15110077CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS..; '1017;,6 LA RODA DR
CONTRACTOR: ANTHONY HODDER
PERMIT NO: 15110077
CONSTRUCTION
OWNER'S NAME:: .MARASCHIN JOAN M TRUSTEE & ET
7504 BOLLINGER RD
DATE ISSUED: 11/12/2015
OWNERS PHONE:;9,082537213,
CUPERTINO, CA 95014
PHONE NO: (408) 2574317
El i.+i''LICEIVSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL F]
,';• r..,.,..2
MAIN ELECTRICAL PANEL UPGRADE (200 AMP);
�icense,Class+•:: '•S`7,3Lic.#1
REMOVE
':Gti+r — % 2 ���
AND REPLACE NEW KITCHEN EQUIPMENT WITH
ontracto mate /UDV
ELECTRICAL.
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.'isl )n full force and effect.
I hereby„affirm under:peualty of perjury one of the following two declarations:
I have and.'will. inaiptain a: certificate of consent to self -insure for Worker's
Compensation' :' p;ovrded fo;;by. Section 3700 of the Labor Code, for the
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $6000
have and':vvill maintain' Worker's Compensation Insurance, as provided for by
ction_ 3700'of ttie'habor�Code; for the performance of the work for which this
APN Number: 36934038.00
Occupancy Type:
ermit is issued.,'
=''h APPLICANT CERTIFICATION
I certify that I have read this' p'lication 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 coristmction„ and lieaeby authorize representatives of this city to enter
upon'the'alioye mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify;and,kee0armless1he City of Cupertino against liabilities, judgments,
costs'ande'x 's which may accrue against said City inconsequence of the
granting'of is':' rmit: Additionally, the applicant understands and will comply
yell
Issued b �! I/ �l/K Date: �, `�
Y' t
with all' n n-po, 'sour e; gulat}ons per t e Cupertino Municipal Code, Section
9.18.' r
(� � r7 0
igna Date t/ �i J
RE -ROOFS:
be inspected to being installed. If a roof is
re
All roofs shall prior any roofing material
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ ;• , ';u OWNER -BUILDER DECLARATION
I hereby af6m that I am;ezempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons: ; •;;�,,.',, ..
ALL ROOF COVERINGS TO BE CLASS "A” OR BETTER
I, as. 'own'er of the.propeify;!of m.y employees with wages as their sole compensation,
will do'the work -and the structure isnot intended or offered for sale (Sec.7044,
Business & Professions Code)'
I, as owner `of the ro 'e y l arri'exclusivel contracting with licensed contractors to
P P rt3,, Y g
HAZARDOUS MATERIALS DISCLOSURE
construct the project 0ec.7044, Business &-Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
`i l''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 .'�� -',! '' I;-;,'.. •
Health &Safety Code, Section 25532(a) should I store or handle hazardous
I have an d;willimaintain•a`Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensaton'as provided f6r by Section 3700 of the Labor Code, for the
'
air contaminants as defined by the Bay Area Air Quality Management District I
performance.' .the work foi'which this permit is issued.
will maintain compliance with a upertino Municipal Code, Chapter 9.12 and
I have andwill maintain Workers Compensation Insurance, as provided for by
3700 'of Labor for
the Health &Safety Code, S do 25505 5533, an 5
��.
7i 2
-12-
Section the CodeJor the performance of the work which this
6� -
+ ner or authorized age t: Date: !"
