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14030006 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6031 BOLLINGER RD CONTRACTOR:SOUTHWEST ELECTRIC PERMIT NO: 14030006 OWNER'S NAME: ANN NG 14435 BIG BASIN WAY STE130 DATE ISSUED:03/03/2014 OWNER'S PHONE: 4082576506 SARATOGA,CA 95070 PHONE NO:(408)506-6421 01 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ UPGRADE(E)100 AMP PANEL TO 200 AMP,SAME LicenseClass Lic.# 0 b LOCATION Contractor T A t���W fA4- L' I.G ? tf 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2500 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:37538003.00 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 WITHIN 180 DAYS QEEEWdg 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 F EXST D 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 ? granting of this permit. ditionally,the applicant understands and will com ed e' with all non-point sou egulations per the Cu ino Municipal Code,Sec ion 918. n Q / RE-ROOFS: Signature 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. ❑ 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 37.00 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 I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio ,25533 X5534. Section 3700 of the Labor Code,for the performance of the work for which this 2 / 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408) 777-3228•FAX(408)777-3333•buildina(c�cupertino.org MISC \ CUPtATCNO PLUMBING []MECHANICALCTRICAL ❑MISCELLANTEOUS PROJECT ADDRESS / ©Q I APN# 13— — �3Q od O AME (C> J 7 E-MAIL u STREET QRE Q ^ 2LC STATE,ZIP I FAX CONTACT N ` , 'V l n PH ' nay ` E-MAIL C�14 C (O • }? STPXWRf S C rb�` 3 FAX ❑ OWNER ❑ OATIERR-BUILDER ❑ 0);WMAGExr ❑ CONIRACI'OR ❑CON LACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CO OR N ' LI SE NUMBER LI SE E^ BUS.LIC# E-MAIL r F K w S S SATE ZIP P O O /v f0 ARCHITEMENGWEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME B-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT W WII DLAND ❑ YES PROJECT W ❑YES IS THE BLDG AN ❑YES BUILDING ❑COMMERCIAL URBAN INTTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLJ1t HOME? ❑ NO DESCRIPTION OF WORK Q C7 ;7-� S' ( d C�JlYvv! tom: TOTAL VALUATION: - s __ �` �0 - By my signature below,I certify to each ofthe wing: I am the property owner or authorized agent to act on the pro rty ovmer's behalf. I have read this application and the information I have prov d.. correct. I have read 1Zescription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bg aut onze representatives of Cupertino to enter the above ident' ed property for inspection purposes. Signature of Applicant/Agent: Date: SPMIENTAL INFORMATION RE UIRED — �' Q 0 ��� t0l, V RTCO L3aTER `# : Na- I XPRES �� STANDARD MEPMisc,4pp_MLdoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 6031 BOLLINGER RD DATE: 03/03/2014 REVIEWED BY: MELISSA APN: 375 38 003 BP#: *VALUATION: 1$2,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP USE: PERMIT TYPE: WORK UPGRADE E 100 AMP PANEL TO 200 AMP SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 200 Amps $47 TOTALS: $47.00 L'���ai t'.'ur(',Eczrti t'?�rrr;?>. Plan( 1r�cti Elec.Plan Check 0.0 Ins $0.00 1c><;Ir. 1'er'tetid P'ee: I'Iurni), Tlerrmid Fl,c. Elec.Permit Fee: IEPERMIT fn,-o 01h,,r Pl mb In n. Other Elea Insp. 0.0 hrs $47.00 }'hrrarb. T'izsp, Fez: tnsp, tie_ 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 prelhiniina information available and are only an estimate. Contact the Dept./or addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan (,'hucict Fee: PME Plan Check: $0.00 PME Unit Fee: $47.00 PME Permit Fee: $47.00 Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes C) No $0.00 Maiming Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131da Stds Commission Fee: IBCBSC $1.00 $186.50 $0.00 TOTAL FEE: $186.50 Revised: 01/15/2014