1508010701�
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10365 DEMPSTER AVE
CONTRACTOR: SWITCHED ELECTRIC
PERMIT NO: 15080107
OWNER'S NAME: SALIL SANE & VELANKAR ASHWINI
PO BOX 1092
DATE ISSUED: 08/13/2015
OWNER'S PHONE: 4087184455
LOS BANOS, CA 93635
PHONE NO: (209) 827-0125
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
REMOVE (E) 100 AMP MAIN PANEL AND REPLACE WITH
q
License Class Lic. # (s Q?Z
(N)
Contractor5--T, >Abdito Date p— i 3 — / S
100 AMP MAIN ELECTRIC PANEL
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.
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: 32647078.00
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
180 FROM LAST CALLED INSPECTIN.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
t 10
costs, and expenses which may accrue against said City in consequence of the
1 V
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
—l�
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:
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)
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, Section 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:
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
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
,
CUPERTINO
GENERAL PERMIT APPLICATION 1505010-'� . MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 • buildina(c1cuoertino.org M I
L_1 PLUAiBIIvG U MECHANICAL L-�SLECTRICAL / U M=ELLAYEOUS
PROJECT ADDRESS /0 �/_S /D„ ^PJ7'�r�
OA�TER NA]vIEP E-MAIL
ril C- v Va h r us
STREETP.DDRESS / Z /_C j1�W /_ r CITY, tTE,ZIP / ,. { FAX
CONTACT N.11,11E �( PHONEQ� F",LA1I/L
C
STREET .ADDRESS j�� / OM� �/ CI SSAT��/�� FAX
ElWI'rm 11O.OAR.'ER-BT-TaDER ❑ OWA'ERAGENT COl\iRACTOR ❑ CO?.TRACTORAGENT ❑ ARCHIiECT ❑ ENGAIER ❑ DEVELOPER ❑ TE\.Aj,7T
CO1hTRACTOR N:A Ar! /J " LICENSE' U1,1BER ?So72
o LICENSE TYPEC /0
BUS. LIC
COMPAt Y N, AI �� yl /�Gc G) E N 0rv/ c
STREET ADDRESS �. r �C Q C'c /tet C, Co I F.AX
CITY, STATE, ZIP v PHO:'E -
1RCHITECT/ENGLN7EER NAME LICENSE NUMBER I BUS. LIC 4
COMPANY NAME I E-MAIL I FAY,
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF W,D ., DUPLEX ❑ MULTI-F.A i1LY PROJECT LN AlILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG .AN ❑ YES
B=L'D'G: ❑ COMAfERCLAL URBAN II.'TERF.ACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HONE? ❑ NO
DESCRIPTION OF WORK n I I A / i
TOTAL VALUATION: z RECEIVEIiBIw
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr perty owner's behalf. I have read this
application and the information I have provided 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 buildinn construction. I autliorize reiDreseDtatives of Cupertino to enter the above- idd-nttiified roperty for inspection purposes.
Signature of Applicant/Agent://� _ Date: /� /�715—
SUPPLEMENTA1,VTORMATION REQUIRED
MEPMiscApp_2011.doc remised 06121/11
CITY OF CUPERTINO 150 01 a "
FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 10365 Dempster Ave
DATE: 08/13/2015
REVIEWED BY: PAUL
UNITS
APN: 326 47 078
BP#:
*VALUATION: 1$3,500
°PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
Amps
PENTAMATION 1 REAP
PERMIT TYPE.
WORK
Remove E 100 Amp main panel and replace with N 100 Amp main electric panel
SCOPE
sul)pl. Inslr Fee
APPLIANCE / EQUIP TYPE
FEE ID
aonh. Pian CheckF-1
QTY
UNITS
BP FEES
Elec. Permit Fee: ]EPERMIT
Services
1 ERT<200
Other Elec. Insp. Ej �hrs$48.00
100
Amps
$48
"zr•mit 1, ee.
sul)pl. Inslr Fee
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Construction Kix.-
ix:Administrative
AdministrativeFee: IADMIN
$45.00
Work Without Permit? 0 Yes (F) 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 preliminar information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-0.53 Eff. 711113)
'eeh. Plan Check
aonh. Pian CheckF-1
Elec. Plan Check 0.0 hrs $0.00
44ech. Permit I-ec
Fl,/,,,,,. Permit F
Elec. Permit Fee: ]EPERMIT
rr/aer.Stecle..tnsh.;herl'lurrtb.lrzsh,
Other Elec. Insp. Ej �hrs$48.00
PME Plan Check:
$0.00
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 preliminar information available and are only an estimate. Contact the Dept for addn7 info.
FEE ITEMS (Fee Resolution 11-0.53 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
"rrxtt Check 1,ee:
'itpj)L PC Fee
PME Plan Check:
$0.00
"zr•mit 1, ee.
sul)pl. Inslr Fee
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Construction Kix.-
ix:Administrative
AdministrativeFee: IADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
'01"anc•ed Planning Peas:
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:
$190.50
$0.00 TOTAL FEE:
$190.50
Revised: 07/02/2015