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15070153V CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20197 HOGUE CT CONTRACTOR: MAINE ELECTRIC INC PERMIT NO: 15070153 OWNER'S NAME: MILTON & BETTY HOWARD 599 LEISURE ST DATE ISSUED: 07/22/2015 OWNER'S PHONE: 4085644920 LIVERMORE, CA 94551 PHONE NO: (925) 443-3377 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL 0 REPLACE (E) 100 AMP SUB PANEL, SAME LOCATION. _ License Class 10 Lie. # $ 302 S 0 INSTALL (N) ATTIC FAN & (N) EXHAUST FAN Contractor MN10te OtCt Date 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: $4114 performance of the work for which this permit is issued. 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: 31624039.20197 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 1 0 D ED INSPECT 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 2 Z / Is Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. / q %J—QjS � �Z7/t� 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 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, Sections 25505, 5533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:7-ZZ- / S 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 9.18. Signature Date CUPERTINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 misc (408) 777-3228 • FAX (408) 777-3333 • buildina(McuDertino.org / PROIECP ADDRESS U 1 C1 , (�(,{ U �i 1 lr LICENSE NUMBERg 302— S U APN P / L 7 U Q OWNER NAME S� _ �PRONqF L , � � 17�` E-MAn. L( E-MAIL STREET ADDRESS�}�� I y `� u CITY. STA;f TIP j1 9 J j 1 FAX CONTACT NAME a S � ARCHITECT/FNCUNM NAME PHONE `]Z� 2 �y� J !'v E-MAu- STREET ADDRESS BUS. LIC # CITY. STATE, Z. FAX ❑ OWNER ❑ OWNERBUIIDFR ❑ OWNER AGENT 10 CONTRACTOR ❑CONTRACADRAGENT ❑ ARcHrrECT ❑ ENGnEEt ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ,' A r, r n , ` W ` U` (% 1 V LICENSE NUMBERg 302— S U LICENSE TYPE G I �) BUS. LIC S COMPANY NAME E-MAn. PAX srREET ADDRESS , O q L. e i s U,(--2 �� j. CRY. ST L , t'1'� (,-f' 9 t ( � 'N3 ARCHITECT/FNCUNM NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CrrY. STATE. ZIP PHONE USE OF EISFD ar DUPLEX ❑ MULTI -FAMILY SUIWINQ [3 COMMERCIAL PROJECT IN WUDLAND ❑ YESPROJECT URBAN INTERFACE AREA ❑ NO TFIDOD IN ❑ YES 0NNE ❑ NO IS DIE BLDG AN ❑ YES EICiBFR HOME? ❑ NO DESCRIPTION OF WORK �r� �C, �w �)6 041el tic, >vQ� `� �f Ir` o evh a -u S tI' Gl 0 TOTAL VALUATION: Li t h-( , V C-) �RE By my signature below, I certify to each of the following: I am the property owner or auftwized agent to act on the property read tills 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 tD ion. I% thoriz eaaatives of Cupertino to enter the above -identified property for inspection purposes. signauue of Applicant/Agent: ,l ��%'. � r 1� Date: 7 'ZZ `/S OFFICE USE ONLY a ❑ EXPRESS ❑ STANDARD ❑ LARGE a ❑ MAJOK MERVLwApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 20197 HOGUE CT DATE: 07/22/2015 REVIEWED BY: MELISSA Mech. Permit Fee: IMPERMIT APN: 316 24 039 BP#: 'VALUATION: 1$4,114 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex p F0,0Thrs PENTAMATION 1 REAP USE: PME Plan Check: PERMIT TYPE: WORK REPLACE E 100 AMP SUB PANEL SAME LOCATION. INSTALL N ATTIC FAN & N EXHAUST SCOPE FAN NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District- etc.) These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) Mech. Plan Check 0.0 1 hrs $0.00 QTY/FEE Elec. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPERMIT Plan Check Fee: Elec. Permit Fee: IEPERMIT Other Mech. Insp. 0.0 hrs $48.00 cr P,'umi� �r,.,�, Other Elea Insp. 0.0 hrs L$48.00 11ech. Insp. Fec: F0,0Thrs �fup. Fez NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District- etc.) These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 100 amps $48.00 Electrical IBELEC200 Services Suppl. PC Fee: Q Reg. Q OT F0,0Thrs $0.00 PME Plan Check: $0.00 =# $50.00 Mechanical 1BREMVENF Ventilation Fan Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $96.00 Construction Tarr: Administrative Fee: IADMIN $45.00 O 0 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure O 0 i Travel Documentation Fee: ITRAYDOC $48.00 Strong Motion Fee: IBSEISMICR $0.53 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $190.53 $98.00 TOTAL FEE: 1 $288.53 Revised: 07/02/2015