13010133CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7736 OBSIDIAN CT
CONTRACTOR: WESTEC ELECTRIC
PERMIT NO: 13010133
OWNER'S NAME: KUSTERS SHEILA J TRUSTEE
PO BOX 1165
DATE ISSUED: 01/25/2013
OWNER'S PHONE: 4082536141
FREEDOM, CA 95019
PHONE NO: (831) 662-2822
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Clan CIA Lia N GS/ I 1
REPLACE (E) EL PANEL, SAME LOCATION
Contractor Cx'4 r///eG Date Q 6
I hereby affirm that I am licensed un er the provisions owfrhapter 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
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36218025.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF W RK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 D ERMIT 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 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
ISS Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source egulations per the Cupertino Municipal Code, Section
9.18.
1 � � 3
RE -ROOFS:
Signature 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
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. 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:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
1 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 nicipal Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health &Safety Code, Sections 25505 . 33 5534
1 �;'�q _
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or autM1orized agen . Date: ��i>•' <" '••
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, 1
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
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \
(408) 7773228 • FAX (408) 777-3333 • buildingGncupertino.oro
MEP
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❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS ro
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APN# 3 6 2 '- 2S�
OWNER NAME
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❑ OWNER ❑ OWNER-BUBDER ❑ OWNERAGENr
ONTRAC]'OR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME 1 "�HC't
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC#
COMPANY NAME
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FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SP). DUPLEX ❑ MULTI-FAMD.Y
BU-1NNO; COMMERCIAL
PROJECT IN WB.DV.ND ❑ YES
URBAN INTERFACE AREA to NO
PROJECT IN ❑ YES
FLOOD ZONE )PO
IS THE BLDG AN ❑ YES
E]CHLERHOMEJ WO
DESCRIPTION OF WORK
TOTAL VALUATION: C6Ov 00
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I hav read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating 'ng cons ction. authorize representatives of Cupertino to enter the above-identifirredproperty for inspection pui�oses.
Signature of ApplicanUAgent: Date: ��/7i7/%-;s
SUPPLEMENTAL INFO ON REQUIRED
OFFICE USE ONLY
VER -THE -COUNTER
r:
Y
❑ EXPRESS
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❑ STANDARD
❑ LARGE
❑ MAJOR
MEPMueApp_2011. doc revised 06121111
CITY OF CUPERTINO
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7'iF11 1I74ZTiMAT(1R _ RITII.IIING DIVISION
Meeh. Plan Check
Nfeclr. Penni! Fee:
Other Hech. Insp. 1
1A"Ch. Insp. Fce: LTJ
NOTE: This estimate does not
Phnub. Plun Check
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. hrsp. Fee.
e to other Departments (Le. Plat
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: 1EPERMIT
Other Elec. Insp. 0.0 hrs $45.00
Ele.c. Insp. Fee:
Works, Fire, Sanitary Sewer District, School
Th 1.d th relimina information avaitabie ana are ontan esamare. "macs me ue ur uour..... ,..
District, etc . ese ees are as on e
FEE ITEMS (Fee Resolution 11-053 E . 7(T /1/12)
7736 OBSIDIAN CT DATE: 01/25/2013
REVIEWED BY: MELISSA
LotADDRESS:
APN: 362 18 025 BP#:
*VALUATION: 1$1,800
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD Or Duplex
p
= amps Electrical
$45.00 1ERT<200 Services
PENTAMATION 1REAP2
PERMIT TYPE:
USE:
0.0
hrs
$0.00
PME Plan Check:
WORK
REPLACE E EL PANEL SAME LOCATION
SCOPE
Permit Fee:
Meeh. Plan Check
Nfeclr. Penni! Fee:
Other Hech. Insp. 1
1A"Ch. Insp. Fce: LTJ
NOTE: This estimate does not
Phnub. Plun Check
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. hrsp. Fee.
e to other Departments (Le. Plat
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: 1EPERMIT
Other Elec. Insp. 0.0 hrs $45.00
Ele.c. Insp. Fee:
Works, Fire, Sanitary Sewer District, School
Th 1.d th relimina information avaitabie ana are ontan esamare. "macs me ue ur uour..... ,..
District, etc . ese ees are as on e
FEE ITEMS (Fee Resolution 11-053 E . 7(T /1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= amps Electrical
$45.00 1ERT<200 Services
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. O OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Construction TDs:
Administrative Fee: IADMIN
$42.00
0
Work Without Permit? O Yes Q No
$0.00
Advanced Plannine Fee:
$0.00
Select a Non -Residential
Building or Structure
0
®A
Travel Documentation Fee: ITRAVDOC
$45.00
Strone Motion Fee: IBSE1SiLIICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$133.50
$45.00 1 TOIALFEE:'
$178.50
nv .
Kevisea: iumuzuiz
9
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 6
b b S i o v e� G
PERMIT #
OWNER'S NAME: {o 0, KG..S e. V'S
PHONE# t09 -Z.53 —(�(
GENERAL CONTRACTOR: PC ,,(
BUSINESS LICENSE #
ADDRESS: 1 6 SO
CITY/ZIPCODE: 60
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBC NTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: XZ
Sig ure Date
Please check applicable subcontractors and complete the following i ormation:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
(
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
NIS
Signature
Dl%29//�
Date