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11060007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10117 N PORTAL AVE CONTRACTOR:MAINE ELECTRIC INC PERMIT NO: 11060007 OWNER'S NAME: JENNIFER SCHAFFER 2013 RESEARCH DR DATE ISSUED:06/01/2011 OWNER'S PHONE: 4088362352 LIVERMORE,CA 94550 PHONE NO:(925)443-3377 LICENSED CONTRACTOR'S DECLARATION "` BUILDING PERMIT INFO: BLDG ELECT PLUMB License Clas Lic.# IbR t MECH RESIDENTIAL F COMMERCIAL Contractor 6 Date l I hereby affir at I am I1nsed under the provisions f C apter 9 JOB DESCRIPTION: 125 AMP MAIN ELECTRICAL SERVICE (commencing with Section 7000)of Division 3 of the Business&Professions REPLACEMENT/UPGRADE 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$4000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number:31621043.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting o s permit. Additionally,the applicant understands and will comply with all n n-p int sourc regulations per the Cupertino Municipal Code,Section f 9.18. Issued t '!� Date: Signature L Date r OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I ii.reby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Heth&Safety Code,Sections 25505,25533,and 25534. 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 O n r or a@th r ed aggnt. ` become subject to the Worker's Compensation provisions of the Labor Code,I must Date: l forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LEND G AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address 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 F b of this permit.Additionally,the applicant understands and will comply �. 1 non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31621043 .00 DATE ISSUED. . . . . . . : 06/01/2011 RECEIPT #. . . . . . . . . : BS000013624 REFERENCE ID # . . . : 11060007 SITE ADDRESS . . . . . : 10117 N PORTAL AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JENNIFER SCHAFFER ADDRESS . . . . . . . . . . : 10117 N PORTAL AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CHRIS GARCIA CONTRACTOR . . . . . . . : SCOTT MAMOLA LIC # 32671 COMPANY . . . . . . . . . . : MAINE ELECTRIC INC ADDRESS . . . . . . . . . . : 2013 RESEARCH DR CITY/STATE/ZIP . . . : LIVERMORE, CA 94550 TELEPHONE . . . . . . . . : (925) 443-3377 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 0 .50 39. 00 0. 00 39. 00 0. 00 1BCBSC VALUATION 4, 000 . 00 1. 00 0. 00 1. 00 0. 00 1BELEC200 METERS 1. 00 42 . 00 0. 00 42 . 00 0. 00 1BSEISMICR VALUATION 4, 000 . 00 0.50 0. 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0. 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 166 .50 0. 00 166 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 166 .50 VISA --------------- TOTAL RECEIPT 166 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10117 n. portal ave. DATE: 06/01/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$4,000 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK 125 amp main panel upgrade. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $42 TOTALS: $42.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elec.Insp. 0.0 hrs $42.00 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (P'ee Resolution 09-05.1 P_�f 7, 1,`10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 i Stroniz Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg= Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50 Revised: 04/29/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: t PERMIT# OWNER'S NAME: y�y�� PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# q,` 02Z'D ADDRESS: gftLl C GJCITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB NTRA ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signa ate Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUFE'htT1N0 (408)777-3228 • FAX(408)777-3333 •building(acupertino.org misc ❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROTECT ADDRESS O r APN�-2>1 U c 1 U g 3 OWNER NAME PHONE MAIL �-{ (�1 0 6) STREET ADDRESS } CITY, STATE,ZIP ♦ FAX CONTACT NAME i r PHONE O y E-MAIL STREET ADDRESS ' O r r CITY,STATE,ZIP 1 \ 1 r'A' FAX \ c G( ! � 1 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT IV/CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME I1 A \ r t LICENSE NUMBER - LICENSE TYPE f O BUS.LIC k 0 COMPANY NAME - V �. E-MAIL l/ FAX STREET ADDRESS r CITY,STATE,ZIP j N �jj PHONE Ngo (j ARCHI TECr/ENGINEER NAME LICENSE NUMBER BUS.LIC k �J COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN ,'RUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK 122S L Mi 071p, N 11f A TOTAL VALUATION: HI CELtfERlel� �_ drys 6'?4""- "��-mo.' s=�,t By my signature below,I certify to ea of the follownon. am the property owner or authorized agent to act an the property owner's behalf. I have read this application and the information I hav ovided is cohave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ui ding construauthorize representatives of Cupertino to enter the above-idntifT d property for inspection purposes. S i gnature o f Appi icant/Agt -kc N Date: f{ I S LE NTAL IMATION REQUIRED g MEPMiscApp_201 Ldoc revised 03/16/11