15040151CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7408 STANFORD PL
CONTRACTOR: ANTHONY LEWIS
PERMIT NO: 15040151
OWNER'S NAME:
SAN JOSE, CA 95125
PHONE NO: (408) 217-8621
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
^�
INSTALL (N) EV CHARGING OUTLET WITH DEDICATED
License Class1�) C,—/Q Lic. # �] Q T
50
AMP CIRCUIT
Contractor k O�'lY
Q-fi�� l W 1 SKpate
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
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $1200
ave and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35932028.00
Occupancy Type:
,$!
Section 3700 of the Labor Code, for the performance of the work for which this
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 O T ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
18 YS LA ALLED INSPECTIO .
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
b Date Z,
granting of this permit. Additionally, the applicant understands and will comply
with all non-poin rce re ations per the Cupertino Municipal Code, Section
918
Date AWL
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
the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
will maintain compliance with
the Health & Safe5, 25533, and 25534.
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
Owner or autho . Date:
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
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, I must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
Lenders 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
TTT U 4QT7M A WnID _ RTTTT .D1T*J DIVIRION
Ifech. Plan Check Pluuib, flan Check Flee. Pian Check
L9ac:h. Permit lee Plumb, Permit Fee: I Glec, Permit Fee-
ofher -1'lerc h. Inv?ED-L- Other Plumb InsP. Other E;lec. Msp.
Mech. hasp_ Fee: Phtnrb. hasp. Tee: Oec. Irrsp. Fee:
NOTE: This estimate does not include fees due to otner departments (i a rtunntng, lKOt1C .. �•��, »•�••»• r •�- -- __
_t----- !'natart the Dent for addn'l info.
'Utstrict, el"L. 11tVJG cra u•c o—. v »w .....».—.».
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
ADDRESS: 7408 stanford pl
-- ------ --
QTY/FEE
DATE: 04/21/2015
REVIEWED BY: MELISSA
;01
APN: 359 32 028
1 BP#:
"VALUATION: 1$1,200
*PERMIT TYPE: Building Permit
Suppl. PC Fee: Q Reg. ® OT
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
$0.00
PENTAMATION SOLAR -RES
PERMIT TYPE: i
USE:
$0.00
WORK
INSTALL N EV CHARGING OUTLET WITH DEDICATED 50 AMP CIRCUIT
Suppl. Insp. Fee -0 Reg. ® OT
0,0
hrs
SCOPE
Ifech. Plan Check Pluuib, flan Check Flee. Pian Check
L9ac:h. Permit lee Plumb, Permit Fee: I Glec, Permit Fee-
ofher -1'lerc h. Inv?ED-L- Other Plumb InsP. Other E;lec. Msp.
Mech. hasp_ Fee: Phtnrb. hasp. Tee: Oec. Irrsp. Fee:
NOTE: This estimate does not include fees due to otner departments (i a rtunntng, lKOt1C .. �•��, »•�••»• r •�- -- __
_t----- !'natart the Dent for addn'l info.
'Utstrict, el"L. 11tVJG cra u•c o—. v »w .....».—.».
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
.._ ..._ _.
FEE
-- ------ --
QTY/FEE
L MISC ITEMS
Plan Check Fee:
$0.00
= # Alternative Energy System
$109.00 ICHRGSTA EV Charging Station
Suppl. PC Fee: Q Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax
Administrative Fee:
0
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
0
0
TmAvl Doetanentallon Fc
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$1.50
$109.00 rl A- FEE:
$110.50
Revised: 04/01/2015