14010055 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11080 SANTA TERESA DR CONTRACTOR:MAINE ELECTRIC INC PERMIT NO:14010055
OWNER'S NAME: SCHLICHTEMEIER RONALD F AND JO 599 LEISURE ST DATE ISSUED:01/08/2014
O R'S PHONE: 4089969279 LIVERMORE,CA 94551 PHONE NO:(925)443-3377
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
REPLACE(E)125 AMP PANEL,SAME LOCATION.ADD(N)
License Class A �d Li..# '�Z�� DEDICATED CIRUIT FOR(E)FURNACE
Contractor IV1CcAl1 •Date kfg �Sy
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
eVormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5532
have and will maintain Worker's Compensation Insurance,as provided for by
A1ection
3700 of the Labor Code,for the performance of the work for which this APN Number:35617030.00 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 WITfIIN 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 FR LED 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 y'
with all non-point source regul Cupertino Municipal Code,Section
.--
918.
,1 RE-ROOFS:
Signature Date b y 8�� 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)
1,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 MuniclJOLC79de,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 5505 d 2 4.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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
918.
Signature Date
GENERAL PERMIT APPLICATION Ki MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �\
(408) 777-3228•FAX(408)777-3333•building(acupertino.org MISC
❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS ` t�VC � eirf��Dr
OWNERNAAPN# 3 G
ME PHONE
STREET ADDRESS C_ \ Dr
CITY, STATE,ZIP. FAX
CONTACT NAME` PHONEC��clut,�_3 E6 \Ya(1 rnlun� rti ��
STREET ADDRES { C� CITY,STATE,ZIP p-JJ JJ�1''ll FAX
L1Y a�C C.4-. 9
❑ OWNER ❑ OWNER.BUBAER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME _ t± ` LICENSE NUMBER LICENSE TYPE(2 16 BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP LA Ce-q475 t PHO"YC(Z \4113,35
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WII.DLAND ❑ YES
7ROIECTOIN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN WfERFACE AREA ❑ NO ZNE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF FORK
lic-
i
4eck cid
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorize ent to act&wee property owners ehalf. I have read this
application and the information I have provided is correct Ljieve reathe Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ng co n. I au ze representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: /
SUPPLEMEINFORMATION REQUIRED oT iJSEanY
� min-f
F
EXPRESS
a � cTet�meixn
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11080 SANTA TERESA DR DATE: 01/08/2014 REVIEWED BY: MELISSA
APN: 35617 030 BP#: "VALUATION: $5,532
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARYPENTAMATION 1 REAP2
USE: SFD or Duplex I PERMIT TYPE:
WORK REPLACE E 125 AMP PANEL SAME LOCATION. ADD N DEDICATED CIRUIT FOR E
SCOPE FURNACE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1ERT<200 125 Amps $47
Special Circuits 1BREMMISC 1 # $139
TOTALS: $186 00
ss
��.a� -'" .
ItiN 5V —
Ltech. Plan t'du:ch Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00-
7(1-1141
0.00;black.Permit Fee: Plumb.Permit ree: Elec.Permit Fee: IEPERMIT
Oiher;llech.Ins/. Other Plumb Ins), Other Elea Insp. 0.0 hrs $47.00
P2:��
1lech. Imp. Fee: Plumb, Irish.Tee: flet.Ins), Fee:
NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These&0 are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Su1)1)1..F'C"Fee:
PME Plan Check: $0.00
Permit Fee:
supful. Insp Fees
PME Unit Fee: $186.00
PME Permit Fee: $47.00
C'onsiruction :Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? ® Yes (E) No $0.00
.ldvca IMI Planning Fees':
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion.Fee: 1BSEISMICR $0.55 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
6-t
$325.551 $0.00 TQAL FES: $325.55
Revised: 01/01/2014