11100210CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22446 LINDA ANN CT
CONTRACTOR: SPRIG ELECTRIC
PERMIT NO: 11100210
OWNER'S NAME:
SAN JOSE, CA 95112
PHONE NO: (408)298-3134
LICENSED CONTRACTOR'S DECLARATION
r— r
PERMIT
License Class — I G Lic. #
BUILDING INFO: BLDG ELECT PLUMB
MECH RESIDENTIAL COMMERCIAL
Contractor (�L tC Date 1 I
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ELECTRIC VEHICLE CAR CHARGER IN GARAGE 40AMP
(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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $1200
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: 32613070.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAYS FROM LAST CALLED INSPECTION.
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
all non -point sour ations per the Cupertino Municipal Code, Section
/ 1
Issued by ate;/ �✓/�lJ
9with
.18.
�. 7
Signature Dates /r
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
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
l hereby affirm that I am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
wil I do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self -insure for Worker's
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
[ certify that in the performance of the work for which this permit is issued, [shall
not employ any person in any manner so as to become subject to the Worker's
Owner or d agent:
Compensation laws of California. If, after making this certificate of exemption, I
LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that I have read this application and state that the above information is
Lender's Name
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
Lender's Address
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
ARCHITECT'S DECLARATION
granting of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
igADDRESS:
22446 linda ann ct.
DATE: 1013112011
REVIEWED BY: bob s.
APN:
BP#:
"VALUATION:
1$1,200
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
install ev charging station at garage location.
SCOPE
3E3
il�ra 1rr,1� t•�a;
� :���.
F,lr°i 1, .
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These Pees are based on the Drelininary information available and are only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (1*'ee Resolution 11-053 E . 7/1,/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$100.00
Alternative Energy System
ICHRGSTA EV Charging Station
Suppl. PC Fee: Q Reg. 0 OT
0.0
firs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. 0 OT
0.0
firs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C'ronstru'.-t n 7' 7.v
0
0
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
'(`rttvtit(1 �rJ<'1t!ta�`.d?tltlr'}dt FPC'+'.
Strony, Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
1 $1.00
SUBTOTALS:
1 $1.50
$100.00
TOTAL FEE:
$101.50
Revised: 10/01 /2011