15040029 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10193 TONI CT CONTRACTOR:VOLTZ ELECTRIC PERMIT NO: 15040029
OWNER'S NAME:
SAN JOSE,CA 95123 PHONE NO:(408)464-8588
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL(N)EV CHARGING STATION IN GARAGE,ADD
License Clas Lic.# 2 (N)
�, �j 100 AMP SUB PANEL IN GARAGE&RELOCATE(E)
Contractor Date OUTLET
I hereb affir that I am licensed under the provisions of Chapter 9 TO ACCOMODATE PANEL/EV CHARGER
(comme cing ith Section 7000)of Division 3 of the Business&Professions
Code an t 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
rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2000
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:31623108.00 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 DAYS FROM L ED 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
granting of this ermit. Additionally,the applicant understands and will comply su !�
with all non- of t source egu ati per the Cupertino Municipal Code,Section
9.18. _
RE-ROOFS:
Signature DatAll 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 byt e ay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with a upertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se tion 255 25 3,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this t
permit is issued. Owner or authorized agent: � aD t
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 CO ST CTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there i onstruction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this perms 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
918.
Signature Date
CITY OF CUPERTINO � 6o4002_j
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10193 TONI CT DATE: 04/06/2015 REVIEWED BY: MELISSA
APN: 316 23 108 BP#: *VALUATION: 1$2,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: SOLAR-RE
WORK INSTALL N EV CHARGING STATION IN GARAGE, ADD N 100 AMP SUB PANEL IN GARAGE &
SCOPE RELOCATE (E) OUTLET TO ACCOMODATE PANEL/EV CHARGER
X/ec:;x.Ahv"£:hcrc; Pluaaa13.Mai?0w,-4- Elec.Plan Check 0.0 hrs $0.00
Uech. Fee., Elec.Permit Fee: IEPERMIT
(itzae:r I'lec.,r.1;'Ispz L);Iz ,.P?r si7.Ifzsy�, Other Elec.Insp. 0.0 hrs $48.00
:19ech.Insp,?ea: Phaarb.I;asl).fee:
NOTE:This estimate does not include fees due to other Depm4ments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the preffininar information available and are only an estimate. Contact the De t for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Alternative Energy System
Supp/.PC Fee: Reg. OT 0.0 hrs $0.00 $109.00 ICHRGSTA EV Charging Station
PME Plan Check: $0.00 Electrical
Permit Fee: $0.00 $48.00 1 1BREMRECEP Recep/Switch/Outlets
Suppl.Insp. Fee-(j) Reg. 0 OT0,0 I hrs $0.00 100 amps Electrical
PME Unit Fee: $0.00 $48.00 IBELEC200 Services
PME Permit Fee: $48.00
Administrative Fee: 1ADMIN $45.00 0
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential G)
Travel Documentation Fee: 1TRAVDOC $48.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SITBTOTALS':'FFF! $142.50 $205.00 TOTAL FEE, $347.50
Revised: 02/14/2015