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15060019 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10635 JOHNSON AVE CONTRACTOR:WESTEC ELECTRIC PERMIT NO: 15060019 OWNER'S NAME: VERNON AND DENISE EAST 1650 WILSHIRE DR DATE ISSUED:06/02/2015 OWNER'S PHONE: 4085719203 APTOS,CA 95003 PHONE NO:(831)688-1178 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL UPGRADE MAIN ELECTRICAL PANEL(200 AMP) Licensess�'.� yr'9-„ ��.E.-yk;F,,�'=sd�ti.: ti:,,z�.�,9y=f-s"; �e-�r-,r•,,- .� I hereby affirm that I am licensed unde 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 rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2400 a 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:37527015.00 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, loe costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 6 - 0 -/5 with all non-point source ulations p e Cupertino M icipal Code,Section 9 18. ai5 s' SFr : . ._,y +3 rt.� ?;-r °5"� _ ;•. * ) rte= RE-ROOFS: -Sign3tur . l.Ga r ` ; ;r +z'1�aY,..; r- Zi / - 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 2 ;255 d 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authoriud,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 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 9 18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building c(D.cupertino.oro M I S C ❑PLUMBING ❑'MECHANICAL ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESSo ,ry , 50 n �� APN# -77 OWNERNAME ••`/i PHONE E-MAIL C/( 0 8-5`71 - c1Zo3 STREET ADDRESS�� 76h•xJ e^_, A VOR CITY, STe6zIP p , 0 c FAX CONTACT NAME PHONE'' E-MAIL 031_2391- 36 le_cAyik ,�� STREET ADDRESS - - CITY,STATE,ZIP PAX �;l ' ' s G'-oo� 831 _L4_*, - 8� I� ❑OWNER ❑OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 5 CONTRACTOR AGENT ❑ ARCHITECT UP ENGINEER ❑ DEVELOPER ❑TENANT -7 CO CTOR NAME J, J� LIC. NSE NLJMBI R LIC_EN;E TYPE BUS.LIC# O COMPANY NAME E-M�t'IIL FAX + ,ue u wes STREET ADDRESS CITY,STATE,ZII' PHONE ARCIIITECT/ENGINEERNAME LICE NSE'NUMBER BUS.LIC# E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE 1�NO EICHLERHOME7 NO DESCRIPTION OF WORK C i �00 c C,P— 1 fr'c TOTAL VALUATIO J2oo RECEI SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY FW,, .OVER-THE-COUNTER Fes- ❑ EXPRESS -U "� ❑ STANDARD z U -'� ❑ -LARGE a ❑ MAJOR CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10635 JOHNSON AVE DATE: 06/02/2015 REVIEWED BY: SEAN APN: BP#: "'VALUATION: 1$2,400 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 REAP WORK UPGRADE MAIN ELECTRICAL PANEL 200 AMP SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 100 Amps $48 TOTALS: $48.00 19ech. F'tan L'heck 1'lrw1b.I'larl Check Elec.Plan Check 0.0 hrs $0.00 itleclr. Permit Few: 1'h,mh.Permit Fire: Elec.Permit Fee: ]EPERMIT Other Alec•h. Insp. Other•Plumb Irtsp. 0.0 Other Elec.Insp. hrs $48.00 ,14ech.Insp. Fee: Phitnfi. h:sp. Fee: flee.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: S'T1Pj.l. .f('Fee PME Plan Check: $0.00 Permit Fee: SuJ)pl. Insp I ee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 Advanced Plarming Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 V11-SUBT,OTAL5 $190.50 $0.00[, `, TOTAL FEE:; $190.50 Revised: 05/07/2015