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13040130 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1,0631 STOKES AVE CONTRACTOR:MAINE ELECTRIC INC PERMIT NO:13040130 OWNER'S NAME ';,l3ERGSTROM BARRY:W AND MARIE B 599 LEISURE ST DATE ISSUED:04/17/2013 OWNER`S PHONEc 4082543921 LIVERMORE,CA 94551 PHONE NO:(925)443-3377 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL❑ C�� Lic.# b2;50 INSTALL PANEL UPGRADE 125 AMPS,ADD 3 CIRCUITS License Class p� Contractor' S uli(2�lt l 1( Date I hereby affirm thatI am licensed under the provisions of Chapter 9 (commencing with;Section 7000)of Division:1 of the Business&Professions Code and that'mylicense is in full force and effect. I hereby affirm under penaltyof perjury one of the following two declarations: I have and wiQ maintain a certificate4 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.Ft Floor Area: Valuation:$9256 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of Bill or Code,for the performance of the work for which this APN Number:32649015.00 Occupancy Type: permit is'issued APPLICANT CERTIFICATION I certify.that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED. correct;',I agree to comply,with all cityand county ordinances and state laws relating WITHIN DAYS OF PERMIT ISSUANCE OR to building construction;.and hereby authorize representatives of this city to enter upon the above mentioned property for;inspectionpurposes. (We)agree to save 180 DAY OM LAST CALLED INSPECTION.. indemnify and keep harmless the City!of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit: Additionally,the applicant understands and will comply with all non-point source re ations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date,,, Z� 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two'reasons. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with.wages as their sole compensation, will dolthe work,:ai dthe''structure is not intended!or offered for sale(Sec.7044, Business&ProfessionsCode) 1,as pier of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the.project(Sec:7044 Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the "! California Health&Safety Code,Sections 25505,25533,and 25534. !will. I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment'or devices.which.emit hazardous Compensatiom as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work forwhich this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have land will maint!ljain Wgrker Is Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,255 ,and 25534. Section 3700 of the Llabof,Code,torte rformance of the work for which this performance I Owner or authorized agent: ate: � permit til.issuediiiiI I certify that in Itpe performance of the wol k for which this permit is issued,I shall not y anem joy person'in any manndi so as to become subject to the Worker's Q., I �. CONSTRUCTION LENDING AGENCY Compensation lawslof Califoril If,aftgr making this certificate of exemption,I become subject to the Wdiker s Comper}satronl provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of to rthwith;cornply with sufh provisions or,,On permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT'CERTIFICATION Lender's Address 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 upon the.above mentioned property,for inspection purposes:(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the'City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit;Addition lly;l the applicant understands and will comply with ah'non-point source regulation's;per the Cupertino Municipal Code,Section Licensed Professional I Srgnati}re Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ( (408)777-3228•FAX(408)777-3333•building(cDcupertinO.Org MISG C:UPERTINO PLUMBING EIMECHANICAL ❑ELECTRICAL EIMISCELLANEOUS PROJECT ADDRESS APN# 63 bWNERNAMEE-MA P IL S r CTRp��D SREs'TQt'G l CllLeTl � / CITY,STA ZIP FAX N4 13�7 V t F CONTACT;NAME PHONE EMAIL STREET ADDRESS. CITY,STATE,ZIP FAX ❑.OWNER` �.❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT_ CONTRACTOR NAM$ . LICENSE NUMBER LICENSE•1• BUS.LIC# . 6256 C lYP£ COMPANY NAME E-MAIL FAX M i�la �°lc' STREET;ADDRESS -' CITY,STATE,ZIP PHONE 9 ter: uot- ?�i 4 LI've eP✓ a ARCHiTECT/ENGINEERNAME LICENSE NUMBER BUS.LIC# COWANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF. . ❑SFD or DUPLEX ❑ MULTI-FAMTLY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES - BUILDING: []COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK l rrn ► �e'�x1c n rrr AN bEl>rA76a a4,1, L11VI m: icr!cL 44ALL u PsA/es I TOTALVALUATION: j..ZL�:• . By;my signature below,I certify to'each of the following: I am the property owner or authorized agent to act on the pr rty owner's behalf I have.read this application and.the information I bdVe providedis correct. I have read the Description of Work and verify it is accurate. I agree to comply.with all applicable local. ordinances and state laws telatinglto building constructio . I a orize re esentatives of Cupertino to enter the above-i ntifiel property for inspection purposes.. Signature of Applicant/Agent: Date: I SUPPLEMENT INPORMATION REQUIRED i. MEPMiscApp_2011.d6c revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10631 Stokes ave DATE: 04/17/2013 REVIEWED BY: Mendez APN: BP#: "VALUATION: $9,256 *PERMIT TYPE:' Building PermitCHECK TYPE: Alteration/ Repair PLAN PRIMARY ___TPENTAMATION 1 REAP2 USE. SFD or Duplex PERMIT TYPE: is WORK install panel 66grad6 125 ams add 3 circuits SCOPE ME �1ech.I tan('hcak Plumb. Plait Check Elec.Plan Check 0.0 hrs $0.00 Avlech.Permit Fee: Plumb.Permit Fee: Elec.Permit Feer IEPERMIT Other Alech.Insp. Other Plumb Insp. Other Elea Insp. 0.0 hrs $45.00 rttech Insp. Fee: Plumb.IrisE�.Fee: Elec.Insp.Fee: NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the relimina information available and are onlyan estimate. Contact the Dept or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E 7f[ /1/12) FEE QTY/FEE MISC.ITEMS. Plan Check Fee: $0.00 125 amps Electrical Supp1q.PC Fee: (F) Reg. O OT 0.0 1 hrs $0.00 $45.00 IBELEC200 Services PME Plan Check: $0.00 3 Electrical Permit.Fee: $0.00 $45.00 IBREMRECEP Recep/Switch/Outlets Suppl. Insp:Feer Reg. Q OT 0,0 hrs $0.00 PM-Unit.Fee; $0.00 PME Permit Fee: $45.00 Construction :Tax.• Administrative Fee: 1ADM1N $42.00 Work Without Permit? ® Yes 0 No $0.00 Advanced Planning Fee:. $0.00 Select allon-Residential Travel Documentation Fee: 1TRAVDOC $45.00 Building or Structure 0 . Strong Motion Fee: 1BSEISMICR $0.93 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $133.93 $90.00 $223.93 Revised: 04/01/2013