12050057 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10194 BONNY DR CONTRACTOR:JOHNSTON ELECTRICAL PERMIT NO: 12050057
CONTRACTOR
OWNER'S NANIE: HENRY ANN TRUSTEE 1302 LINCOLN AVE STE 204 DATE ISSUED:05/04/2012
OWNER'S PHONE: 4083936663 SAN JOSE,CA 95125 PIIONF.NO:(408)266-0236
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C%4Lic.p - '/�.��
-� __ , MECH r RESIDENTIAL r COMMERCIAL r
Contractor A GI N-(�jrr-�.` 0 "bate
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: UPGRADE ELECTRICAL PANEL TO 200AMP
(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.FI Floor Area: Valuation:$1000
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
permit is issued- APN Number:35911046.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
cored. I agree tocomply with all city and county ordinances and laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of thisis city
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 City
int once liabilities,judgments,of
ents, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this perimi. A4"ally,the applicant understands and will comply
with all non-point source: gut ions per the Cupertino Municipal Code,Secli Issued b / /V
918 y: �T r Date: ,f-�•fl}
Signature Date 6 -�'
RE ROOFS:
❑
OWNER-BUILDER DECLARATION 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
I hereby 1 am exempt from the Contractor's License Law for one of inspection.
the following ng two
wooreasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature orApplicant: Dale:
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 IIA7.ARDOIIS MATERIALS DISCLOSURE
declarations: 1 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 IIea11h&Safely Code,Sections 2,5505,25533,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 Ileelth&
performance of the work for which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material.
I have and will mainain 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 deft d by the Bay Area Air Quality Management District I will
permit is issued. maintain complont with the Cupertino Municipal C9de,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Ifealth&Waucd
Sections 2.5.505,25533,and 2Z>. //C)not employ any person in any manner so as to become subject to the Worker's Owner ogent: J
Compensation laws of Cali fomia. If,after making this certificate of exemption,I Dale:
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. r
CONSTRUCTION LENDING AGF.NCI'
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 stale 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,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9'18' Licensed Professional
Signature Dale
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot: '
APN . . . . . . . . : 35911046 .00
DATE ISSUED. . . . . . . : 05/04/2012
RECEIPT #. . . . . . . . . : BS000016717
REFERENCE ID # . . . : 12050057
SITE ADDRESS . . . . . : 10194 BONNY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . : . . . . . . . . . . : HENRY ANN TRUSTEE
ADDRESS . . . . . . . . . . : 10194 BONNY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JOHNSTON ELECTRICAL
CONTRACTOR . . . . . . . : BRIAN JOHNSTON LIC # 23411
COMPANY . . . . . . . . . . : JOHNSTON ELECTRICAL CONTRACTOR
ADDRESS . . . . . . . . . . : 1302 LINCOLN AVE STE 204
CITY/STATE/ZIP . . . -: SAN JOSE, CA 95125
TELEPHONE (408) 266-0236
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 1, 000 .00 1.00 0. 00 1.00 0.00
1BSEISMICR VALUATION 1, 000 .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
---- --------------- --------------------
CHECK 174 .50 #2801
---------------
TOTAL RECEIPT 174 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -----------------
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
ti
CITY OF CUPERTINO
'FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10194 Bonny Dr DATE: 05/04/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $1,000
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
RIMARY SFD or Duplex PEMIT TYPE:
NTAMATION 1REAP2
USE: PER
P
WORK Upqrade electrical panel to 200 amp.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1ERT<200 200 Amps $44
TOTALS: $44.00
u,,:b. Plem Chsk Plumb. Plan Check Elec. Plan Check 0.0 1 hrs $0.00
mwh. Prnuil Fee: Phnub. Permit F,r: Elec. Permit Fee: IEPERMIT
Orher,t&rh, Irsp. Other Plumb Insp. Li I
Other Elec.Insp. 0.0 hrs $44.00
.bleeh. imp. Fec: I I 'Plumh, hr.,p. re_e. lilec•.Insp. Fee:
NOTE: This estimate does not include jees'due to olhii'Depailmenls(ie. Planning, Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prefinddna information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS (17ee Resolution 11-053 F(f. 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee.
Suppl. PC Fee
PME Plan Check: $0.00
Penni[ l'4rc"
Sit/)/)/. hisp Fee .
PME Unit Fee: $44.00
PME Permit Fee: $44.00
Conn l«-non Tax
Administrative Fee: (ADMIN $41.00
Work Without Permit? O Yes 0 No $0.00
ddlymt cd Planning Fees:
Travel Documentation Fee: ITRAVDOC $44.00 A
Strong Motion Fcc: ,1BSEISMICR $0.50 Select an Administrative Item
Bide Stds Commission Fee: /BCBSC $1.00
SUBTOTALS: " $174.50 $0.001 TOTAL FEE: $174.50
Revised: 04/01/2012
Zc> > o u -7
GENERAL PERMIT APPLICATION MEP .
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DNISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I /�
CU (a�
PERTINO (408)777-3228• FAX(408)777-3333•buildinacuoertino.ora /v'
PLUMBING .. MECHANICAL ❑ELECTRICAL ❑MISCETreNc0U5
FROJECTADDRESS // DO I APN#
OVMFJt NAME ANN /C/✓A?
S REE[ADDRESS CITY,STATe.ZIP FAX
CONTACT NAME ./ PHONE E-MAIL
STREET ADDRESS _ �U CrTY.STATE. ZIP FAX
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❑DwNm ❑ OWNER-BIRDER oavnrnACEx+r ❑ mAcmR ❑CONTRACTOR AGENT ❑ ARamFiT ❑Daoauut ❑ DevmoPm ❑TeuNr
CONTRACTOR NAME LICENSE NUP MERIJlSE IE BUS. N
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COMPANY NAMEa-MAIL FAX
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S[AEEC ADDRESS CITY,
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ARCHMEMENGINFFA NAME LICENSE NUMBER BUS tic a
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD.DUPLEX ❑ MULnFAAMY P0.0IERBl WILDLAND ❑ YES PRO=IN ❑YES IS THE BLDG AN ❑ YES
BUDDING: ❑COMMERCIAL tRBANMTERFACEAREA NO FLOOD ZONE NO MCHLZRHCM NO
DESCRIPTION OF WORK
TOTAL VALUATION: /00 U RECEIVED BY:
By my Signature below,I certify to each of the follo the property a raer or authorized agent to act on the property awaces behalf I have read this
application and the infbrmatian I have pravideos-66trerctj. ,hfive read the Description of Work and verify it*I
I m comply with all applicable local
an
ordinces and serve laws relating m buildin tructi I authorim represrntativa of Cupertino to ewer the above deo ad property for inspection pu@oses.
Signature of ApphwnUAgeat - Dam: Ir
SUVLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
u OVER-THE-COUNTER .
d
CRESS
Y
V
r ❑ STANDARD
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❑ LARGE
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❑ MAJOR
MHPMwcApp_2011.doc revised 06121111