15090009CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10720 MARTINWOOD WAY
CONTRACTOR: ROMANO ELECTRIC
PERMIT NO: 15090009
OWNER'S NAME: CARLSON ERIC R TRUSTEE
2198 LAUREL DR
DATE ISSUED: 09/01/2015
OWNER'S PHONE: 4082572597
SANTA CLARA, CA 95050
PHONE NO: (408) 564-0583
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
INSTALL (5) RECESSED LIGHTS IN KITCHEN.
(�� Lic. #
License Class C V
j.� I
Q
Contractort ) j!C ' mate
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: $925
formance of the work for which this permit is issued.
ae
ve 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: 36935032.00
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 LAST CALLED 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
/ !�
f�i Date:
granting of this permit. Additionally, the applicant understands and will comply
Issued by: /� L
with all non -point source regulations per the Cupertino Municipal Code, Section
ROOFS:
9.18.
�� (` _ �
Signature \�j C Date �
All roofs shall be inspected prior to y roofing material being installed. If a roof is
any r
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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: ., Date: r
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
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ina(a cupertino.orcl J M�j/Y14L�
❑ PLUAIMING ❑ MECHANICAL F LECTRICAL ❑ MCSCELLAINTEOUS
PROJECT ADDRESS V^� APN n
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OWNERNAME Ct
P E -
_ E•NL4II
STREET ADDRES CITY, ST ZIP
( FAX
CONTACT NAME PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWN'r'm ❑ OwN'ER-BunmER ❑ OWNER AGENT -PON'MA.CTOR ❑ CON`17RACTORAGE1,Tf ❑ ARC11 ECI ❑ ENOWEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR MA 10 LICENSE N R
LICENSE TYPE
BUS. LIC r
COMPANY N'
EMAIL
aY
FAX
STREETADDUSS , f
CITY, STA ZIP 7
,^
PHO
ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS. LIC{:
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF FD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLANTD ❑ YES
BUILDING: 1] COMMERCIAL I URBAN INTERFACE AREA NO
PROJECT IN ❑ YES
FLOOD ZONE 19.1\10
IS THE BLDG AN❑�qYES
EICHLER HOME? W'NO
DESCRIPTION OF WORK
TOTAL VALUATION:
C r, . ED BY;
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the propertyowner'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 buil ing construction. I authorize representatives of Cupertino to enter the above Identi ed property for inspection purposes.
Si-gnature of Applicant/Agent: Date:L�
SUPPLEMENTAL INFORMATION REQUIRED
A.
MEPAdiscApp_2011.doc remised 0 612 1/11
CITY OF CUPERTINO
FM -7 FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
10720 MARTINWOOD WAY
DATE: 09/01/2015
REVIEWED BY: SEAN
JimADDRESS:
APN:
BP#:
"VALUATION: $925
xPERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION 1 REAP1
PERMIT TYPE:
WORK
INSTALL 5 RECESSED LIGHTS IN KITCHEN.
SCOPE
Suppl, Insp Fee
APPLIANCE / EQUIP TYPE
FEE ID
llhunb. Plan Cheek
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPERMIT
Fixtures, Lighting
1BREMFIXT
Other Elec. Insp. 0.0 hrs $48.00
5
#
$72
Permit Fee:
Suppl, Insp Fee
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$72.00
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 hated on the nreliminary information available and are only an e.ctimato_ Contart tho 1)ont fnr addn'l in Fn_
FEE ITEMS (Fee Resolution 11-053 Eff iilil3)
Mech. flan Chec-k
llhunb. Plan Cheek
Elec. Plan Check 0.0 1 hrs $0.00
Meeh. Permit Fee-
Plumb. 1'z.
Elec. Permit Fee: IEPERMIT
Orber ;V�c•h,
l)rhef Plumb Insp.
Other Elec. Insp. 0.0 hrs $48.00
iilnsp.
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 hated on the nreliminary information available and are only an e.ctimato_ Contart tho 1)ont fnr addn'l in Fn_
FEE ITEMS (Fee Resolution 11-053 Eff iilil3)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Sul)Il..PC Fee
PME Plan Check:
$0.00
Permit Fee:
Suppl, Insp Fee
PME Unit Fee:
$72.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? Yes (j) No
$0.00
Advanced 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:
$214.501
$0.00 TOTAL FEE:
$214.50
Revised: 07/02/2015