B-2016-1342 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1342
10380 CASTINE AVE CUPERTINO,CA 95014-1353(326 41 024) (NEXT GENERATION'
ELECTRIC)
SAN JOSE,CA 95112
OWNER'S NAME: JONES PETER B AND BARBARA A TRUSTEE DATE ISSUED:02/10/2016
OWNER'S PHONE:408-257-9385 PHONE NO:408-726-6907
LICENSED CONTRACTOR'S D C A R A TION
BUILDING PERMIT INFO;
License Class C-1 Q Lie.#984642
Contractor(NEXT GENERATION ELECTRIQj Date 02/10/2016 X BLDG X ELECT =PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE 125 AMP SUB-PANEL.
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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
performance of the work for which this permit is issued.
2. 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 permit is issued, Sq.Ft Floor Area: Valuation:$1000.00
APPLICANT CERIIEICATION
certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county APN Number: Occupancy Types
ordinances and state laws relating to building construction,and hereby 326 41 024
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,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the pplicant understands and will
comply with all non-point source reg ti ns per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
Code,Section ,18.
Issued by: �7
Signature4doii Date 02/10/2016 Date:02/10/2016OWNER � �✓
-B D R D CLARATIONRE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property;or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered
for sale(See.7044,Business&Professions Code) Signature ofAppiicam:
2. I,as owner of the property,am exclusively contracting with licensed Date:02/10/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the'
2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. 1 certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the C portion Municipal Co ,Chapter 9.12 and '
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Co , ections 25505,25533 nd 25534.
exemption,I become subject to the Worker's Compensation provisions of the
Labor Code,I must forthwith comply with such provisions or this permit shall-
,wner or authorized agent
be deemed revoked. Date:02/10/2016
APPLICANT CERTIFICATION CONSTRUa1O`N LE ING
I certify that I have read this application and state that the above information is I hereby affirm that there is a c struction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Signature Date 02/10/2016 Professional
................_.__..........._.._.
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(a)cupertino.org
CUPERTINO
misc
y
❑PLUMBING MECHANICAL 2-�Ij1 6 —
ECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN
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STREET ADDRESS O Q � & � CITY,STATE,ZIP � ` F�
CONTACT NAME [ PHONE o. r� EMAIL
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❑ OWNER 11OWNER-BUILDER ❑ ORN�TERAGENT CONTRACTOR ElCONTRACTOR AGENT 1:1ARCHITECT y❑]EINGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME C 1 C-f—,r4—m ILICENSE N�sER LICENSE TYP BUS.LIC 4
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COMPANY NAME E-MAIL 5 C> FAX
STREET ADDRESSV� � CITY,STATE,ZIP 44 Cs PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OFI SFD or DUPLEX ElMULTI-FAMILY PROJECT IN WILDLAND. ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? NO
DESCRIPTION OF WORK
l Q (0 IQ Cit.t/l l
TOTAL VALUATION: �� 4 00 RECEIS ED B
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on th` r perty owner's beha . I ave read this
application and the information I hav Flo is correct. I have read e Description of Work and verify itis accurate. I agree to cornpl all applicable local
ordinances and state laws relating t ding constructs n. I au representatives of Cupertino to enter the above-tplentified property Pr inspe ion purposes.
Signature of Applicant/Agent: Date:
//to 116
PLEM N RED TAL INFORMATI REQUIRED
Q . ..._ •OFFICE UWONLT �
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MAJOR ,,.,
MEPMiscApp_2011.doc revised 06121/11