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11090007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20607 PARADISE DR CONTRACTOR ► PERMIT NO: 11090007 ,Q 4 OWNER'S NAME: KENNETH TAN ( DATE ISSUED:09/01/2011 OWNER'S PHONE: 408551212 �` PHONE NO: L. LICENSED CONTRACTOR'S DECLARATION r Q q BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C 1 Li,.# L J t �-I MECH RESIDENTIAL COMMERCIAL � Contractor �I'� 'Cu-, Date CA.(s I• t I hereby affirm that I am licensed under the provisions of Chapter 9 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. 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$1600 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number:35915011.00 Occupancy Type: 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 DAYS 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- int s roe regulations per the Cupertino Municipal Code,Section /- 1. 9.18. Issued by:��` � �..._- Date Signature Date sci,wt • OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, 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 Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I 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 I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I 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,I shall Health& afety 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 ora o ' a become subject to the Worker's Compensation provisions of the Labor Code,I must Date: da •a �L 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 Hork's I certify that I 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 harmless the City of Cupertino against liabilities,judgments, cow*z.and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply 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 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35915011. 00 DATE ISSUED. . . . . . . : 09/01/2011 RECEIPT #. . . . . . . . . BS000014646 REFERENCE ID # . . - : 11090007 SITE ADDRESS . . . . . : 20607 PARADISE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . KENNETH TAN ADDRESS 20607 PARADISE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : NICHOLAS G HAYDEN CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41 . 00 0. 00 41 .00 0. 00 1BCBSC VALUATION 1, 600 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 600 .00 0. 50 0. 00 0 .50 0. 00 1EPERMITFE 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20607 paradise dr. DATE: 09/01/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$1,600 RIPERMITTYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex7- PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK service upgrade to 200 amps. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $44 TOTALS: $44.00 T7TElec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT LAOther Elea Insp. 0.0 hrs $44.00 NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addh7 info. FEE ITEMS (Fee Resolution 11-053/,,1 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee_ IBSEISMICR $0.50 n Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $133.501 $0.00 TOTAL FEE: 1 $133.50 Revised: 07/0 11 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• building(c CUDertino.org MISC CUPERTINO ❑PLUMBING ❑MECHANICAL Z/ECTRICAL ❑MISCELLANEOUS PROJECT ADDRESSo G b Pia s OWNER NAME M �� PHOkTM c_ •= i L _. E � ^ art, �' _, a�¢. ken ► Q .cam► STREET ADDRESS AO^ o.')r— `� - CITY, STATE,ZIP C - FAX �f CONTACT NAME `w ^ _ PHONE�+Q ` C E-MAIL ON& Cdr STREET ADDRESS ` ` CITY,STATE, ZIP c - -� �4 FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT IKONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER `% LICENSE TYPE C� BUS.LIC# At COMPANY NAME , _ w '` E-MAIL ►-^yC, ^aC. FAX STREET ADDRESS (�` 1 l0 CITY,STATE,ZIP S� ( ^-� ^� e PHONEG SC). 1,�L Sq -- 1 .rV. ARCHTTECTIENGINEER NAME LICENSE NUMBER BUS.UC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE JSE OF or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROSECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK � TOTAL VALUATION: 6�+1 RECEIVED BY: G By my signature below,I certify to each of the f owing: I am the property owner or authorized agent to act on the progeny owner's behalf. I have read this application and the information I have provided i e . i have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to building con `I an a representatives of Cupertino to enter the above-identified property for inspection pu{poses. Signature ofApplicant/Agent: Date: C1 -01 ' !fit l SUPPLEMENTAL DA RMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER ❑ EXPRESS X U W ❑ STANDARD U ❑ LARGE ❑ MAJOR MEPMsscApp_2011.doc revised 06121111 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1-0Q a- 1E WL PERMIT# OWNER'S NAME: jw%A�61&_ i[' PHONE# GENERAL CONTRACTOR: )rUIE74zr&- BUSINESS LICENSE # 3 ADDRESS: t CITY/ZIPCODE: `'WA W- Ct a *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL O CUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL UB ONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: C3�'1 •O 1 l Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork C ment Finishing Electrical s S�t5OCaAC- %l 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 F-T-Tile Owner/(�ontjactor Signature Date