13040176CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20298 PINNTAGE PKWY
CONTRACTOR: DANIEL MACKEY
PERMIT NO: 13040176
CONSTRUCTION INC
OWNER'S NAME: NANCY GRANZELLA
2593 HEBRON AVE
DATE ISSUED: 04/24/2013
OWNER'S PHONE: 4086790051
SAN JOSE, CA 95121
PHONE NO: (408)274-6799
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
License Class � � Lie. # 5 %y d5 3
UPGRADE ELECTRICAL IN KITCHEN WITH 4 (N)
h _
C�">� `� — �`� `� 3
OUTLETS
Contractorc-^�t lticf= Date
(TAMPER-RESISTANT/GFCI), ADD 2 (N) SWITCHES, 7 LED
I hereby affirm that I am licensed under the provisions of Chapter 9
RECESSED LIGHTS (REMOVE 2 FLOURESCENT) _
(commencing with Section 7000) of Division 3 of the Business & Professions
Cade 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: $25000
performance of the work for which this permit is issued.
1 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: 36947018.00
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DA= PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 D S ROM ISA T CALLED 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 coT i�
s ed ,,
with all no - int source u ions per the Cupertino Municipal Code, Section
� RE -ROOFS:
9.18.
- / 3
Signature Date I
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
1, 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(a) 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
0
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Se ions 25 and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date:
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
w—w-
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 20298 PINNTAGE PKWY
DATE: 04/24/2013
REVIEWED BY: MELISSA
UNITS
APN: 369 47 018
BP#: 30 'o I /
*VALUATION: 1$25,000
YPERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: 1 REAP1 i
WORK
UPGRADE ELECTRICAL IN KITCHEN WITH 4 N OUTLETS TAMPER-RESISTANT/GFCI ADD 2
SCOPE I
(N) SWITCHES, 7 LED RECESSED LIGHTS (REMOVE 2 FLOURESCENT) p
APPLIANCE / EQUIP TYPE
FEE ID
P1111W). Nall C/1
QTY
UNITS
BP FEES
Elec. Permit Fee: IEPERMIT
Fixtures, Lighting
1BREMFIXT
Other Elea Insp. 0.0 hrs $45.00
9
#
$67
Recep/Switch/Outlets
1BREMRECEP
Supp/. 111sp Fee
6
#
$45
PME Unit Fee:
$112.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: IADMIN
$42.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$112.00
Strom? Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sever District, School
District. etc ). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112)
A<fech. Ncm Check
P1111W). Nall C/1
Elec. Plan Check 0.0 hrs $0.00
ilfech. Permit Fee:
P1nmFi. Permit Fee:
Elec. Permit Fee: IEPERMIT
Other rlkch, hash.
Other Plamb htsp.
Other Elea Insp. 0.0 hrs $45.00
Illech. Lisp. Fee:
Phimb. hrsp. Fee:
Elec. htsp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sever District, School
District. etc ). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee.
A
Suppl, PC Fee
PME Plan Check:
$0.00
PCYnAt t Fee:
Supp/. 111sp Fee
PME Unit Fee:
$112.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee: IADMIN
$42.00
Work Without Permit? 0 Yes (j) No
$0.00
Adv<nlcecl Pla ming Fees:
Travel Documentation Fee: ITRAVDOC
$45.00
Strom? Motion Fee: IBSEISMICR
$2.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $247.501
$0.00 TOTAL FEE:
$247.50
Revised: 04/0.1/2013