14030068 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22390 HOMESTEAD RD CONTRACTOR:BIG BOY ELECTRIC PERMIT NO: 14030068
OWNER'S NAME: HAM JAYNE YEH 2932 MONTERREY DR DATE ISSUED:03/11/2014
OWNER'S PHONE: 2063181533 BATON ROUGE,LA 20814 PHONE NO:(225)505-8500
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
STARBUCKS-INSTALL 1 (N)OUTLET RECEPTACLE AT
License Class y Lic.# SALES AREA FOR FUTURE USE AND 1 (N)30AMP CIRCUIT
Contractor IN MAIN PANEL
fJ .' Date I t
I hereby affirm that I am licensed i.der the provisions of Ch pter 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:$500
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:32601027 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 DAY 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 ED 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
granting of this permit. Additionally,the applicant understands and will co Issued Date:
3/ 11
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
—i RE-ROOFS:
Signature /( Date 1 [L1` 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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 Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sccti . 505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this /
permit is issued. Owner or authorized agent: Date: Z 11
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 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
61
GENERAL PERMIT APPLICATION
o MEP
Im COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 `
CUPERTINO (408)777-3228• FAX(408)777-3333•building(a)cupertino.org M 'SC
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PLUMBING MECHANICAL LECTRICAL � MISCELLANEOUS
PROJECT ADDRESS ,ry APN# 0
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OWNER NAME.` • /� /�/� PHONE j� � E-MAIL A)
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STREET ADDRESS I fL_ �0 � /yLII _ TE,ZIP_(,I , / V/Cy • FAX
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CONTACT NAME . "�_ i t PHONE
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STREET ADDRESS f' 1r ` sc- CITY,STATE ZIP (�''/� A FAX
❑OWNER ❑ OWNER-BUILDER WNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT 1❑1\ARRC�H'ITTECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR WE Yj.QJ�F'j W i�-CA �e— LICENSE NUMBER LICENSE TYPE BUS.LIC# J l
COMPANY
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STREETADDRESS;1-;1 -----,- e CITY,STATE,ZIP e_q �� � - C� PHONEI/�7�•^'►
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ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL 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? O
DESCRIPTION OF WORK _i ,,,
'570 ^-Yyxa& s,()
TOTAL VALUATION: 0-D'
' -
By my signature below,I certify to each of the following: I am the property owner or authorized agent t ow is behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accur e. I e to comply with all applicable local
ordinances and state laws relating to it ' g cons xox I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgent: Date: _
SUPPLEMENTAL INFORMATION REQUIRED OMCE USE ONLY '
OVER-THE COUNTER'
EXPRESS
v
STANDARD
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a ❑ LARGE
a
MAJOR
MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
W*PERMIT
DDRESS: 22390 HOMESTEAD RD DATE: 03/11/2014 REVIEWED BY: MELISSA
PN: 326 01 027 BP#: EVALUATION: $500
PE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY Commercial Building PENTAMATION 10EAP10
USE: PERMIT TYPE:
WORK INSTALL 1 N OUTLET RECEPTACLE AT SALES AREA AND 1 N 30AMP CIRCUIT IN MAIN
SCOPE PANEL > Gov
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Recep/Switch/Outlets 1BREMRECEP 1 # $47
Special Circuits 1BREMMISC 1 # $139
TOTALS: $186.00
gl
m
y,r,�,,j 'i`a a( ,,cck 1'lr�nb, Pluo(�"hc<°n Elec.Plan Check 0.0 hrs $0.00
1 <:h_ I'2rttillr>c>. t'ta,n:/;.Pcrf nt I<Er: Elec.Permit Fee: 1EPERMIT
Oni.r PIumh Ira sr>. Other Elec.Insp. El hrs $47.00
f'r`Und Iiiap; Fee I
NOTE: This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelimina inormation available and are onlyan estimate. Contact the Det or addn'l info.
FEE
yy ITEMS (Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS
I
k if-in 1.heck
PME Plan Check: $0.00
Pe,,-;nit F(!,":
sul,7)/ his"')Fee
PME Unit Fee: $186.00
PME Permit Fee: $47.00
(I c?i�,rticuon e`er:;:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? 0 Yes (E) No $0.00
Advanced Fe":
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion Fee: IBSEISMICO $0.50 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
s�
S $325.50 $0.00 : TOTAL FEE: $325.50
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Revised: 01/15/2014
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