14030114 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1053 COLONY HILLS LN CONTRACTOR:ROCK SOLID BUILDERS PERMIT NO: 14030114
OWNER'S NAME: JOE&RUTH STEVENS PO BOX 20265 DATE ISSUED:03/19/2014
OWNER'S PHONE: 4087251084 SAN JOSE,CA 95160 PHONE NO:(408)997-7625
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
2 IN KITCHEN AREA: REPLACE 5(E)AND ADD 7(N)
License Class Lie.#157
too RECEPTACLES,5(N)CIRCUITS&2(N)
0 /f� ' SWITCHES.(E)FLUORECENT TO REMAIN
Contractor IC�1� 1 s ✓
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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3000
ave 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:35930005 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 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 L 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 3
granting of this permit. Additionally,the applicant understands and will comp! s
with all non-point source r ulations per the ertino Municipal Code,Se
9 18.
E-ROOFS:
Signature Date 3�Iel 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-BUI DER 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. 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 Munic' ode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25505,25533, d 34.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date: ✓'`�
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,l CONSTRUCTION LE DING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lend 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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 X
.12. (408) 777-3228.1=AX(408)777-3333•buildinaCa7cupertino.org k MISC
GUptkTINO
❑PLUMBING ❑MECHANICAL I?k.ECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS I C 011 APN# 57 9 _ '70 _ O Q�
OWNER NAME C'!� f) PHONF�(I G ' l j E-MAII.
//�
STREET ADDRESS J �(� L/ CITY, STATE,ZZIIP'... `J I JU I FAX
CONTACT NAME PHO466 q [�•-ir _2 E-M-AIL
STREET ADDRESS CITY,STATE,ZIP FAX
13 OWNER 11 OR'NER-BUII,DER ❑ OWTIERAGII�'T ❑ CONTRACTOR 11CONTMACTORAGENT 13ARCHITECT ❑ENGINEER ❑ DEVELOPER TENANT
CONTRACTOR NAME sh A� w< /'„. �w w/ LICENSE NUI MERq� ��/-� LICENSE TYPE BUS.LIC#
J7T►Y� /'6'> �.-Ut�J�71(/I -MAIL '�I <
COMPANY NAME ��r U TU
� �,`Ikifv a FAX
STREET ADDRES V j- /_�� CITY,STATE,(JPHONTE p a ,)J"7v
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# 1
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD or DUPLEX ❑ MULTI-FAMQ Y PROJECT IIi WII DLAND El YES PROJECT IN ❑YES IS THE BLDG AN YES
BUILDING: ❑COMMERCIAi URBAN INTERFACE AREA ❑ NO +FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WO ,�!� i- Mau-
e�f„ .�^/� ( 1/n -I Qt e jpTarpt-A A � • 21 v1N1 WV 1 •`V�S�v`
Vl
Sty ceV, _- 1:1 Ye?'►'1Gull
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property o r or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is.correct, have read the ser' tion of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building contra ' . I authori re a tatives of Cupertino to enter the above-identified pr perty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL I1slFOR1,7ON REQUIRED
AVERTH1iCOL33TR
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Al
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MA3OR
I✓IEPMiscApp_2011.doc i-evised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1053 COLONY HILLS LN DATE: 03/19/2014 REVIEWED BY: MELISSA
APN: 359 30 005 BP#: `VALUATION: 1$3,000
,PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION 1REAP10
USE: p PERMIT TYPE: A
WORK IN KITCHEN AREA: REPLACE 5 E AND ADD 7 N OUTLET RECEPTACLES 5 N CIRCUITS &2
SCOPE I(N) SWITCHES. (E) FLUORECENT TO REMAIN
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Recep/Switch/Outlets 1BREMRECEP 14 # $47
Special Circuits 1BREMMISC 1 # $139
TOTALS: $186.00
lF�e., yE;En phiwb. Plant hock Elec.Plan Check FO.0 rhs $0.00
hrd^rnrt F,ee; Ple,,rn/=, 1lcnnfi Fv: Elec.Permit Fee: IEPERMIT
Ljfrjsp Lj Other Elea Insp. 0.0 hrs $47.00
Phanh. In p. Fee, Eiec.Lnp t'ae
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 prelimina information available and are only an estimate Contact the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11-053 E, . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check F`,e:
Srrppl. :C'1 ee
PME Plan Check: $0.00
t')e r-n,a,"t l-'( ..
,`;up 3l1rrt',, Fee
PME Unit Fee: $186.00
PME Permit Fee: $47.00
Administrative Fee: 1ADMIN $44.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $47.00 4
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
$325.501 $0.00 TOTAL FEE: $325.50
Revised: 01/15/2014
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RE
ICE CEIVED
�� Zo MAR 19 2014