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10020132CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10575 METEOR PL CONTRACTOR: MDE ELECTRIC INC. PERMIT NO: 10020132 OWNER'S NAME: HIRSCH PETER M AND JACQUELINE 152 COMMERCIAL ST DATE ISSUED: 02/24/2010 VER'S PHONE: 4087335216 SUNNYVALE, CA 94086 PHONE NO: (408) 738-8600 es' LICENSED CONTRACTOR'S DECLARATION IWILDING PERMIT INFO: BLDG ELECT PLUMB r License Class C —f O Lic. # 37 162-5- MECH r RESIDENTIAL r— COMMERCIAL r Contractor K&O i- �zt_ F TrZ 1 Date Z_-221-10 JOB DESCRIPTION: CHANGE OUT ELECTRICAL SUB PANEL 125AMP 120 TO I hereby affirm that I am licensed under the provisions of Chapter 9 ; 40VOLT (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 performance of the work for which this permit is issued. 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 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature qA� .ems— Date LJ OWNER -BUILDER DECLARATION [ hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this pen -nit is issued, I shall 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 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. 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save mnify and keep harmless the City of Cupertino against liabilities, judgments, , and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. � Date Signature � � l 3q. Ft Floor Area: NPN Number: 32644007.00 Valuation: $1500 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Date.2, 2_ � /U Issued by: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE [ have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owp,# or authJ% razed agent. ..Cry.!/ Date: �T CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32644007.00 DATE ISSUED.......: 02/24/2010 RECEIPT #.........: BS000009813 REFERENCE ID # 10020132 SITE ADDRESS 10E75 METEOR PL SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: HIRSCH PETER M AND JACQUELINE ADDRESS 10575 METEOR PL CITY/STATE/ZIP ...: CU73ERTINO CA, CA 95014-1326 RECEIVED FROM MA:ZSHALLTRIC GOLDCMAN LIC # 30517 CONTRACTOR ....... COMPANY MD3 ELECTRIC INC. ADDRESS ........... 152 COMMERCIAL ST CITY/STATE/ZIP ... 5UqNLECA 408YV738,8600 94086 TELEPHONE CHECK 127.50 #026205 --------------- TOTAL RECEIPT 127.50 QUANTITY AMOUNT PD -TO -DT THIS REC- FEE ID UNIT ---------- -------- --NEW-BAL- ---------- 1BCBSC ------------- VALUATION ---------- 1,500.00 ---------- 1.00 0.00 0.00 1.00 0.50 0.0 0.00 1BSEISMICR VALUATION 1,500.00 0.50 42.00 0.00 42.00 0.00 1EPERMITFE FLAT RATE 1.00 1.00 42.00 0.00 42.00 0.00 1ERT<200 UNIT'S 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 127.50 0.00 127.50 0.00 TOTAL PERMIT METHOD OF PAYMENT AMOUNT REFERENCE --------------- NUMBER CHECK 127.50 #026205 --------------- TOTAL RECEIPT 127.50 CITY OF CUPERTINO CITY OF C UPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # l _ -�. 32 Date: Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work on Yes ❑ No If yes, provide letter from HOA Owner's Name: Phone #:Cqo, 7 3 3 S�Z- t t -4.00 t Z -s3 Phone: Contractor: WIDF F1Fc`t2� Fax: o g— �T- Contractor License #: c-lv—3-7162G Cupertino Business License #: ? I Phone: Contact: II L l© Q O� Fax. Residential Commercial Job Description: C jgq''yq�o Otot^� moi✓ .`- �� Q 1e L�-- iP 120V �'Z� a V t�43 41^AFL- Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V-:3 Valuation: Square Footage: -S-0c) 'tea Project Size: Express Standard ❑ Lar e ] Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it -, include in plan set & the sheet index. to the application or if applicabl Points Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 Jsi� CITY OF CUPEkTINO CITY OF C_UPERTINO GENERAL BUILDIING APPLICATION FEE SCHEDULE Quantity/Sf G// ` Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco A:)plications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Wir dow-structural shear wall/masonry (includes plan ck fee) B 1EPERMITFEE Electrica: Permit Fee E 1MPERMITFEE Mechani,;al Permit Fee M 1 PPERMITFEE Plumbin,; Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand A]one Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standarc. Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B I TRAVDOC Travel & Documentation B 1BUSLIC Business License B _1Z Z 2 v 5 of 5 CITY OF XPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Buildi:n De artment JOB ADDRESS: PERMIT # /015775- .lw� �©�2 �� . C u pl^2rr.-vv �l OWNER'S NAME: -raiz PHONE # GENERAL CONTRACTOR: r, -) .D E_�L��` i lZ1 C__ FAX # I am not using any subcontractors: Al �C__I_, Signature Date and rnmrilete fhe following information: . 1edSC LiLuCK kA a un-a.vic SUBCONTRACTOR ... ___-r_____ --- ---- BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork -Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date