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10050007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 939 S TANTAU AVE CONTRACTOR:E G ELECTRICAL PERMIT NO: 10050007 SERVICES 'NER'S NAME: JOHN SKINNER 1170 F ISMARCK DR DATE ISSUED:05/03/2010 OWNER'S PHONE: 4084465451 CAMPBELL,CA 95008 PHONE NO:(408)370-2222 ❑ LICENSED CONTRACTOR'S DECLARATIONBUILDING PERMIT INFO: BLDG ELEC PLUMB License Class Lic.# J MECH F_ RESIDENTIAL r- COMMERCIAL JOB DESCRIPTION:UPGRADE MAIN PANEL TO 200 AMP Contractor Date �/ I hereby affirm I am licensed under the provisions f Ch pter 9 (commencing 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 perfonnance of the work for which this permit is issued. Sq.F1 Floor Area: Valuation:$2500 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 APN number:37538050.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the TWNER-BUILDER!DECLARATION ned property f r inspection purposes. (We)agree to save `WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnifyrmless the C' of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,andich may ac a against said City in consequence of the granting . dditio ly,the applicant understands and will comply with all nregu ions per the Cupertino Municipal Code,Section Issued by: �,, '�. Date: 9.18. ,natureDate 6 RE-ROOFS: ❑ ER-BUILDER DECLARATION All rc ofs shall be inspected prior to any roofing material being installed.If a roof is instal ed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspe;tion. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signs ture of Applicant: Date: 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I hai a 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 Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compV�S the Cupe lino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safelction 25 2(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Addiould se equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this conhde ed by the Bay Area Air Quality Management District I will mair i with the Cupertino Municipal Code,Chapter 9.12 and the pen-nit is issued. Healode,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shallnot employ any person in any manner so as to become subject to the Worker's Ownrized agent:Compensation laws of California. If,after making this certificate of exemption,I iDate: 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. CONSTRUCTION LENDING AGENCY I herby 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 ?n the above mentioned property for inspection purposes.(We)agree to save .-innify andysoue e City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expeaccrue against said City in consequence of the granting of thionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-polations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date N O r) CITY OF CUEERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37538C50 . 00 DATE ISSUED. . . . . . . : 05/03/2010 RECEIPT # . . . . . . . . . BSOOOC10303 REFERENCE ID # . . - : 10050007 SITE ADDRESS . . . . . : 939 S TANTAU AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JOHN c:KINNER ADDRESS 939 S TANTAU AVE CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4601 RECEIVED FROM . . . . : E.G.EI,ECTRICAL SVCS CONTRACTOR . . . . . . . : EDWARD GORGINIAN LIC # 24831 COMPANY . . . . . . . . . . : E G ELECTRICAL SERVICES ADDRESS . . . . . . . . . . : 1170 DISMARCK DR CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) ;.70-2222 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 500 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 2, 500 . 00 0 .50 0 . 00 0 .50 0 . 00 1BUSLIC FLAT RATE 1 . 00 :.14 . 00 0 . 00 114 . 00 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 1ERT<200 UNITS 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 241 . 50 0 .00 241 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 241. 50 #z:75 --------------- TOTAL RECEIPT 241. 50 INO CITY OF CUPERT CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM rwswo ,--) APN # Date: 72 S v0 U Building Address: q�67S r^ k-lu—1 7VA Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Own Name: De IYZ16 C act � � � one: �d '�� ELECW7c9JCA ax: Contractor License#: 76 9SW Cupertino Business License#: o Co b_t: Phone: Fax: Residential Commercial ❑ Job Description: (fiAJAJ AAJ EL �� To200A Building Permit Info: Bldg ❑ ElectZ Plumb ❑ Mech ❑ Type of Construction (Usage ass): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B E] Valuation: ZsnO Square Footage: Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or IGENCOM 1STUCOAP Stucco Applications (up to 400 so B additional stucco application 1 WINREP Replacement vindows/sliding glass B door (ea 8 wi idows) IWINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) IEPERMITFEE Electrical Pernit Fee E 1MPERMITFEE Mechanical Permit Fee M IPPERMITFEE Plumbing Permit Fee P I ELCPLNCK Stand Alone Electric Pln Ck(hourly) E I MECPLNCK Stand Alone Viechanical Pln Ck(hrly) M IPLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1STPLNCK-(3 Hr Min Standard Pla-1 Check (when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT I TYPES IBSEISMICR Seismic Res.dential B I IBSEISMICO Seismic Commercial B IT AVDOC Travel &Documentation B 1 1BUSLIC Business Lii;ense B 1 �T I/-6 5 c f 5 Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# LJ OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: I Ric) Q ITY/ZIPCODE: *Our municipal code requires all businesses work' the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCU C INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB O RAcTORS HAVE OBTAINED A CITY F PERTINO BUSINESS LICENSE. ' I am not using any subcontractors: Signature ate Please check applicable subcontra rs and complete ,:he following information: S/ 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