The URL can be used to link to this page

12040099 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1538 PRIMROSE WAY CONTRACTOR:T D ELECTRIC PER>IT No: 12040099 SERVICE OWNER'S NAME: RICHARD& SHERIL WOODBURN 12242 SARATOGA SUNNYVALE RC DATE ISSUED:04/18/2012 OWNER'S PHONE: 4082552767 SARATOGA. CA 95070 PIIONE NO:(408)374-7113 ❑ LICENSED CON]RAQ OR'S DECLARATION r r r C fi BBUILDINGI'E:R\IIT INFO: ULUG E:LF.f.'1 PLUMB Class_O—� Lic.9 77d-� Sd Z r r r -r-�� ?IECII RESIDENTIAL' COMMERCIALContraclon- � t' +1! YVII%v 1MnC [�� CI— I hereby affirm that 1 am licensed under the provisions of Chapter 9 30B DE:SCRIP"IION: SERVICE UPGRADE TG 200 AMP (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 penally of perjury one of the following two declarations: I have and will maintain a certificate of consent to sell'-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code.far the performance of the work for which this permit is issued. Sq.Ft Flour Area: Valuation:52500 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:36615015.00 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 sone 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 DAY 'ROM LAST CALLED INSPECTION. indcmnily and keep hammless the City 01'Cupcninu against liabilities,judgments. _// casts,and expenses%%hich may accrue against said City in consequence of the -z OZZ graining of this permit. Additionally,the applicant understands and will comply Issued by: Zl✓ Dalt. with all non-point soul,;regulations per the Cupertino Municipal Code,Section 9,18, �� RE:-ROOFS: C h Signature —� 1 Date All roofs shall be inspected prior to any tooling material being installed.Lfa root'is installed without first obtaining an inspection. I agree to rcnuwe all new materials tin inspection. ❑ OWNER-BUILDER DECLARA'T'ION Signature of Appficam: Date: I hereby affirm that I am exempt from the Contractor's License Law for One of the following two reasons: ALL ROOF COVERINGS'I'O BE:CLASS"A"OR BE:I-I'E:R h as owner of the property,or my employees with wages as their sole compensation, wi11 do the work,and the stricture 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 NIA I'F.RIAIS DISCLOSURE: construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilcallh&Safc(y Code,Sections 25505,25533,and 25534. 1 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: Ilcallh&Safety Code,Section 25532(a)should I store or handle hazardous I have and Ivill maintain a Certificate of Consein 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.ter the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work far 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 (he Ilealill&Safely Code,Sec n'25505, 533,�n 25534. Section 3700 of lire Labor Code.f'or the performance of the work for which this Permit is issued, Owner or authorize)agent Uala 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 ol'Cnlilbrnia. If,after making this certificate of exemption.I C..ONSTRIiC'1'ION LENDING AGENC\' 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 nhC performance of forthwith comply with such provisions or this permit shall be deemed revoked. w'ork's for which this permit is issued(Sec,3097.Civ C) Lender's Name APPLICANT CERTIFICATION Lender's,Wdress 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 indcmnily and keep harmless the City of Cupertino against liabilities.judgments, ARCI I II_ECf'S DF.CLARA HON 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 Prolessional 9.18. Signature Date GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 950143255 M I /� CUPERTINO (408)777-3228•FAX(408)777-3333•buildingl5cuoertino.orD / y� /v— ❑PLUIVMrNG El MECHANICALCTRICAL ❑MISCELLANEOUS PROTECT ADDRESS APN tl MV /1 I(5' 6K OWNERNAME I lO o ur snub. i w STHESTADDRESS It C[7Y�3jAlE,� r FAX CAMAR NAME B O �/' /7 - -P�� ✓f'�U t R�E59 .SLAT FAX SNI `� �-V D Y ❑OWNER ❑ owNEA-truI DER . ❑ OWNER AGENT CONTRACTOR ❑CONnUCIVRAGENT ❑ ARau EcT ❑EmrtmER ❑ DEVELOPER ❑ TENANT N r "#-Met #- FID _7F TYPB BUS.LOCM Og/, COMPANY NAC— F-WAILC...'��i 0Com/—/ . YY1C �. FAX ADO / 15� ,7A?�tjn� r-7 m g 35c� (� ARCHITECOFli(iR= LICENSE NUMBER BUS.LIC a COWANY NAME E-MAB. FAX STREELADDRERS ClW.STATE,Z? PHONE USE OF wDUPLDC ❑ mmr;-FAMD.Y. FROOFLrINWRDIAND ❑ YES PROIEC.T Ba ❑YES 3THE BLDG AN ❑YES BDBDDI6: tOELV4R(LAI. URBAN LNiFAFACFAREA NO FIDOD 201E NO EICHLER HOME? O DESCRDTION OF WORK } T TOTAL VALUATION: _'/s/�) UD RECEIVED BY: By my sigoaaue beloww.I certify to each of the follawing: I am the property Owner or amhorized agent to act w the property oavees behalf I have read this application and the iffotmatiaa I have provi is correct have read the Description of Work and verify it is accurate. I agree m comply with 0 applicable local ordiamrcra and state laws relating to g trocti I an representatives of Cupertino to enter the above-r DSed/yraparty Cor inspection pul�oses. Signature of AppficaadAgene Dam: SUPPLE Y ENTAL INF TION REQUIRED OFFICE USE ONLY m OVER-THF COUNTER 6 ❑ EXPRESS u u ❑ STANDARD x u ❑ LARGE 6 ❑ MAJOR MEPMacApp_2011.doc rev&ad 06/211ll