13100153 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23300 VIA ESPLENDOR UNIT V54 CONTRACTOR:MISSION VALLEY PERMIT NO: 13100153
ELECTRIC INC
OWNER'S NAME: CLIFF LEE H TRUSTEE PO BOX 3332 DATE ISSUED: 10/24/2013
OWNER'S PHONE: 6509696707 FREMONT,CA 94539 PHONE NO:(510)745-8847
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL0 COMMERCIAL
License Class �-Z 0/3 Z Lic.# C / D' INSTALL 120VOLT RECEP LOCATED PORCH AREA
Contractor M tSS fay+ JP.cc ayA—z!t bate /0 -7 Y- 3
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:
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
rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$600
I ve 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:34255039.00 Occupancy Type:
mit 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPE TI07.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, a
costs,and expenses which may accrue against said City in consequence of the �' lV � '�3
granting of this permit. Additionally,the applicant understands and will comply Issued by: 4.!w Date: 1
with all non-point ou ce regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 0— Z 13 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
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)
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 M mcipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ions 5,255 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:Iv—Z •l}'
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
GENERAL PERMIT APPLICATION a MEP
La COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION I•���
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255MISC
CUPEitTINO (408)777-3228• FAX(408)777-3333•building(ftypertino.org \(�
❑PLUMBING MECHANICAL []ELECTRICAL ❑MISCELLANEOUS
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT _CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
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USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN=LAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK / C�
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TOTAL VALUATION: � RECEIVEDBY F
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the propyrty owner's behalf. I have read this
application and the information I have pro)yde4 is correct. I h ve read the Description of Work and verify it is accurate.`I agree to comply with all applicable local
ordinances and state laws relating o bui in nstruction. I thorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
PPLE NTAL INFORMATION R11QUIRED ,` 4, oFzz`
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 23300 via eslpendor v54 DATE: 10/24/2013 REVIEWED BY: mendez
APN: BP#: "VALUATION: $600
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex PENTAMATION 1 REAP?
USE: p PERMIT TYPE:
WORK install 120volt recep located porch area
SCOPE
1" Elec.Plan Check 1 0.0 hrs $0.00
l-f;ch_ f' rrtrit T er: P ;rr..'', f'z rnN 1e- Elec.Permit Fee: lEPERMIT
Olhu; Phi„d,i'wj, Other Elec.Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelinddna information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 11-053& 7111131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Electrical
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $139.00 IBREMMISC Special Circuits
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-0 Reg. Q OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: 77F $47.00
('017. truction Tn:V:
Administrative Fee: IADMIN $44.00 0
Work Without Permit? 0 Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $139.50 $139.00 TOTALFEE-T $278.50
Revised: 10/01/2013