The URL can be used to link to this page

B-2017-1337CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1337 1121 MILKY WAY CUPERTINO, CA 95014-5064 (362 19 016) RAY SCHEIDTS ELECTRIC INC SAN JOSE, CA 95112 OWNER'S NAME: KISHIMOTO ZENICM AND YUKIKO OWNER'S PHONE: 408-315-1209 LICENSED CONTRACTOR'S DECLARATION License Class —110 Lic. #231624 Contractor SAY SCHEIDTS ELECTRIC -INC Date 12/31/2017 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: 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. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulation er the Cupertino Municipal Code, Section 9.18. Signature Date 8/11/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) z. I, as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. z. 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. a. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature. ISSUED: 08/11/2017 PHONE NO: (408) 292-8715 BUILDING PERMIT INFO• X BLDG X ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION REPLACE PANEL (125 AMP)- SAME LOCATION Sq. Ft Floor Area: Valuation: $2500.00 APN Number -Occupancy Type: 362 19 016 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by Jasmine Archbold Date: 08/11/2017 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. Signature of Applicant: Date: 8/11/2017 ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, ,S c ' nr 5505, 25533, and 25534. Owner or authorized agent:,// Date: 8/11/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARC'HITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Date 8/11/2017 Prnfaggir GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION MEP 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255. MISC CUPERTINO (408) 777-3228 • FAX (408) 777-3333 - building(cDcupertino.orq [:]PLUMBING ❑ MECHANICAL ® ELECTRICAL [:1 MISCELLANEOUS PROJECT ADDRESS i '^ Millcey Way, Cupertino Ca, 95014 APN # f OWNER NAME Zenichi Kishimoto PHONE 408-315-1209 E-MAIL zenkishimoto@icloud.com STREET ADDRESS ' Ike Wa i Y Y ('Richard CITY, STATE, ZIP C Cupertino a, 95014 FAX CONTACT NAME A. Marin PHONE 408-292-8715 E-MAIL ricbrse@pacbell.net STREET ADDRESS 1055 N 7th Street CITY, STATE, ZIP San Jose CA, 95112 FAX 408-292-9423 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT I CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Richard A. Morin LICENSE NUMBER 231624 LICENSE TYPE CIO BUS. LIC # l COMPANYNAME Ray Scheidts Electric p E-MAIL richrse@pacbell.net FAX 408-292-9423 STREET ADDRESS 1055 N 7th Street CITY, STATE, ZIP San Jose CA, 95112 PHONE 408-292-8715 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ®SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WtLDLAND ❑ YES PROJECT IN. ❑YES IS THE BLDG AN ❑YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? 0 NO DESCRIPTION OF WORK Change service from 100 amp to 125. amp TOTAL VALUATION•RECEIVED B $2,500.00 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the roperty owner's behalf. I have read this application and the information I have ovided is rrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating,to buil ' g c me 'on. I authorize representatives of Cupertino to enter the above -identified property for inspection proposes. Signature of Applicant/Agent. Date:7/3I/zoi7 ' , UPP M f NTAL ORMATION REQUIRED ❑ ovEI��E c�JUNTE, ,& ❑ EPREs� Si z� MEPMiscAnn 201 ] .doe revised 06/21/11