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13100057541, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20030 STEVENS CREEK BLVD CONTRACTOR: W B ELECTRIC INC PERMIT NO: 13100057 OWNER'S NAME: PREG BILTMORE P O BOX 235 DATE ISSUED: 10/08/2013 OWNER'S PHONE: 6509313456 RAYMOND, CA 93653. PHONE NO: (559)689-3888 JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE] ❑ LICENSED CONTRACTOR'S DECLARATION License Class CIA Liz. INSTALL TEMP POWER ON NEW CONSTRUCTION SITE Contractor ud f) Date W "' ii " L 3 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: $6800 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 36903004.00 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 0 AYS 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 DA OM LAST CALLED INSPE ON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ,/ granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: v with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 1© RE -ROOFS: 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 1, 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, Sec ' s 2 , 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 10 -' 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 asto become subject to the Worker's Compensation laws of California. Ii, 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a0cupertino.org \ —(PLUMBING MMECHANICAL I i/IELECTRICAL MMISCELLANEOUS MEP MISC PROJECT ADDRESS 200 3,0 51"n -is C LZL�= OWNER NAME 9_am iTN EUS, PHONE AII - 3y S STREET ADDRESS S. J ¢� l -v- CITY, STATE, ZIPs c c^qa31clu 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 %0(6 1LLLC.TV(A LICENSE NUMBER S 12 4!5 LICENSE TYPE A BUS. LIC # 2-7 CIS O COMPANY NAME C-. E-MAIL � W10 e�e.k:c.• FAX LA0V-i4-7-y Ivy STREET ADDRESS 2 Z Cd to �-OW O ItsCay 3e 6. ( CITY, STATE, ZIP PHONE �1G�{—$coo-oE.QcI ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING. ❑ COMMERCIAL PROJECT IN WIIALAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK 1Nti SOW Z.'DO 1 E t `2tCA(� TOTAL VALUATION: . i d (3. 'V 0RECEIVED 83i -w a`s c.fi a 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 ha a ead this application and the information I have rovided is c ct. I have read the Description of Work and verify it is accurate. I agree to comply with al plicable local ordinances and state laws relating uildl con ct ut rize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 1 SUPPLEMENTAL INFORMATION REQUIRED RE Q - g (iF �a����"01=ILY, ��Rk _ ' E"XPRESS MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO go FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School niciriri om 1 Thoco foot aro haeod nn rho nroliminary infarmatinn ovoilahle and are only an estimate_ Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) 20.030 SCB DATE: 10/08/2013 REVIEWED BY: Mendez JimADDRESS: APN: BP#: *VALUATION: $6,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: I PENTAMATION I PERMIT TYPE: 1 REAP2 WORK install temp power on new construction site SCOPE Plumb Insp.Li NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School niciriri om 1 Thoco foot aro haeod nn rho nroliminary infarmatinn ovoilahle and are only an estimate_ Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: .tech. Plan Check Plutnb. Plan Check Elect. Plan (.:heck Permit F'ee: F_ Plumb. Po7nit Fee: Elec. Permit Fee: $0.00 (they Afec h. Imp.OI', Plumb Insp.Li 01her Ele(_ Imp. Li $0.00 :tech. Insp. Fec: Plumb. Insp. Fee: Elec. Insp. Fee: $0.00 Suppl. Insp. Fee -0 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 0 # new units W1, , NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School niciriri om 1 Thoco foot aro haeod nn rho nroliminary infarmatinn ovoilahle and are only an estimate_ Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: .tech. Plan Check Plutnb. Plan Check Elect. Plan (.:heck Permit F'ee: F_ Plumb. Po7nit Fee: Elec. Permit Fee: $0.00 (they Afec h. Imp.OI', Plumb Insp.Li 01her Ele(_ Imp. Li $0.00 :tech. Insp. Fec: Plumb. Insp. Fee: Elec. Insp. Fee: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School niciriri om 1 Thoco foot aro haeod nn rho nroliminary infarmatinn ovoilahle and are only an estimate_ Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 FiKl amps Electrical $47.00 1BELEC200 Services Suppl. PC Fee: (j) Reg. ® OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 0 # new units $0.00 Administrative Fee: 1ADMIN $44.00 0 E) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 1 0 0 i Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.68 Select an Administrative Item Bldg; Stdsx Commission Fee: IBCBSC $1.00 On $92.68 $47.00 4 _TOTAL FEE, $139.68 Revised: 10/01/2013