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13110005 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20220 LYNTON CT CONTRACTOR:BWC ELECTRIC PERMIT NO: 13110005 OWNER'S NAME: ANURAG JAIN 2587 AMARYL DR DATE ISSUED: 11/01/2013 OWNER'S PHONE: 4084464214 SAN JOSE,CA 95132 PHONE NO:(408)307-3318 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class r 0 Lic.# —7 DT f PANEL UPGRADE 200 AMP Contractor Aflazl .�l C Date t / 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 t 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:$2000 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:36935019.00 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 city and 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 inspection purposes. (We)agree to save 180 DAY M 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: /Z �L2dlA 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. RE-ROOFS: Signature Date_ Date 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 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) 1,as owner 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. I 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 Compensation,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 for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,SectioMs 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 1.v, Date:t! permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this 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.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(cilcupertino.org131 100 ■ ■ I S C ❑PLUMBING ❑MECHANICAL (ELECTRICAL //11 [:]MISCELLANEOUS PROJECT ADDRESS -0 , D L ,vrv/v C t APN#2/�vI 3 1 CA OWNER NAME 1.wa�6. % ` PHO „_ )u-q6 4L� `I .�J E-MAIL STREET ADDRESS 2 J y l''/, l�(p/ G / ,t CITY, STATEE,�ZIP/ , u FAX CONTACT NAME //.'� /- L/ /V (�� (/' / PHO ,, ,lQ _ E-MAIL STREET ADDRESS ,w CITY,STATE,ZIP t FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 41,wEl 6,e:4_ LICENSE NUMBER .� ,� j LICENSE TYPE:i/1O BUS.LIC# COMPANY NAME �( `' E-MAIL I FAX STREET ADDRESS[�rl- '` IU � . CITY,STATE,ZIPn . � X, / C�f-(/ ` PHON) ARCHITECT/ENG INEE' RR NAMEV LICENSE NUMBER ' G D 1 L. BUS.LIC#� !!!d COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WI DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA la NO FLOOD ZONE jx]NO EICHLER HOME? 2L NO DESCRIPTION OF WORK TOTAL VALUATION: Z t� RECEIVE B By my signature below,I certify to each of the following: I am the property owner or authorized agent to act thpe,ope owner s behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it Is acc rate. I agree to comply with all applicable local ordinances and state laws relating to buildAg construction. I authorize reprreg^entatives of Cupertino to enter the above-identi d property for inspection purposes. Signature of Applicant/Agent: � // L. 'V/12—v� Date: l 1 r SUPPLEMENTAL INFORMATION REQUIRED "oFPi` L7 oVEx TB�COUNT&R <„ �" `❑ EXPRESS `r''`�� l Tl�r ir'. '��F39u��;4 ,�� MEPMiscApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: 11/01/2013 REVIEWED BY: MENDEZ APN: BP#: `VALUATION: $2,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION 1 REAP2 USE: SFD or Duplex PERMIT TYPE: WORK PANEL UPGRADE 200 AMP SCOPE Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: lEPERMIT thlrcj Uhch. Ins,- Other Ph'ifnb h 1" Other Elec.Insp. 0.0 hrs $47.00 ah'tx-h_Sa. 1° t; /';rrratr,. Ir;.ilz(cc: liiec.Ir�rlr.!c,'e NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School estimate Contact the Dept addn'1 District,etc . These fees are based on the relimina information available and are onlyaninfo. FEE ITEMS (Fee Resolution 11-053 Eff. 7%Z'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 200 amps Electrical Suppl. PC Fee: Q Reg. Q OT LO.0 hrs $0.00 $47.001 IBELEC200 Services PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Cbnsfraction Tax: Administrative Fee: ]ADMIN $44.00 E) Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fe � e: $0.00 Select allon-Residential Building or Structure 0 Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: ]BCBSC $1.00 SUBTOTALS: $139.50 $47.00 TOTAL FEE: $186.50 Revised: 10/01/2013