11080143CITY OF CUPERTINO BUILDING PERMIT
BUILDI.N(.
.ir1)RrSS: 10081 CARMEN RD
CONTRACTOR: SPRIG ELECTRIC
PERMIT NO: 11080143
OWNEIVS _
,) 1 r:
SAN JOSE, CA 95112
PHONE NO: (408)298-3134
❑
! ICFN'SED CONTRACTOR'S DECLARATION
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License ('
�(�� Lic.6%�
r r r
'/18/11
MECH RESIDENTIAL COMMERCIAL
Contractor
ate✓ Date
1 hcreb >
! : In licensed under the provisions of Chapter 9
JOBDESCRIPTION: INSTALL E.V STATION AT EXISTING EXTERIOR SIDE
(comment
:inn 7000) of Division 3 of the Business & Professions
YARD
LOCATION 40 AMP CIRCUIT
Cede an !
11,�e is in full force and effect.
1 hereby w
III penalty of perjury one of the following two declarations:
I have an '
•:r;t a certificate of consent to self -insure for Worker's
Compen::.
,led for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $2174
perform; for which this permit is issued.
1 have an;'
ui . worker's Compensation Insurance, as provided for by
S, ction -
I i Code, for the performance of the work for which this
pr mit i>
APN Number: 35701093.00
Occupancy Type:
I'PLICANT CERTIFICATION
I certify t
-his application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
c,erect. I
with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
it, builds
and hereby authorize representatives of this city to enter
u;,,)n the
property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
i. Iemnij
ss the City of Cupertino against liabilities, judgments,
is, an
W' may accrue against said City in consequence ofthe
sting
dditionally, the applicant understands and will comply
Issued by: Date:
uh all it
regulations per the Cupertino Municipal Code, Section
9.18.
J
RE -ROOFS:
natur,
Date_
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.
_ ItUILDER DECLARATION
Signature of Applicant: Date:
�•rcb,
� csempt from the Contractor's License Law for one of
1-0114)
;.
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
is owns
rop, or my employees with wages as their sole compensation,
N. ,II do tl
:ructure is not intended or offered for sale (Sec.7044,
aincsN,nlc)
as own
am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
iStniCi
044, 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
rrch
I Ity of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
,ve an
aai Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
npcm
rn- i 1'or by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
li rnu
r which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
We all
:t ion . -
orker's Compensation Insurance, as provided for by
',,de, for the performance of the work for which this
the Health & Safety Code, Sections 25505, 25533, an(255553)4.
� ► ��R
� ��
Owner or authorized agent: Date:
snit iN
i i l'N I,
ice of the work for which this permit is issued, I shall
':;,
oy manner so as to become subject to the Worker's
.;ipCi.
,i fornia. If, after making this certificate ofexemption, 1
CONSTRUCTION LENDING AGENCY
untc
C ` rr's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
.)rovisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
'L]CANT CERTIFICATION
Lender's Address
ri i Iv ,
;ipplication and state that the above information is
Ci. !a
.h all city and county ordinances and state laws relating
-
J hereby authorize representatives of this city to enter
tkt
,ruperty, for inspection purposes: (We) agree to save
nni
;N the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
,.,%, accrue against said City in consequence of the
I understand my plans shall be used as public records.
.:ionally, the applicant understands and will comply
'I all I
tilations per the Cupertino Municipal Code, Section
Licensed Professional
Date
CITY OF CUPERTINO
WE FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10081 carmen rd.
DATE: 08/18/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
1$2,174
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION SOLAR-RES
PERMIT TYPE:
WORK
install new EN station at exis'iting exterior side yard location
SCOPE
/VOTF. - The_ce fees are hated on the nreliminary intormntinn availahle and are nnly an estimate_ Contort the Dent tar addn'1 info_
FEE ITEMS (Fee Resolution 11-053 E '. 7/1111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$100.00
Alternative Energy System
ICHRGSTA I EV Charging Station
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(""issl'►mlion Tflk
Acoustical Fee: 0 Yes (E) No
$0.00
0
0
Work Without Permit? 0 Yes E) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
ffavel wncnialio)E.['Ces:
Strong Motion Fee: IBSEISMICR
$0.50
0.5 hrs
$41.00
Admin./Clerical Fee
IADMN
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$141.00
TOTAL FEE:
$142.50
Revised: 07/04/2011