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15120023RE CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11141 CHADWICK PL CONTRACTOR: ECP ELECTRIC PERMIT NO: 15120023 OWNER'S NAME: UPPULURI VENKATA N AND KASHIBATLA R 4843 SUTCLIFF AVE DATE ISSUED: 12/03/2015 OWNER'S PHONE: 4087188412 SAN JOSE, CA 95118 PHONE NO: (408) 507-3267 ilz LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] V, REPLACE (E) 100 AMP PANEL WITH (N) 100 AMP PANEL, License Class'C 0 Li,. # �% ((� SAME LOCATION Con tractor L-( Qc4y-i c Dat 1_Z, •- 3 — (S' 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: $1800 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: 35617079.00 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 DA -S--FRO 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 Date: granting of this permit. Additionally, the applicant understands and will comply s with all non -point source regulations per the Cupertino Municipal Code, Secti 9.18. Signature (? DateTl� RE -ROOFS: 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(x) 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 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this %d Owner or authorized agen�,�_.____2 �' Date,�n�3 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 CUPERTINO"- GENERAL PEP,1101 i APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ' BUILDING DIVISION 10300 T ORRE AVENUE' CUPERTINO, CA 95014-3255 (408) 777-3228 ' FAX (408) 777-3333 • build inc(d,)cuoerino.crq Is 012 o0Z ❑ PLUh,IBIT-�G ❑ MECHANICAL 9ELECTRiCAL ❑ M, ISCELLAu\EOUS PROJECT ADDRESS 1114 chaff yd ' I .APN A!'7 J 5" /d� - / 0!2 ck. � �L �i OCvTrRNA1✓s � ( I �'E- -7L E•I✓e.�Z kahl 1 rit _l6 ' "s 1Z STREET A MI)PaSS I CITY, STATE, ZIP I FAX CO_iTACT N. IME PHONSE 4o8•�'Q?-32(oZ F.t 2gjL r STREET? -DD=- S 'J CITY, STATE, Z2 p, I FAX �I G -e • LSI i g ❑ Om, --a ❑ORR. -3u-Ti D�2 ❑ CMINFEiACL1,TT ❑ C01,71RACTOR ❑ COI.7TFJ,CTORAG---\-T ❑ .,,RC:.7,zicT ❑ zNGL�=:R ❑ D-=�rLOPE ❑ TEN, CONTRACTOR KUCu - !A2 ��1rQ LS LICENSE NUI\GER X3231(9 LICENSE TYPE BUS. LIC SGP Cl-ec �'ic, c• io COMPANY N AIa E-M.4IL !I 1 � 2G'i ^ v I FAX �C � �I •GC� r l L g C .. � r l G a VIQO . eotW STREET ADDRESS 4 �� c ��-*c �v2 • CITY, STATE, ZIPPHONE ��>� SoS� C • �tSll ARCMTECT/ENG1-KiERNAME �y/ I LICE -SENUMBER BUS. LIC COMPANY NAME E-MAJL I F? STREET ADDRESS I CITY, STATE, ZIP I PHONi LTSE OF STD or DLTLFX ❑ 1✓L LTI-F:Ah� Y . PROTECT IN A'IIDL A- D ❑ YFs ?ROY--- LN ❑ Y tS IS THE BLDG AN ❑ 1=S Bu-=N1G: C ❑ COh4.!'-- .CLQ UR3A.N 1Ni--M'rACE APak ❑ NO FLOOD Z013 ❑ No I EICFZ - H0m-'-? ❑ NO DFSCP,IPT ONOF lh'ORK ii C' iQ kewe mAurA o aml ayid C u 6 pLe . 5 i d i i 0 ct C,.0 �"154 (C'C'-P, b 0 5.��, � -R - 1 0 -c -e-- TOT?L`'ALUATION: goo ` E. By my signature below, I certi:"y to each of the follov"ing: Ian the prope_-Ly Owner or autborized agent to act on the propel owner's behalf. I have read this applicztion and he irrfornation I have pro�Tided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local o,di-jances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identin-ed property for inspection purposes. Signature of Applicant/Agent:<Zf::�71e�_� C(2nn. Date: SU?�� -PPLENTAL D\'F'ORvIATIOi� REQUIRED `..'� � S OVER Tim COLrR T NMI }Vh yxa'� �"' VIZ.- �4RU 3 y TZ?�JOI2 s ;tg -A/FP-i'1'isc4vp_2011.doe revised 06121111 CITY OF CUPERTINO 10 PWA I VVIR IV Q.TlrX4 A TnP —'R'FTT1,D1NG DIVNION LaADDRESS: 11141 CHADWICK OW Pc_ FEE 111) DATE: 12/03/2015 REVIEWED BY: MELISSA UNITS APN: 356 17 079 1 BP#: Services *VALUATION: 1$1,800 *PERMIT TYPE: Electrical Permit PLAN. CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex $48 0.0 PENTAMATION I REAP2 USE: PERMIT TYPE: WORK REPLACE (E) 100 AMP PANEL WITH (N) 100 AMP PANEL, SAME LOCATION SCOPE ]EPERMIT APPLIANCE / EQUIP TYPE FEE 111) QTY/FEE QTY. UNITS BP FEES 1 Services 1 ERT<200 100 Amps $48 0.0 TOTALS: 10TE: This estimate does not include fees due to other Departments (i.e. Planning, ruouc worKs, Pire,,3anitary,3ewerutsti-tL;t, acwuul District, etc.). These fees are based on - the preliminary information available and are only an estimate. Contact the Dept for addh 'I info, FEE ITEMS (Fee Resohition 11-053 Eff.'7111IJ3 FEE QTY/FEE MISC ITEMS Afech. Pian Supj)L P(7fi'(-,,e hvi"t, 1", 1 1 Mil Check 4 '�L PME Plan Check: Elec. Plan Check 0.0 hrs $0.00 lliwb, PME Unit Fee: $48.00 Elec. Permit Fee: ]EPERMIT Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (D No $0.00 Other Elec. Insp. 0.0 hrs Travel Documentation Fee: I TRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Elea insp. /,'ec: $1.001 10TE: This estimate does not include fees due to other Departments (i.e. Planning, ruouc worKs, Pire,,3anitary,3ewerutsti-tL;t, acwuul District, etc.). These fees are based on - the preliminary information available and are only an estimate. Contact the Dept for addh 'I info, FEE ITEMS (Fee Resohition 11-053 Eff.'7111IJ3 FEE QTY/FEE MISC ITEMS Plan Supj)L P(7fi'(-,,e PME Plan Check: $0.00 pergrit flee .. PME Unit Fee: $48.00 PNM Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (D No $0.00 Ad1'ance4l Phmning ]`ees: Travel Documentation Fee: I TRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.001 JUT L SUBTOTALS: $1 90 .50 1 $0.00" TOTAL E:,:�,F $1 Revised: 10/01/201