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14090065 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10728 DEEP CLIFF DR CONTRACTOR:R&C CONSTRUCTION PERMIT NO: 14090065 OWNER'S NAME: MOLLARD ROY S AND CATHLEEN TRU 1220 AUDREY AVE DATE ISSUED:09/11/2014 OWNER'S PHONE: 4084550632 CAMPBELL CA 95008 PHONE NO:408-391-4325 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMITINFO: I31.DG ELECT PLUMB License Class Lic.# y� l�� F_ p MECH RESIDENTIAL COMMFRCIAI. Contractor & QD Date (� �� JOB DESCRIPTION ELEC"I'RICAL,PANEL UPGRADE TO 200 AMPS 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1500 G1 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:35604008 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 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 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 Issued by: Date:��y -/ G1� granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9 18 l RE-ROOFS: Signature �� A0-^oJL_Date r.l \ All roots shall be inspected prior to any roofing material being Installed. If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for Inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Data I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER 1,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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec 7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25.533,and 25534. 1 will 1 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(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 1 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,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this &. Owner or authorized agent Uate: 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,1 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 1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 riiGENERAL PERMIT APPLICATIONE P COMMUNITY DEVELOPW;iENT DEPART(SENT-BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO,CA 95014-3255 (408) 777-3228-FAX(403)7777-3333-building(D-guoe�iino.ora m I eu�f TiNo f�Z0�006S�z ❑PLU7J,PI1�G - ❑I�CtL�I�ZC.SL CTma'—L ❑b�SSCELLAI\ OliS PROj---=ADDPESS I (\�� �� 31T 35 Q 0-%,Nm:,l aym J PHONE { _­v-Qo� ,-u- STIR= J STIR P ADDRESS I C1-i Y, S? E,ZIP ^ I FAX co"—,Acr N«-"\ Q�1 I PHVv S ADD? P STAir FAX ❑ OqT ❑ c01*�acroR ❑C0j M,,CroR aG-\!T ❑ =3 c�cr ❑�c� ❑ Delo? ❑ �n*r CGl� k LI cT'" LjCMKSB7'Y?BJ-2 BUS.LIC: col�fxy NA1"m ' C I =I' I FAX ,{-- � tJ STR'T F DDP ESS n I CI�saw ZIP I PIi TL I^} OV i 3� 43z �RCH[i GI1� RNx1J" I L1CaTSE1,"aGER I BUS.LIC' C0IJPAArY N.41J� E W.p II I FAX STp,== ADDRESS I C1IY,STATr,ZIP I P 301;8 USE OF JTZFD or DUPM ❑ 24M71-FAMLY PROJEE=TN WILDLAND ❑ YFS PROM=A ❑YFS IS TF---BLDG AN ❑ YFS BUIIDLNC: COI✓.MERCL4L I IMBAN B\-1MFACB AREA _'0 I FLOOD Z01-m �F.o EIC:3T. HO1Js? NO DESCRIPTION OF WORK 2 C`3� .01 TOTAP?UP.TION: / O V� ���` L\% By ny signati*e belo\u,I!-Itify to ez 11 a Lhe follo;;�1z� I am the propel owner or autho,-ized agent to act on the property o\;mer's behalf. I have read this applic€:ion and the info ra ion I have pro;'ided is correct I haver--ad the Description ofWork-and verify it is acc+±-ate. I ag7ee f0 COnp]y with all applicable local ordinances and Stale;a'A'S Ielatmg o b 'ding ce CiIOn. I- orate rep.esentatiVeS Of Cupw tIIIO t0 enter the agve-ldentr:ed 7e`' 'for LSpeCtlOn pL+ipOSeS. S I�a Ire Of:_ppllCa t%?z'�:t:�� Is �� Date: SUPPLEMENTAL P,7FORNL4TION RE USD ON I ,_ - _ .i2U1 IFPhlisctpp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10728 Deep Cliff Dr DATE: 09/11/2014 REVIEWED BY: Sean APN: BP#: J ����©j VALUATION: 1$1,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION 1 REAP2 USE: SFD or Duplex PERMIT TYPE: i WORK Electrical panel upgrade 200 am SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 200 Amps $48 TOTALS:. $48.00 J. ,3Lv'i 0 ec,k Check Elec.Plan Check 0.0 hrs $0.00 Pe>;';u%t Beer t'lu nh.F flrnzit Pee, Elec.Permit Fee: IEPERMIT of c r 11-ch. llnvs Other.Plurntz IruP. Other Elec.In 0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 11-053 F711113) FEE QTY/FEE MISC ITEMS Nun Check f`'z C: PME Plan Check: $0.00 '';c't'i12it/'c.'C.'. PME Unit Fee: $48.00 PME Permit Fee: $48.00 "OX: _T= Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $190.50 $0.00 TOTAL FEE: $190.50 Revised: 08/20/2014