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11080116CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 22435 SANTA PAULA AVE I CONTRACTOR: SUM'S CONSTRUCTION I PERMIT NO: 11080116 I OWNER'S NAME: CHENG CHRISTOPHER 115791 WINCHESTER BLVD I DATE ISSUED: 08/15/2011 1 " 'NER'S PHONE: 4084586014 L LICENSED CONTRACTOR'S DECLARATION f License Class__ Lic. # ? / .0 -,(- 3 3 Contractor Nk i I Sww Date (,5- Ilt I hereby affirm that I am licensed under the provisions 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. 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 permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatur Date S t` OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 Section 3700 of the Labor Code, for the performance of the work for which this 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the ng of this permit. Additionally, the applicant understands and will comply wtin all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date MONTE SERENO, CA 95030 1 PHONE NO: (408)202-6501 BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB f— MECH RESIDENTIAL F COMMERCIAL f— JOB DESCRIPTION: UPGRADE SUBPANEL TO 100AMP **SEE NOTES** Sq. Ft Floor Area: I Valuation: $900 APN Number: 35704053.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS F M LAST CALLED INSPECTION. p Issued bv: � i !r } Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner authorized age t: Date•_( CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of "ark's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professi CUPERTINO GENERAL PERMIT APPLICATION - COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinQ(Jr.cuoerino.ora lio$ 01 (('0 PLUMBING 'IEC_ -TAMC? r �. ❑ ❑- I��L..CTRICAI. ❑14fISCELLANEOUS PROJECT ADDRESS 2 2 A. l G l' �� l I A?N m � Gj OWNER NAME C 1lY t S C r\ C h PHONE Ar7 $ f G6! E -M III l STREET ADDRESS [ CITY, STATE, ZIP FAX CONTACT NAME 1' +/ o I U,� �} PHONE(/1 �� ] '2,,3 Z -- 5z' I E-MAIL STREET ADDRESS CE; CITY, STATE, ZIP & � Gq., k.(,M ,Q�J (� FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT �ONTRACI'OR ❑CONTRACTORAGENT ❑ ARC=CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME `(j ( C v"^ LICENSE NUMBER D I D A� p 0 ja <f 7 LICENSE TYPE Z3 BUS. LIC # CONOA.NYNAME �U i�1 rj rjll�� SiC�u C..E-MAIL S U +-• CO w c�t� r �. L �cbY� C,. ' Gj /�,A.' ci -i FAX STREET ADDRESSrn r ty ��,.✓ CITY, STATE, =P a S S o ARCHTI'ECTIENGINEER NAMEI LI NUMBER BUS. LIC # COMPANY NAME ' j E-MAIL AX STREET ADDRESS CITY, STATE, ZIP PHONE ,SE OF ❑ SFD or DUPLEX ❑ MULTI-FAIMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK '� )) D I— V` r ✓A � � b b /rf,r� '2-42 C-1 ✓ � C mit SV' �'/ R f-7 TOTAL VALUATION: (�� 1 RECEIVED BY: By my signature below, I certify to each of the (following: I am the property owner or authorized agent to act on the property owner's behalf. I have read 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 buil Q c "astruction' I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: �/� Date: SUPPLEl NTAL INFOR TION REQUIRED _ =CF USE ONLY w IS OVER-THE-COUNTER ❑ EXPRESS U W u ❑ STANDARD ❑ LARGE ❑ MAJOR 1,EPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35704053.00 DATE ISSUED.......: 08/15/2011 RECEIPT #.........: BS000014445 REFERENCE ID # ...: 11080116 SITE ADDRESS .....: 22435 SANTA PAULA AVE SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: CHENG CHRISTOPHER ADDRESS ..........: 22435 SANTA PAULA AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: YAT L SUN CONTRACTOR .......: YAT LEUNG SUM LIC # 25867 COMPANY ..........: SUM'S CONSTRUCTION ADDRESS ..........: 15791 WINCHESTER BLVD CITY/STATE/ZIP ...: MONTE SERENO, CA 95030 TELEPHONE ........: (408)202-6501 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 900.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 900.00 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 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 174.50 --------------- 174.50 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL CITY OF CUPERTINO wF%72 FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 22435 santa -paula dr. QTY/FEE DATE: REVIEWED BY: bob s. BP FEES APN: BP#: 'VALUATION: $900 'PERMIT TYPE: Electrical Permit 100 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 REAP2 PERMIT TYPE: wORK upgrade sub panel to 100 amp. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Services 1 ERT<200 100 Amps $44 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes E) No $0.00 TOTALS: Travel Documentation Fee: IIRA VDOC $44.00T- j Elec. Plan Check0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 0.0 1 hrs 1 $44.00 NOTE: These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Iff ' 1.-11) 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: IIRA VDOC $44.00 Stronjz Motion Fee: IBSEISMICR $0.50 =hrs Admin./Clerical Fee $41.00 ]ADMIN Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $133.50 $41.00 TOTAL FEE: $174.50 Revised: 07/04/2011