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11110149 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19720 DRAKE DR CONTRACTOR:WILLOW GLEN ELECTRIC PERMIT NO: 11110149 INC OWNER'S NAME: GRAVES MARGARET P AND ROGER E 1085 WARREN AVE DATE ISSUED: 11282011 'NER'S PHONE: 4085290680 SAN JOSE,CA 95125 PHONE NO:(408)289-9725 IF LICENSED CONTRACTOR'S DECLARATION Lr. r' r. BUILDING PERMIT INFO: BLDG ELECT — PLUMB - License Class y �0 Lic,8 511 q)AW:Il d W 66Ak EW(i'fi'6ate 1 MECH r RESIDENTIAL r COMMERCIAL r Contractor r 1 hereby affirm that lam licensed under the provisions of Chapter 9 JOB DESCRIPTION:ELECTRICAL UPGRADE TO 200AMPS (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:$3500 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 permit is issued. APN Number:31632019.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and slate 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 / with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: DotpC� /J Signature • ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to anyy roofing material bang installed.If a roof is I hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will 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. 1 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(x)should t 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 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work forwhich this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Own r authorize nt: Compensation laws of California. If,after making this certificate of exemption,I Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work'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, ARCHITECT'S DECLARATION cAllhand expenses which may accrue against said City in consequence of the t rg of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. wt n all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO • 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31632019.00 DATE ISSUED. . . . . . . : 11/28/2011 RECEIPT #. . . . . . . . . : BS000015414 REFERENCE ID # . . . : 11110149 SITE ADDRESS . . . . . : 19720 DRAKE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GRAVES MARGARET P AND ROGER E ADDRESS . . . . . . . . . . : 19720 DRAKE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2434 RECEIVED FROM . . . . : MATTHEW J LONDRE CONTRACTOR . . . . . . . : LONDRE, MARK T LIC # 15897 COMPANY . . . . . . . . . . : WILLOW GLEN ELECTRIC INC ADDRESS . . . . . . . . . . : 1085 WARREN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 289-9725 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1. 00 41.00 0. 00 41.00 0. 00 1BCBSC VALUATION 3, 500.00 1. 00 0.00 1 .00 0. 00 1BSEISMICR VALUATION 3,500 .00 0.50 0 . 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1. 00 44 .00 0. 00 44 .00 0. 00 1ERT<200 UNITS 1.00 44 . 00 0. 00 44 .00 0. 00 1TRAVDOC FLAT RATE 1.00 44 . 00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 174 .50 0. 00 174 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 174 .50 VISA --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL • X1 ( 1011(49, GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 M I SC • CUPERTINO (408)777-3228• FAX(408)777-3333• buildinDf2icuoerdne.orD PLUMBING MECHAMCAL CTRICAL %/MI�S/CE11LANEOUS PROJECT ADDRESS i { //t`1''I *�n b 'vC.- �Lp I l/(.YJP`- OI o OWNERNAME {l eL' Graves PHONE5a — 06 p E-MAIL STREE[ADDRESS I q^�d(] 1 CITY, STATE,ZiP %a 'r f J FAX CONTACT NAME /I/lIl �drl' PHONE 'f7 E-MAIL STREETADDRES9 (V 1 (,\ CITY,STATE, ZIP FAX ❑owNER ❑ OWNER-S=ER ❑ OWNERACENr FyLcoymACTOR ❑CONTRACTORACFNT ❑ AacHrrECT ❑ENoDmm ❑ DEVELOPER ❑TENANT CONTRACTORNAMEMG{-k L, f— LICENSE NUMBER r9j/p I/r)� LICENS�T1 EU9.tico 1589 8-MAIL I7n 1"D1 ?`f IM II OW CeiU[TA't.CJVn FAX STRMADDRESSp. lV (, CITY,STATE,ZIP PHONE x A30 s� S se 05255 ARCHTIECl/ENOWEER NAME LICENSE NUMBER HUS.LIC a COMPANY NAME' E-MAIL FAX STAEETADDRESS CITY,STATE,ZIP PHONE OF ]E'SFD m DUPLEX [3MULT7-FAMO.Y PROIECrW wILDCAND ❑ YES PROD T N ❑YES 13 THE BLDG AN [3 YES IND: ❑COMMERCIAL URBAN INTERFACE AREA M_NO FLOOD ZONE El NO EICHLER HOME} 9NO DESCRIPTION OF WORK TOTAL VALUATION: 3,500 RECEIVED BY: Jl� By my signature below,I certify to each of the fallowing: I am the property owner or autborized agent m act on the property owner's behalf I have lead this application and the information I have provided is correct}have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating ' g constructs . I authoriu t7mentatives of Cupertino to enter the above de ri property for inspection pu@oses. Signature of ApplicantlAgenN Date: SUPPLEMENTAL INFORMATION REQUIRED OWCSE ONLY 1�1u OVER-THE-COUNTER d ❑ EXPRESS Y U W ❑ STANDARD S U .... ❑ LARGE 6 ❑ MAJOR MEPMircApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION . ADDRESS: 19720 drake dr. DATE: 11/28/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $3,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP2 USE: PERMIT TYPE: WORK electrical upgrade to 200 amps. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 100 Amps $44 TOTALS: F $44.00 ifech. I''lmr Check Plumb. flan Check Elec.Plan Check 0.0 hrs $0.00 htech. 3'eroit Fx. 1'lunib, Petnut Fire Elec.Permit Fee: IEPERMIT • 01her H.....I.Insp, Other Plum")hup. Other Elec.Insp. 0.0 Ins Ltia 1lech.I n.. Fee: Plumb. Imp,Fee: Flex.Insp. I"ce: NOTE:This estimate does not Include fees due to other Departments(le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelinina Information available and are only an estimate. Contact the Dept for addn7Info. FEE ITEMS (Fee Resolution 11-053 EK 711111) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Suppl, P(-["c, PME Plan Check: $0.00 Fc:rmir Fee: Supp/. Gasp Fee PME Unit Fee: $44.00 PME Permit Fee: $44.00 Construction Tox Administrative Fee: IaDMIN $41.00 Work Without Permit? Yes tD No $0.00 .4ddanced Plarming 7"eez: Travel Documentation Fee: ITRA FDOC $44.00 Stroh Motion Fee: IRSEISMICR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: 1RCeSC $1.00 SUBTOTALS:,j $174.50 $0.00 TOTAL FEE: $174.50 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR /SUBCONTRACTOR LIST JOBADDRESS: •q 'ZQ Drake v2. PERMIT# OWNER'SNAME: ve5 PHONE# 5:11— '069b GENERAL CONTRACTO . 1n/' [; BUSINESS LICENSE# 15X9 ADDRESS: To '%)y 91430 CITY/ZIPCODE: Sen •30S/SS *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: l) Signature I bate Please check applicable subcontractors and complete the following information: •/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum /Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock • Tile �� Owner/Contractor Signature Date