BLD-2021-1946BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21376 RUMFORD DR Cupertino APN: 326 41 012 PERMIT NO: BLD-2021-1946
OWNER'S NAME: OWNER'S PHONE: Not Provided
CONTRACTOR: J M C ELECTRICAL SERVICES INC, 1713 LITTLE ORCHARD ST UNIT D SAN JOSE CONTRACTOR PHONE:
DATE ISSUED 9/29/2021 12:35:27 PM ISSUED BY:VALUATION: $4000
JOB DESCRIPTION
Removing existing obsolete 100 amp meter main panel and installing new, safe, 100 amp meter main panel. Meter to stay in exact same location. PGE has approved the panel
change
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: J M C ELECTRICAL SERVICES INC
LICENSED CLASS: C10 ELECTRICAL
LICENSED NO: 964755
EXP DATE: 08/31/2023
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 penatly of perjury one of the following three declarations:
1 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.
2 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.
3 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 become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith
comply with such provisions or this permit shall be deemed revoked.
I understand and agree that I am electronically signing and filing this application and that checking the box below has the same legal effect as manual signature. I also
understand that I have the option of filing a paper copy of this application with a manual signature but have chosen instead to file this application electronically.