12080335 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDKE55: 10118 KIDOEWAY DK CONTRACTOR:S K K ERAICI KIC PERMI I-,NO: 12080335
OWNER'SNAME: DONK LGONARDJ AND RU-1'11 K 2932 BRANDEIS CI MVIT. ISSUED:08x12012
OWNER'S PHONE: 4089731590 SAN.(OSE,CA 95148 PHONE NO:(408)202-5556
❑ I.ICENSI.D COQ FR ACTOR'S DECCLARAJ'ION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C^ 10 Lia 4 A a d3 o V
:plECli r RESIDEN'T'IAL r COCOMMERCIAL�+
Contractor SSI 9 w, Date P^3/—LZ
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE AND REPLACE 100 AMP SUB-PANE(.
(commencing wilh Section 7000)of Dkision 3 of the Business\Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following too 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 Fluor Area: Valuation:$1695
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of the work for which this
permit is issued. AI;N Number:34241015.00 Occupanq'Type:
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above information is
correct.l agree to comply 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 ISD DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the Citof Cupertino against Iiabilities,judgmens, t
costs,and expenses which may accrue against said City in consequence of the ISO DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understandsand will comply
with all non-point source regulations per the Cupertino:Municipal Code,Section Issued by: � /� / 72:ve- / Date:b-31 •/a
9.18. P
Signature Date
7�r RP;ROOFS:
❑ OWNER-IRII LDER 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 affirm that 1 am exempt from the 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 d Professions Code)
I,as o%,ner of the property,am exclusively contracting w'idn licensed contractors to ALL ROOF CONTRINGS TO BE CLASS"A"OR BF.TFER
construct the project(Sec.7044,Business R Professions Code).
I hereby affirm under penalty of perjury one of the following three DA%ARDOUS M.4I'1?RIALS DISCLOSURE
declarations: I 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 Ile:dlh\Safety 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 I Iealth S
performance of the work for which this permit is issued. Safety Code,Section 25532pt)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided tot 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 defied by the Bay Area Air Qualily Management District I will
omit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
P
I certify that in the performance of the work for which This permit is issued,I Shall Health S Safety Cade.Sectios'_5505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner o ialhorized ngenl: p
Compensation laws of California. If,after making this certificate o'exemption,I T Lr--`��a��Date: y r
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with suchprovisions or this permit shall be deemed revoked. CONSTRI1CI'ION LENDING AGENCY
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 state 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 sive
indemnify and keep harmless the City of Cupertino against Iiabilitics,Judgmenls,
costs,and expenses which may accrue against said City in consequence of the ARCHITECTS 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 Cupenino Municipal Code,Section
9.18. Licensed Professional
Signature Date
I
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10118 Ridgeway Dr DATE: 08/31/2012 REVIEWED BY: Sean
A PN: BP#: Ja�(j �33 VALUATION: $1,695
*PERMIT TYPE: Electrical Permit PLAN CIIECR TYPE: Alteration /Addition / Repair
PRIMARY Building is PENTAMATION
USE: Multi-Family Dwelling >3 Stories O Yes I) No PERMITTYPE: 1REAP2
11'ORK Remove and replace 100 amp sub-panel in garage.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1ERT<200 100 Amps $45
TOTALS: $45.00
,Neth. Plan Check Phonb.Plan Cheek Elec. Plan Check 0.0 hrs $0.00
,Neth. Permit Fee: Plumb.Permit Fee: Elec. Permit Fee: IEPERMIT
Othcn•,Mech.Imp. Other Plumb Insp, Other Elea Insp. 0.0 hrs $45.00
,Neth.hup.Fee: Plumb. Insp. Fee: Efec.Insp.Fee:
NOTF,: This estitrrate does trot includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District, etc. . These feav are ha.sed on the prelindnat3 information available and are oniv an estinmte. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolmion 11-053 EI7 7/1/1I) FEE QTY/FEE MISC ITEMS
Plan Check Pee:
Sapp/. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suppl. htsp Fee
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Consn•uction Tac: 17
Administrative Fee: 1AD,Mhv $42.00
Work Without Permit? O Yes (D No $0.00
Advanced Planning rets:
Travel Documentation Fee: ITRA MOC $45.00 A
Strong, Motion Pee: IRSEISMICR $0.50 Select an Administrative Item
131cie Sids Commission Fee: IRCRSC $1.00
SUBTOTALS: $178.50 $0.001TOTAL FEE: $178.50
Revised: 07/01/2012
GENERAL PERMIT APPLICATION
f �xf.�Zl� .
COMMUNITY DD JELOPMENT DEPARTRMENT • BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, C"-.95014-3255 M i
CUPERTINO (408) 777-3228 • FAX (408)T77-3333• building( Duperino.oro 103
JA b
❑?LiitflIIJG ❑hCC?_sNC.L' =r FC C?1 a DXE-01
?RCJ-CT.l7DR.'s I A=N q `J y_ ! _ �-L / —D/✓
OWNER NAME ..... IL c-MA
V y
ST:CE-ADGRESS O CT', Si.4�3
FAX
CONTACT NAM.tc
�
THO E'.O 2N l O ZQ�^ .SIAOPCD Co.S-Y -¢l¢CT//YiC- CC)
S F-=ADDRESS cTY,sraTE EP .
Fax
- 632-IS Lo
❑ OWNER ❑ OWNc—Ii-aU++�ER ❑ OW1. ACE.Yi FOT—i..CMR ❑COr, Ci OR ALr'T'r ❑ ❑Edo: , ❑ DM_oP�'2 ❑
CONTRA�OR NAME 'CENSE NLMBER _C SYPQ I Bus.L:C: J33!
COND'ANY NAME E.MAE.
FAX
-5 32-/Seo
T-RL�ADDRESS l C:7Y,STA l FRONS
AdC.-�T h7JGA�4 tia.4G �� LICENSE NUMBER BUS.LIC a
CONL^ANY NAME' E-MAII.
FAX
SST ADDRESS l CITY,STAT;LT - FHONE
UEZOF
yEs
aU[1 G: CONC, C]AL ML1Ti-FAhII.Y l USAN Dr[E FACE AAEA NO l FLOOD ZONE 11O0 l C—sq HOME'-? ❑NO
DESC=ON OF WORK
2
_ 3o A o i
( - 15 A
TOTAL VALUATION:g / /_ �/C I RECEIv�9Y:
By my sia e below,I cs e
y a f!/ach of:he ';ol!ow g: I z.: e p one y ow a or z horn d aged;n ac-,on the p ope y erc's behalf. I have road diis
annHez^:on=d"the isoma::or.I have provid-a
is co.-EcL I cave read chc Descecoc of Work aad very is is ac==c. I ag:ce m comply WiLS ali applicable local
o:dia�,ces and Sam laws:e!acrg m Sui7 cor:�m:cdoa I an:hor'�m;, rescadves of C>.roer.:=c a LSe aSov:.ic�:i5e':zene.-1 for irspecdon ouipeses.
Sigaav^e of Appliur.JAg.oc Da:E:
S PLErLENTA,L IN70RNL471,0N REQUIItED OFFICE USE ONLY
y OVTR-TBE-COWTER
r
❑ EXPRESS
V
❑ STANDARD
U
Z ❑ LARGE
5
❑ NWOR
1 fE?AV c4pp-i011.doc revised 06/21/11 '