12080172 CITY OF CUPERTINO BUILDING PERMIT
RUILDING ADDRESS: 11042 FIRETIIORNE DR CONTRACTOR:DALCON,INC. PERMIT NO: 12080172
OWNER'S NAME: PENNEY MARLENE A 75711 CIIESI;NUTS'I' DATE ISSUED:08115/2012
OW'NER'S PBONli: 4083569168 SAN JOSE,CA 95110 I'I IONE NO:(408)298-1690
LICENSED CO.I'RAC'FOR'S DECLARATION r_ r r
1/�//,�\J/\ � -'Jr�ZF') �� BUILDING PERMIT INFO: BLDG ELECT PLUMB
WCense Class Lie.a r/ r r
` ` � Q MECH RESIDENTIAL CO;\11hIERC1Al.
Contractor tx&2r— (-i\p(.Ccre, Date U( IZ
I hereby affirm that I nor Hicensed under I he provisions of Cha pler 9 JOB DESCRIPTION: REMOVE AND REPLACE 125 AMPSUBANEL
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
hereby affirm under penally of perjury one of the following mo declaraliuns:
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 Vnlualion:$1500
1 have and will maintain Worker's Compensation Insurance,as provided for by Sy.Pt Floor.\rca:
Section 3700 of the Labor Code,for the performance of the work,for which this
permit is issued APN Number:32344004.00 Occupancy)}pe:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct)agree to conmph 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: �Eq� Ai G/ Dale:
9.18. �
Signature Date 01 A /6L
RF.ROOFS:
0 O\VNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.Ifa roof is
installed without first obtaining an inspection,I agree to remove all new materials for
hereby affirm ilial I am exempt from 111e Contractor's License Law for one of inspection.
the following two reasons:
I,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 g Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to AL1.ROOF COVF-RINGS TO RE CLASS"A"OR BETI'F.R
construct the project(Sce.7044,Business S Professions Code).
1 hereby affirm under penalty of perjury one of the following three IIA'J.ARUOIIS\I,\"I'ISRL\LS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Cenificale of Consent to self-insure for Worker's California health S Safetv 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 S
performance of the work for which this permit is issued Safety Code,Section 25532(x)should 1 store or handle harvrduus 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 theerf'ormance of the work for which this contaminants its defined by the Bay Area Air Quality Management District I will
P ilia intain compliance with the Cuperlino Plunicipal Code,Chapter 9.12 and the
permit i5 issued. Health&'Safety Code,Sections 25505,25533.and 25534.
I certify that in the performance of the work for which this permit is issued,I shall
no employ any person in an),manner so as to become subject to the Worker's (tarter arm athorize a en
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Compensation laws of California. If,alter nnaking this certificate ofesempetion,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 deenned revoked CONS'1'RIIC'I'ION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
AIT LICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and slate that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and slate 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 ol'Cupertino against liabilities,judgments, ARCIIITE.C.-I"S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this pennon.Additionally,the applicant understands and will comply 1 understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code.Sectiam
9.18, Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 11042 Firethorne DATE: 08/15/2012 REVIEWED BY: Sean
APN: 13P#: -VALUATION: 1$1,500
PERMIT TYPE: Electrical Permit PLAN CII ECR TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1REAP2
USE: PERMITTYPE:
WORT: Remove and replace 125 amp subpanel.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTl' UNITS BP FEES
Services 1ERT<200 125 Amps $45
TOTA LS: $45.00
Meth. Plan Check Plumb.Plan Check Elec. Plan Check 0.0 1 hrs $0.00
mech.Permit Fee: Phtmh.Pcrmii Fee: Elec. Permit Fee: IEPERAHT
Other Afveh.Insp. Ocher Plumh Ing), Other Elec. Insp. 0.0 hrs $45.00
Mcch.Insp. Fee: Plmnb. hngt. Fee: Elec.hap. Fee:
NOTE: This estimate does not include feev due to other Departments(i.e. Planning, Public II'orks, Fire,Saniaq,Se ver District,School
District, etc.). These fees are based on the prelitninart information availahle and are only an estinate. Contact the Dept for arfrin'I in a.
FEE ITEMS (Fee Resolution 11-053 F_fT 711/1/I FEE QTY/FEE MISC ITEMS
Plan Chuck Fee:
Supp(. PC Fee
PME Plan Check: $0.00
Penni! Fee:
Suppl. Insp Fee
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Consmuction Tax:
Administrative Fee: ]ADMIN $42.00
Work Without Permit? Q Yes Q No $0.00
Advaneecl Planning Fees:
Travel Documentation Fee: ITRA I'DOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
13lde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $178.50 $0.00 TOTAL FEE: 1 $178.50
Revised: 07/01/2012
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GENERAL PERMIT APPLICATION EP
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE -CUPERTINO, CA 950143255 p p Is C
GUPERTINO (408)77-3M - FAX(408)7777-3333 - buildinciccuoedno.ora M
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DESCRIFIION OF WORK
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TOTALVALUAnON: 4 /Woo I RECEIVED BY: G
my sgnaa:r below,I cm—ify to each of Lite followi--g: I am'W a oropeny owns or au:hcrizcd zgtzr b act on[he popery own 's behalf I Nve read dis
application and the in`arm cion I have provided is cor ct. I have.ad the Deceipdon of Work and verify it is aaumtc. I agree to comply wit all applicable local
ordinances and state laws relating to building cons=cdon. I auth 'w representatives of Cupertin_:c enter.LSe aboveve-i enn/ti expMpe.—"for inspection puiposes.
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AePM1sc4pp_2011.doc revised 06/21/11