10040067 CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR:SOLEX ELECEEMM
7
BUILDING ADDRESS: 10161 PHAR LAP DR 2010
OWNER'S NAME: JOETTA MAIER
1903 ADELAIDE WAY
L ER'S PHONE- 4088365828
SAN JOSE,CA 95124 8
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C- w Lic.# 4-� 1 1 3 MECH r RESIDENTIAL f- COMMERCIAL
Contractor Date
JOB DESCRIPTION:RES TEMP POWER @ PERMNT LOC
I hereby affirm that I am licensed under the provisions of Chapter 9
(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 Valuation:$1000
performance of the work for which this permit is issued. Sq.Ft Floor Area:
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:32639056.00 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 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 �-� Date:
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by:
9.18.
Signature s4
Date
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
13 OWNER-BUILDER DECLARATION
installed 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 inspection.
the following two reasons: Date:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
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 Health&Safety Code,Sections 25505,2553te and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety compliance
Code, the ton Cupertino
5532(a)should I store orCodehandletha ardou r 9.12 smat the Health
Ith&
performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insurance,as provided for hi contaminants as defined by the Bay Area Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Healt &Safety Code,Sections 25505,25533,and 25534.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's Ow r or a h i d agent-
not
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked.
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
u"^n the above mentioned property for inspection purposes.(We)agree to save
inify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
granting of this ermit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-po t source egulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
5 ITEMS OF 6 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 32639056 . 00
DATE ISSUED. . . . . . . 04/09/2010
04000010142
RECEIPT # . . . . . . . . .
REFERENCE ID # 10040067
SITE ADDRESS 10161 PHAR LAP DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JOETTA MAIER
ADDRESS 10161 PHAR LAP DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1113
RECEIVED FROM SOLEAREFXSELECTRIC TAWI LIC # 28129
CONTRACTOR . . . . . .
COMPANY SOLEX ELECTRIC
ADDRESS 1903 ADELAIDE WAY
CITY/STATE/ZIP SAN
JOSE
71,5308 95124
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW-BAL
----------
--------
---------- 0 . 00
---------- ---------- 1 . 00
1, 000 . 00 1. 00 0 .00
1BCBSC VALUATION 0 . 00 0 .50 0 . 00
1BSEISMICR VALUATION 1, 000 .00 0 . 50 42 . 00 0 . 00
1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 00 42
.00 0 . 00
1 . 0 . 00 42 . 00
1ERT<200 UNITS 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00
127 . 50 0 .00 127 . 50
---------- ----
------
0 . 00
TOTAL PERMIT
ON
VOICE ID DESCRIPTI
VOICE ID DESCRIPTION
-------- ----------------
402 TEMPORARY POWER
CITY OF CUPERTINO
TEMP POWER
CITY
E T
C U i�,INO PERMIT APPLICATION FORM
Date: ;
rA:P:N
uilding Address:
o 141 ' g LAP r Phone #:
Owner's Name:
r Phone #:
Contractor:
Fax #:
Phone #:
Contact:
Contractor License #: C- (v �;-3/J 3-7
Cu ertino Business License#:
2Y
Job Description: �^
Residential Commercial
Li
ff!t
(cost of project):
Type of Construction: N/A
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>1K E 1REAP14
Amps
IERT<200 Res. Temp.Power<200 E
1 ERT2001 K Res. Temp Power 200-1 K E
Amps
1 EPERMITFE Electric Permit Issuance E
1 ELCPLNCK Electric Plan Check E
1BCBSC Cal Bldg Standards B ALL PERMIT
Commission Fee TYPES
1BSEISMICR Seismic Residential B
1TRAVDOC Travel & Documentation B
Fee
Revised 01/07/09