15120098' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20197 HOGUE CT
CONTRACTOR: MAINE ELECTRIC INC PERMIT NO: 15120098
OWNER'S NAME: MILTON & BETTY HOWARD
599 LEISURE ST DATE ISSUED: 12/10/2015
OWNER'S PHONE: 4085644320
LIVERMORE, CA 94551 PHONE NO: (925) 443-3377
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REPLACE 3 SWITCHES & 8 OUTLETS IN MASTER
License Class,A 1�:, Lic. # 0
BEDROOM
".,�� (2�
�e�`i rC Znc Date ALP2611 S
AND BEDROOM #2; REPLACE 100 AMP SUBPANEL AT
Contractor r�
KITCHEN
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
Sq. Ft Floor Area:
Valuation: $3231
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
APN Number: 31624039.20197
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 FROM 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: ei Date: I?- 1 t U
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulatio he Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signatures Date PS f $
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 (Sce.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(x) 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 25 , an 25 4.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent.
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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building a?cupertino.orcl
F— NF.W CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS ^ , pejT 6 0 N
APN #
OWNER NAME �`- �
PHONE �
E-MAIL
! ,
r W
STREET ADDRESS
ao 6 U GT
CITY, STATE, ZIP
c* C150 /C(
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME -
LICENSE NUMBER `y n
S/®02-7�
LICENSE TYPE
BUS. LIC #
i
t
COMPANY NAMEq. � � a ^ � E-MAIL �z
G �J
FAX
STREET ADDRESS CITY, STATE, ZIP
P101 L _ � sv a S'7' 1. . Zv _ d R G S
PHONE
'?D.5 zeq7 '3377
ARCHITECT/ENGTNEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK�
A,ea c l & ev.�r_ 's nJ— .'+�L �T 4 _n
d if e'4e.n
`3 4- �e IS
EXISTING USE
PROPOSED USE CONSTR. TYPE
# STORIES
USE
TYPE
TOCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY: TOTAL VALUATION:
PLANNING APPL # I-]NOPLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
' ^71-TOT
By my signature below, I certify to each of the following: the property owner or authorized agent to act n e property owner's behalf. I have read this
application and the information I have provided is cor Ce rea Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buictio I aut a representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: _1a 110
SUPPLEMEINFORMATION REQUIRED
PLAN CHECK TYPi
ROUTING sLtp
❑ OVER-TH.E-COUNTER .
❑ BUILDING PLAN RE VIEW
_New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ . STANDARD'
❑ PUBLIC WORKs
form if any Hazardous Materials are being used as part of this project.
❑ `TARGE '
❑ FrREDEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
E1MAJOR
❑ SANITARY SEWER DISTRICT
submittal Of Building Permit application.
ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20197 Hogue Ct
FEE ID
DATE: 12/10/2015
REVIEWED BY: Phuong
APN: 316 24 039
BP#:
*VALUATION: 1$3,231
: PERMIT TYPE: Electrical Permit
IBREMRECEP
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION 1REAP10
PERMIT TYPE: A
WORK
Replace 3 switches & 8 outlets in master bedroom and bedroom #2; Replace 100 amp subpanel at
SCOPE
kitchen
100
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEEMISC
QTY
UNITS
BP FEES
Elec. Permit Fee: ]EPERIVIT
Recep/Switch/Outlets
IBREMRECEP
Other Elec. Insp. 0.0Thrs $48.00
11
#
$48
Services
1 ERT<200
100
Amps
$48
PME Unit Fee:
$96.00
PME Permit Fee:
$48.00
Administrative Fee: ]AWItIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
A
Travel Documentation Fee: ITRAVDOC
$96.00
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Prelindnary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 1.1-053 Lff7,,L1,,".13
—j
FEE
QTY/FEEMISC
Elec. Plan Check 0.0 hrs $0.00
A.wm;Fee,
Elec. Permit Fee: ]EPERIVIT
0!f f
Other Elec. Insp. 0.0Thrs $48.00
,ch.
We
Phj;nb.
Fcf,',
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Prelindnary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 1.1-053 Lff7,,L1,,".13
—j
FEE
QTY/FEEMISC
ITEMS
an, F(?e:
A
PME Plan Check:
$0.00
PME Unit Fee:
$96.00
PME Permit Fee:
$48.00
Administrative Fee: ]AWItIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
A., z 11,
A
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldk-y Stds Commission Fee: IBCBSC
$1.00
SUBT'OTALS:.
$238.50
TTAL FEE.
O::Oo O
:$:
$238.50
Revised: 10/01/2015