B-2016-2496 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2496
18960 NEWSOM AVE CUPERTINO,CA 95014-3618(375 35 013) MAINE ELECTRIC INC
LIVERMORE,CA 94551
OWNER'S NAME: ABRAMS JULIA DATE ISSUED:08/11/2016
OWNER'S PHONE:408-7814681 PHONE NO:(925)443-3377
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#$30250
Contractor_MAINE ELECTRIC INC Date 04/30/2017 X BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MEECH 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:
I hereby affirm under penalty of perjury one of the following two declarations: REPLACE PANEL(125 AMP);SAME LOCATION
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
/ 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
permit is issued. Sq.Ft Floor Area: Valuation:$7684.00
APPLICANT CRTIF7 ATION
I certify that I have readthis application and state that the above
information is correct.I agree to comply with all city and county ordinances ATN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 375 35 013
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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date Issued by:PAUL O'SULLIVAN
Date:08/11/2016
E -B DER DE I N
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. 1 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. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials xequikements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate Of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:
I certify that I have read this application and state that the above information is CON!6—
TI N LE A EY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date professional
GENERAL PERMIT APPLICATION
MEP
{x COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•GUPERTfNO,CA 95014-3255 PQO 16 '
C,UPERl`1! 40 (408)777-3228 FAX(408)777-3333•building cupertino.or« Is C
PLUMBING MECHANICAL ELECTRICAL MISCELLANEOUS
PROJECT ADDRESS16 r 9 ` .395
tltnde' _ ! R AP3506
N#
OWNERNAME 1
CJ+ C �I PHO® i o E-MAIL
STREj qZIEFAX
® L� f! ( l�J't�2?rAJ aD . c— SQ
CONTACT NAME PHONE E-MAIL
_
JEFF RAINEY 510-427-4260 jeffrey.rainey@att.net
STREETADDRESS 1069 EDGEMERE LANE CITY,STATE,ZIP HAYWARD, CA 945454 FAX510-783-1041
OWNER OWNERBUII>DER 11 OWNERAGENT ❑CONTRACTOR D4 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER E TENANT
CONTRACTOR NAME LICENSE NUMBER �/q -LICENSE TYPE BUS.LIC
J // E-MAIL 3o /(� _(5 s/
COMPANY NAME £V 3?
STREET ADDRESS CITY,STATE,ZIP 0_6,5c� �+/ PHONE ['mss Y
215
3-3377
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC 4
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE;ZIP PHONE
USE OF :SFD or DUPLEX ❑ MULTI-FAMII,Y PROJECT IN WILDLAND ❑YES PROJECT IN E.YES �IS THE BLDG AN ❑YES
BUILDING: E COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK i '2— F
TOTAL VALUATION:
l G4#EIEI� Y ,L
�J 1
Ok-L
By my signature below,I ce ify to each of the following: I am the property owner or authorized a e e n the property owner's behalf. I have read this
application and the information I have provided is correct I p1cription of and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building co on. I authorize re se " s of Cupertino to enter the above-identifiedoperty for inspection purposes.
Signature of Applicant(Agent: Date: 'C
SUPPLEMENTAL REQUIREI?
' �'tk�7'1F7�CD'477�I3'E1€
MEPMiscApp 2011.doc revised 06121111