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11120077 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6351 BOLLINGER RD CONTRACTOR:BJ ELECTRIC INC PERMIT NO: 11120077 OWNER'S NAME: KOO KWOK K AND MA SHEUNG T 985 SPENCER AVE DATE ISSUED: 12/13/2011 O ER'S PHONE: 4082539679 SAN JOSE,CA 95125 PRONE NO:(408)971-6E49 Pr LICENSED CONTRACTOR'S DECLARATION r r BUILDING PERMIT INFO: BLDG ELECT PLUMB' License Class Lic.q , MECH r RESIDENTIAL r COMMERCIAL Contractor Date 2' j_ 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 I JOB DESCRIPTION:SERVICE UPGRADE TO 200AMPS (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$750 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36919003.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAVS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature Date-4-q i OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is hereby affirm that I am exempt from the Contractor's License Law for one or installed without first obtaining an inspection,1 agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Cade). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,l shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or author' nt: r J r ' become subject to the Worker's Compensation provisions of the Labor Code,I must Date: I forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harnless the City of Cupertino against liabilities,judgments, cand expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION t g of this permit.Additionally,the applicant understands and will comply wi all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date • CITY OF CUPERTINO 6 ITEMS OF 19 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36919003.00 DATE ISSUED. . . . . . . : 12/13/2011 RECEIPT #. . . . . . . . . : BS000015555 REFERENCE ID # . . . : 11120077 SITE ADDRESS . . . . . : 6351 BOLLINGER RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KOO KWOK K AND MA SHEUNG T ADDRESS . . . . . . . . . . : 1095 MILKY WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : BRIAN CHENG CONTRACTOR . . . . . . . : BRIAN CHENG LIC # 26995 COMPANY . . . . . . . . . . : BJ ELECTRIC INC ADDRESS . . . . . . . . . . : 985 SPENCER AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 971-6849 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL ---------- ------------- ---------- ---------- --------- ---------- ---------- -ADMIN HOURS 1. 00 41.00 0.00 41 .00 0.00 1BCBSC VALUATION 750.00 1.00 0.00 1.00 0 .00 1BSEISMICR VALUATION 750. 00 0.50 0.00 0.50 0.00 IEPERMITFE FLAT RATE 1.00 44 .00 0.00 44 .00 0. 00 1ERT<200 UNITS 1.00 44 . 00 0.00 44 . 00 0. 00 1TRAVDOC FLAT RATE 1.00 44 . 00 0.00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 174 .50 0.00 174 .50 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL • l I � a ��-1 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 • CUPERTINO (408)777.3228•FAX(408)777-3333•building(E cuoertino.oro M I S PLUMBING MECHANICAL JKELECMCAL MISCELLANEOUS PROJECT ADDRESS /� .� OuINGj O �M — 005 OWNER NAME &ok le b kon PHONE(? E-MAIL STREETADDRESSI. ( J ` CITY, STATE,ZIP /� (� FAX CONTACT NAME -JA-ST S / _ n /VI G ,- /I,.Lv PHO E-MAIL STREETADDRESS OJ '/�IJW V-) CITY,STATE, zip ; FAX c L q r l� ❑OWNER ❑ OwNER.BUDDER ❑ OWNER AGSM' A CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHtTRCT ❑ENGINEER ❑ DEVEIDPER ❑TENANT CONFRACTORNAME I'�(/� I �lt/�� UCENSE NUMBER /(��1 / /nSLICENSEE TYPE BUS.LIC SN/ q� / ((,[D'/(� COMPANY NAME rA /I / V ( q E-�L SC/YR V��'(J' I'J _L�(I C'�- FAX f `EIdO/ l�J�/101 JB®T STREET ADDRESS ✓ ('`�liV""f^ `j/ CITY.STATE,21P �// �,l( /A /1 PHONE q„7 gflcs> ^ ARCHR'EC(ENGINEER NAMED Wi'- l' LJCENSE NUMBER } V I't l , , d-' BUS.UC N Ud / T 6 T COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE,ZD' PHONE SE OF ❑SM.DUPLFX ❑ MULTI-FAMMY PROJECT IN WDDIAND EJ YES PRo=IN [3 YES TSTHEBLDGAN ❑YES BUDING:D ❑COMMERCW- URBAN INTERFACE AREA //)) ❑ NO FLOOD ZONE EI NO MCHLER HOME? El NO DESCRIPTION OF WORK C elm O oOAwk 1,76 TOTAL VALUATION: 7�0- lJG RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorind agent to act on the property owner's behalf. I have toad this application and the information I have provided is correct. {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 building cons n. I authorize representatives of Cupertino to enter the above-id 'Se{d� perry for inspection puP�oses. Signature ofApplicanNAgenC Date: P- (f SUPPLEMENTAL INFO TION REQUIRED OFFIICE USE ONLY N OL7- VER-THC-COUNTER 6 ❑ EXPRESS Y U w ❑ STANDARD U U ❑ LARGE 6 ❑ MAJOR Afl-7PMvcApp 2011.doc revised 06/11/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • ADDRESS: 6351 bollinger rd. DATE: 12/13/2011 REVIEWED BY: bob s. APN: BP#: -VALUATION: $750 "PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP2 USE: PERMIT TYPE: WORK service upgrade to 200 amps. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 100 Amps $44 TOTALS: $44.00 Heck Aran Check Plumb. Plan Check Elec. Plan Check 1 0.0 1 hrs $0.00 item. I'Lrmq Hire: Plunih. Peoaut Fee: Elec.Permit Fee: IEPERMIT • 0ho ;t9rdr.kap. Othe, Pi:anh lu p. Other Elec. Insp. 0.0 hrs $44.00 d.lrh.Ince. !•'e:.' Plumb' bxsp.l''re: (ilea Invp. Fee NOTE: This estimate does not Include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the Prelindna Information available and are only an estimate. Contact the Dept for adda7Info. FEE ITEMS(Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check, Focc .Sleppl. PC.Fee PME Plan Check: $0.00 pern it Fre: Suppl. Insp Pea PME Unit Fee: $44.00 PME Permit Fee: $44.00 t"onstruction Tox: Administrative Fee: IADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 Advanced Planning Feaa: Travel Documentation Fee: ITRA VDOC $44.00 Shona Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE- $174.50 Revised: 12/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 SU P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'SNAME: PHONE# F 3 �d GENERAL CONTRACTOR: tL7,(,I f4 ti n/C� BUSINESS LICENSE# -7C1 ADDRESS: S" L'L Mvt— CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRA TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ! " Signa ure Date Please check applicable subcontractors and complete the following information: t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing V Electrical Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Co tractor nature bate