this permit is issued. 1 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: 34232081.00 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 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 180D S FROM LAST CALLED INSPECT ON. 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 I J v l , 8 `D granting of this permit. Additionally, the applicant understands and will comply Issued by: v Date: with all non -point urce regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 4 / 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 25505, 25533 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this ; permit is issued.q Owner or authorized agent: Date: r 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Admilk (408) 777-3228 • FAX (408) 777-3333 • buildlno(d)CUDertlno.Orq CUPERTINO ❑ PLL1b�IlvG ❑ M I MECHANICAL Z<FCTRICAL ❑ MISCELLANFOUS PROJECT ADDRESS ^/OO Q Q �/ J / Oak % C� ppl 1 , t I O��JI ERNAI✓E L' /Q !-% �U 4QG(/f PHOT E �� SOS�'/COt t 16 t I✓e tITQC� lro7ititatl CrO�c STREET ADDRESS /00'O 7 (�� al, `l L ^L CITY, STATE, ZIP /1 / + �G 15b/ FAX (h�tC (� ( /�77 CONTACT NAME � / PHONE E-MSIL —7/76 0.�Gt4•. @ 4., irlcec�e%t7�nc . STREET.ADDRESS CITY, ST 70je C. �i/ FAX E3Owmm 11owI -R-B=DER ❑ C, ^-,NER AGENT[ 2 CO\7PLACTOR ❑ CONTRACTOR AGENT ❑ ARC=CT ❑ ENGLNEER ❑ D_'1 tLOPER ❑ TENA1Sr CONTRACTORN?A/'� /J Com` LICENSETtiABERLICRTSETYPE ^ BUS. LIC r %� � �/ Z o COMPANY N.AI✓,E E -MAR. FAX STREET ADDRESS � � w I � CITY, STATE, ZIPLf� PHONE ARCIDTECT/ENGA71ER NAME 1 l LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD o, DUPLEX 99 MULTI-F.A,=Y PROJECT IN WILDLAND ❑ 1'ES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BL=L\''G: ❑ COIvD mcIAL URBAN LNTERFACE AREA L@ NO FLOOD ZONE NO EICHLER HOME? NO DESCRIPTION OF WORK TOTALVALUATION: RECEIVED Bl By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provi ed is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' g co truction. zuthorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT Dv'FORMATIONREQUIRED o icEUSE,`onL� OVER TBI COUNTER S L � � L7 ; C : © LARGE © AZAJOR MEPYisc.4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO 150w�6R FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10007 Spanish Oak Ct. DATE: 08/10/2015 REVIEWED BY: PAUL UNITS APN: 342 32 081 BP#: *VALUATION: 1$3,500 °PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps PENTAMATION 1 REAP2 PERMIT TYPE. WORK Remove and Replace 100 Amp Main Electrical Service SCOPE "i-q)Pl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID Vllfn >. flan Check. QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Services 1 ERT<200 Other Elec. Insp. 0.0 hrs $48.00 100 Amps $48 .f� rnit .Fee: "i-q)Pl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 '�»t,sli"Ut:lttat7 ./t1:x: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes e) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 t .� 7/1/13,) ,Alech. Ply n Check Vllfn >. flan Check. Elec. Plan Check 0.0 hrs $0.00 Afech. P�>r [Pill -b. Perwil Fc, Elec. Permit Fee: IEPERMIT Other llech. In.sp. cher Piutlih jav" Other Elec. Insp. 0.0 hrs $48.00 'I ln,,P. Fee_ =�r;, !, I' v Ll , NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 t .� 7/1/13,) FEE QTY/FEE MISC ITEMS ."tan Check .Fee: iipyl. PC Fee PME Plan Check: $0.00 .f� rnit .Fee: "i-q)Pl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 '�»t,sli"Ut:lttat7 ./t1:x: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes e) No $0.00 Jvaneed Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $190.50 $0.00 TOTAL FEE: 1 $190.50 Revised: 07/02/2015