13050158 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 1148 STAFFORD DR CONTRACTOR:JOHNSTON ELECTRICAL PERMIT NO:13050158
CONTRACTOR
OWNER'S NAME: JEUNG ALBERT M AND VALERIE M T 1302 LINCOLN AVE STE 204 DATE ISSUED:05/22/2013
OWNER'S PHONE: 4084463577 SAN JOSE,CA 95125 PHONE NO:(408)266-0236
❑ LICENSED CONTRACTOR'S DECLARATION
JOBDESCRIPTION: RESIDENTIAL[] COMMERCIAL
License Class C�U Lie:.# ' � UPGRADE(E) 100 AMP PANEL TO 200 AMP PANEL,SAME
/ LOCATION
ContractorDate
I hereby affirm tha6 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:$900
I have and will.maintain Worker's Compensation Insurance,as provided for by
Section 3100 of the Labor Code,for the performance of the work for which this APN Number:36207007.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify:that have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 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 authorizerepresentatives of this city to enter
upon,the'above mentioned property for inspection;purposes. (We)agree to save 180 DAYS CALLED INSPEC ION.
indemnify and keep'harmless the City Cupertino against liabilities,judgments,
costs,and expenses which ay accrue st said City in consequence of the 7f2 3
granting of this.permit. A io y; applicant understands and will comply 0he Date:
with all.noti=point source a lat per the Cupertino Municipal Code, ection
9.18 � r
RE14— -ROOFS:
Signature Date S� 13 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,land.the structure isnot 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 B Are it Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the unicipal Code,Chapter 9.12 and
I have and will maintain Workers Compensation Insurance,as provided for by the Health&Safety Code,Section ,25533,and 25534.
Sectwn 3700 of Labor Code,for the erformagce of the work for which this Owner or authorized a en Date
P, g '
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 orthis 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 certifythat I have.read this application and state that the above information is
con ectl I agree tq comply with all cit;and county ordinances and state laws relating
to building construe tion,and hereby authotize representatives of this city to enter
upon the!above:men.boned 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.
grantmg'of this,penniii Additionally,the applicant understands and will comply
8 all cion-point sopa'a',regulations;per the Cupertino Municipal Code,Section Licensed Professional
Signature I Date
;i'
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1148.STAFFORD DR DATE: 05/22/2013 REVIEWED BY: MELISSA
APN: 362 07 007 BP#: "VALUATION: $900
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP2
USE: p PERMIT TYPE:
WORK UPGRADE E 100 AMP PANEL TO 200 AMP PANEL SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services IBELEC200 200 Amps $45
TOTALS: $45.00
MM
M
kfech.flan Check Plumb,Plan Check Elea.Plan Check 0.0phrs $0.00
:lfech. f'ernait.Fire: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT.
Other Mech.Insp. Other Plumb Insp. Other Elec.Insp. 0.0 hrs $45.00
,Rech.Insp.'Fee: Plumb. Insly,Fee: Elec.Insp.fee:
NOTE:This estimate does not include fees due to other Departments(�a Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). These ees are based on the prefindna information available and are only an estimate Contact the Det or addn7 info.
FEE ITEMS(Fee Resolution 11-053 Eff. 7/1/121 FEE QTY/FEE MISC ITEMS
Plein Check F'ee:
Sirplrl:PC E;ee
PME Plan Check: $0.00
Perrnit Fee:
Suppl. Insp Fee
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Constrztction :Teri:
Administrative Fee:, IADMIN $42.00
Work Without Permit? . ®Yes Q No $0.00
Advanced-Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00
Strom4Motion Fee: IBSEISMICR $0.50 Select an Administrative Item .
Bldg Stds Commission Fee: IBCBSC $1.00
$178.501 $0.00 z 78.561.
Revised: 04/29/2013
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A
GENERAL PERMIT APPLICATION ��
MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ��
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinaCa cupertino.ora � MISC
❑PLUMBING ❑MECHANICAL UCfECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS y TK/� APN# 36 7 6)-1- (J- mss,O
OWNERNAME PHONE E-MAIL
-Zoe—r � �v3 - yo/ —Is r
STREET ADDRESS Y(J % , ,10 CITY, STATE,ZIP FF
CONTACT NAME i PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
�Y
STREET ADDRESS CITYSTATE ZIP t PHONE
G/rt�iov , l G� 9�l�S'
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAI FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME?
DESCRIPTION OF WORK
7VI-Ae
TOTAL VALUATION:
By my signature below,I certify to eoftting: I am the property owner or authoriagent to act on the property owner's behalf. I have read this
application and the information I haorrect. 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 truction.. I authorize representatives of Cupertino to enter the ab ve-iden Ified property for inspection purposes.
Signature of Applicant/Agent: Date: a /
SUPISLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
W OVER-THE-COUNTER
❑ EXPRESS
U
STANDARD
zUz
a ❑ LARGE
a
MAJOR
MEPMiscApp_2011.doc revised 06/21/11