15080146CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22276 S DE ANZA CIR
CONTRACTOR: STEPHEN KING
PERMIT NO: 15080146
ELECTRICAL INSTAL
OWNER'S NAME: YAN DAVID S TRUSTEE
208 STANFORD AVE
DATE ISSUED: 08/19/2015
OWNER'S PHONE: 6509961863
MENLO PARK, CA 94025
PHONE NO: (650)387-6183
RL LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL EJ COMMERCIAL ❑
e- —1 V 3Z� 3
REMOVE AND REPLACE (E) 125 AMP PANEL
License Class Lic. #
Contractor 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: $1800
performance of the work for which this permit is issued.
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: 35602018.00
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
WIT�IIN 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 LAST CALLED IN SPE TI N.
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:
with all non -point source regulati ns per the Cupertino Municipal Code, Section
9.18.
1 {
I
RE -ROOFS:
,rj,�
Signature Date ((// I•
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. 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(x) 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, 25533, a rd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
p
11 „ 2e
Owner or authorized agent: i0� �.l 0 C Date: �1/ J
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, 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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 15060)L{-6
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d)Cuoertino.org
U PLUlvmN-G L MECHANICAL C=CAL ❑ bESCELLANEOUS
PROTECT ADDRESS 2— S. ,\ e A . _ Z cr APN', �� C "13,
OWNERNAME '\ n , ` n Phi t O LO - / ^/ E-IJAIL
STREET.ADDRESS � 4 (� �� ��/�(� 1 A CITY, STATE, ZIP/'/�.l^ P j� CA 6�FAX
(-,fvj' (� 1 j- l.i(X�.�/
CONTACT NAME PHONE E-VL4.
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STREET.ADJ ES$�V �'�.L-o.��vp F ✓LJ �c�P �i+�/�Z 1. �
❑ 01Vt7.R� ((❑��OW1: `R -BUILDER ❑ 01WNFERAGEN'T ❑ CON"FRACTOR CONTRACTOR AGENT ❑ ARCFSECT ❑ ENGINEER ❑ DEVELOPER ❑ TE?;F.TFT
CONTRACTOR N?AI,!5 ' /- ( LICE u �Eii�� LICENSEz 5 I O BUS. LIC r
COMP.ANYNAME J �+•(,W E-M3AIL[/ T� (- l
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iso g5a---Ae_ !r-4LbO
STREET ADD ( 3 C/YbJ,�ZP/^s r S
/
.A.RCHITECT/ENGNTER NAME LICENSE NUMBER I BUS. LIC::
COMPANY NAI✓M
E-MAIL
FAY,
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD .,DUPLEX ❑ MULTI-F02,fILY
PROJECT IN WILDLAN'D
❑YES
PROTECT IN ❑ YES
IS THE BLDG .AN ❑ YES
BL=L'\''G: ❑ COI` MERCIA.L
URBAN P,=FACE AREA
❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
L-2� DC
4C4 W l
TOTFLVALUATION: RECEIVED BI
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the p perty owner's behalf. I have read this
application and the information I have provided is correc 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 to ding constru on. I j_uthorize representatives of Cupertino to enter the above -identified
-�property�r inspection purposes.
Signature of Applicant/Agent: _ _ Date: ///�+�/, I / tir 7/D 1-5
SUPPLEMENTAL rNFORIvIATION REQUIRED
MEPMiscApp_2011.dOC revised 06/21/11
�CITY OF CUPERTINO
M
lil FEE ESTIMATOR - BUILDING DIVISION 150F)0146-
191
ADDRESS: 22276 S De Anza Cir
DATE: 08/19/2015
REVIEWED BY: PAUL
UNITS
APN: 356 02 018
BP#:
"VALUATION:
1$1,800
°PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
$48
PENTAMATION
PERMIT TYPE: 1 REAP
WORK
Remove and Replace E 125 Amp Panel
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
Phtmb. Plan (-'heck
QTY
UNITS
BP FEES
Elec. Permit Fee: ]EPERMIT
Services
1ERT<200
her Elec. Insp. 0.0 hrs $48.00
125
Amps
$48
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
(:"anslrueiion Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (D No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc.. These ees are based on the prellmina information available and are onlv an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131
;♦tech. Plan (.'heck.
Phtmb. Plan (-'heck
Elec. Plan Check 0.0 1 hrs $0.00
A1ech. Permit Fire:
PhImh, Permit Fee:
Elec. Permit Fee: ]EPERMIT
Other iWech. Insp.
Other Phanb Insp.LJ
her Elec. Insp. 0.0 hrs $48.00
Afech. Insp. Fee:
Phrmb. Insp. Fee.
L±1
c. Insp. 1"C'
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District etc.. These ees are based on the prellmina information available and are onlv an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131
FEE
QTY/FEE
MISC ITEMS
Plan Check .Fee:
Suppl. P(:' Fee
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
(:"anslrueiion Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes (D No
$0.00
.-ldvanc•ed .Planning Fees:
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$190.50
$0.00 TOTAL FEE:
$190.50
Revised: 07/02/2015
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
C U P ERTI N O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 7773333 • buildina(ocuoertino.org
Z�y 4� P rr
Address ofAarms Smoke: r,
vb6)
e:
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no in, access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon.
Monoxide Alarms be installed in the following locations:
AREA I
SMOKE ALARM
CO ALARM,
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
I X
X
On every level of a d-veDina unit including basements
X
X
Within each sleeping room
I X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to compiv vvith the terms and conditions of this statement
O r (or 0%)1yer Agent's) Name:
ltl I
signature .....: ........ .................. Date .
Co" ractor Na e:
�/�f
I S .................. ...,.C.........�.... Date:f/..�.l...
Smoke and GO jorm.doc revised 0318/14