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14120112 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7542 WATERFORD DR CONTRACTOR:GRID ELECTRIC PERMIT NO: 14120112 OWNER'S NAME: SAN JOSE,CA 95124 PHONE NO:(408)316-3859 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL License Class Lic.# %n /� �,/� 200 AMP PANEL UPGRADE �l Vll,, ©�(� CJy Contractors /� f f Date 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1800 ave 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:36616011 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 180 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 DAYS ST 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 regulations per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signature �� � Date/0 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 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 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,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agent: Date:�� 4 permit is issued. 1 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 n�1 (408)777-3228•FAX(408)777-3333•building(c CUPERTINO cupertino.org \U MISC 1� [:1 PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS.!�L^ r APN# GY I ca 1(� b OWNER NAME L EI-MAIL STREET ADDRESS 5- 2 b�Y�f"' ,Q��( D r CITY, T �,j�� t,^ O` FAX CONTACT NAME, (� PH E-MAIL STREET ADDRE I n CITY,SZAP, t o ItiJ FAX ❑OWNER El OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR El CONTRACTOR AGENT 11ARCHITECT FAX ❑ DEVELOPER ❑ TENANT CO RACTOI NAM 1 LICE9FjAIIji�(BFt LIC SE Tr BUS.LIC# go COMPANY NAME t (E-JMAAIIL 19 FAX STRW?I q7 CI 140 :IS-e T / ✓` P O 31G 3�Sy ARCHITECT/EN(GGIINEER NAME V LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.,DUPLEX MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: E]COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? NO DESCRIPTION OF WORK REGEIUE=. TOTAL VALUATION: 1 � �• �,i' By my signature belo ,I certify to each of the following: I am the property owner or authorized agent to act on the prop owner's behalf. I hav this application and the information I have provided is correct. I have read the Description of Work and verify it is Dan . I agree to comply with cable local ordinances and state laws relating to buildin��n. I authorize representatives of Cupertino to enter theve-ide tifi pro erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED oPPicE USE oNi x w� '-� ❑. OVER-TAE-COUNTER' ( EXPRESS U n, STANDARD Z t. MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7542 waterford dr DATE: 12/22/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$1,800 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP USE: PERMIT TYPE: WORK 200 amp panel upgrade SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $48 TOTALS: $48.00 1'1'111nh7 I1/on(`wel, Elec.Plan Check 0.0 1 hrs $0.00 Perwif Fee: 11himb, Permit Elec.Permit Fee: IEPERMIT P7urnl,Irt,'oLi OtherElec.Insp. 0.0 hrs $48.00 e a.I;zJiz i < 1'haaiib. Ins/). Fee: Iaac.h i " V,c: NOTE: This estimate does not include fees due to other Departments(he.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These,fees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 Ejf. 7/1/13) FEE QTY/FEE MISC ITEMS PC Fcc PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 ,'1r1�°Far�c'<3c�/'1ctrte�r'rtfn I+<'P:S: Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 nw _a $190.50 $0.00 TOTjAL FEE: $190.50 Revised: 10/01/2014