permitis.$sued.ls`il
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 hof 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! wiflr.such`provision's or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
' 'h';` •: j' !: ;APPLICANT CERTIFICATION
Lender's Address
;;'j
I certify that I, have,'iead.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 buildir4 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 liarmless;the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses;iwhich 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', :; ;;i• ,,
I''i•'iE� :I; I. •;i.. i.. C', ",FrSu
Signature 'I :; !ii r Date
CUPERTINO-
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPI\riENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build ina(cDcuDertino.org �677 m I %J
DPLU,SING DMECHANICAL ,ELECTRICAL DAi-ISCELLAKPOUS
PROJECT ADDRESSI 7 7 �1 L6� (`-"L/ �� %T D �� 4P�D��
V
OZ� ' i IJ iv J ✓ 1 /" 1 fl �1 � /'%v
I P Olmb `
�- 7�/3
E-1✓�AIL
STR? ADDS ; p CITY, A�
FAX
CONTTACZ NAME
PHIv-
�' T.LAIL
'��
L
ST n SS.�,�
.4 Z �- L
CITY TALE, ZIP
F_AX
❑ O'WN-a ❑ 01AI ER -BUILDER ❑ ORRN�t AG= -'H COhrI-RACTOR ❑ CONTRACTOR AGENT ❑ ARcg=, c-, ❑ ENGu -.=-ER ❑ D-zA .LOPER ❑ T=I�"ATZ
LICENSE NU NOFR
I LICENSE TYPE
I BUS. LIC
COIJ ANY'. � ✓ r �� � ,�
ai
I E -NAIL
I FAX
STR_El'�cS, ,� 2
(J (� l
CITY ,aIATP
PHONE
A-RCIETECTrNGLh`EER NAME LICENSE NUMBER
BUS. LIC
COMPANYNA1VIE
E-IJAIL
I FAY,
STREET ADDRESS
CITY, STATE, ZIP
—T—
PH0;
USE OFSrr-D or DUPL.'rX ❑ 1J,U'LTI-FAIULY PROJECT LN WaDL/ ND ❑ YES
I
PROJECT IN ElYES
IS THE BLDG AN El Y Es
BuZTDLG: ❑COIvAtCLq✓ LiRBP-NTATERFA.CEAREA
NO
FLOOD ZONE NO
EICYZERHONE7 NO
Ce
TOTAL VALUATION: ��
3 S
r RcCEIVED BY r ' g>
By my signature belov,,, I certify t each f the following: I am the grope ow r ori-,thorized agent to act on the property owner's behalf. I have read this
application and the information have ovided is ect. I have read the esc ption f \��o and verify it is accurzte. I agree to comply;; ith all applicable local
crdinances and state laws rel g to ilding co / ction. I authorize re rese tatives f Cu ertino to enter o e -identified property-7for_inspecuon purposes.
or ms
Signature of Applicam' a t: (1l/
Date ��f 1 2--S~
2-o
SU-PPLEhIENTAL D\'FOY4ATION REQUIRED
r..;,
f
OFFSC$LSEO�LI,.
KOV£ TIi1 CO,T3TER
5„x
f
!"R
.
i-4RG;+;'
;v ,."M
RdEPA7iscApp_2011.doe remised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10776 LA RODA DR DATE: 1111212015 REVIEWED BY:, SEAN
APN: BP#: *VALUATION: 1$6,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM
USE:. PERMIT TYPE:
WORK MAIN ELECTRICAL PANEL UPGRADE (200 AMP); REMOVE AND REPLACE NEW KITCHEN
SCOPE EQUIPMENT WITH ELECTRICAL.
111"vi"b. Nan ("heck Elec. Plan Check 10.0 1 hrs $0.00
1"lumb, 11=�rnnul*:'ee: Elec. Permit Fee: 1EPERMIT
()fher.11htrnb lhu - Other Elec Insp. 0.0 hrs
.M'ech Insa! Fe#.->: Alitmb..bisp. fee: [-,7ec. hup. Fee:
NOTE.- This estimate does not include fees due to other Departments (L e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These -fees are based on the preliminary information available and are only an estimate. contact the Deptforaaan't info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7111132
FEE
QTY/FEE
I MISC ITEMS
Plan Check Fee:
$0.00
= s.f.
$645.001
Remodel, Kitchen (<---300 sf)
1,MMVSUT
'A
Suppl. PC Fee: 0 Reg. 0 OT
rO. 0
1 hrs
$0.00
PMIE Plan Check:
$0.00
200 amps
$48.00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OTFo-ol
hrs
$0.00
PMEUnit Fee:
$0.00
PM[E Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
(D
Work Without Permit? 0 Yes (D No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
'A
Travel Documentation Fee: ITRAVDOC
$48.00
Stron Ly Motion Fee IBSEISMICR
$0.78
Select an Administrative Item
Bldg Stds'C6mmission F ; ee: IBCBSC
$1.00
4
$142.78
$693.00
!PTAL :F
Revised: 10/01/2015