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10080180 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20886 IOLLYMAN LN CONTRACTOR:NEKO ELECTRIC PERMIT NO: 10080180 OWNER'S NAME: CHEN CHENG-LUNG AND JY-HUEY H 22430 C JPERTINO RD DATE ISSUED:08/26/2010 1ER'S PHONE: 4083486995 CUPER rINO,CA 95014 PHONE NO:(408)446-4141 ❑ LICENSED CONTRACTOR'S DECLARATION r r—�T�� .� BUILDING PERMIT INr®FO: BLDG ELECT PLUMB r License Class Lic.# 3 7 MECH RESIDENTIAL COMMERCIAL Contractor l:,e T V'-4 Date 2 - C I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:6"FLUORESCENT CAN(7QTY),KITCHEN LOCATION (commencing with Section 7000)of Division 3 of the Business&Professions ONLY 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 F oor Area: Valuation:$1050 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. tl-( APN Number:35925044.00 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, W[THIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 181) DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations.per..Zhe Cupertino Municipal Code,Section 9.18. Issued hy. Date: > , j G Signature ,Jh `�- %� Date 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: inspecticn. 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, Signatur;of Applicant: Date: Business&Professions Code) I,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. complia ice 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 Additiot sally,should I use equipment or devices which emit hazardous air contami Tants as defined by the Bay Area Air Quality Management District I will permit is issued. 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&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(r authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby Affirm that there is a constriction lending agency for the performance of work's I certify that I have read this application and state that the above information is for whicl i this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender';Name to building constriction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender';Address i,'-mnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION r,--ting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I underst ind my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPEFTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot . APN . . . . . . . . : 35925044 . 00 DATE ISSUED. . . . . . . : 08/26/2C10 RECEIPT #. . . . . . . . . : BS000011284 REFERENCE ID # . . . : 1008018C SITE ADDRESS . . . . . : 20886 JC,LLYMAN LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTIVO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHEN CHENG-LUNG AND JY-HUEY H ADDRESS . . . . . . . . . . : 20886 JC,LLYMAN LN CITY/STATE/ZIP . . . : CUPERTIVO, CA 95014-4349 RECEIVED FROM . . . . : MOTAHAREH MESBAHI CONTRACTOR . . . . . . . : ALI PAnAHAL LIC # 31642 COMPANY . . . . . . . . . . : NEKO ELECTRIC ADDRESS . . . . . . . . . . : 22430 CUPERTINO RD CITY/STATE/ZIP . . . : CUPERTIYO, CA 95014 TELEPHONE . . . . . . . . : (408) 446-4141 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------- --- ---------- ---------- ---------- 1BCBSC VALUATION 1, 050. 00 1 . 00 0. 00 1. 00 0 .00 1BREMFIXT NO. FIXTURES 1. 00 6_ .00 0. 00 63 . 00 0 .00 1BREMRECEP NO. OUTLETS 1. 00 4 . 00 0 .00 42 .00 0 .00 1EPERMITFE FLAT RATE 1. 00 4 . 00 0 .00 42 .00 0 . 00 1TRAVDOC FLAT RATE 1. 00 4 . 00 0 .00 42 . 00 0 . 00 ------- --- ---------- ---------- ---------- TOTAL PERMIT 19C . 00 0 .00 190 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---- ---------------- CREDIT CARD 190 . 00 VISI. --------------- TOTAL RECEIPT 190 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- - ------- ---------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL 512 FINAL HANDI-CAP CITY OF CUPER TINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $1,000 R*PERMITT'YPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY I'(17,t_L PENTAMATION 1 REAP 14 USE: SFD or Duplex =�t)<M.IHI'11; PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Temporary Power 1 ERT<200 1 $42 TOTALS: $42.00 � f.a> 1 purr i'Ircch Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT Other Elec.Insp. 0.0 hrs $42.00 hl /)' NIC NOTE: Theseees are based on therelimina in ormation available and are onlyan estimate. Contact the De t or addn'l info. FEE ITEMS (Fee 12esolrition 09-051 Eff 7%7%10) FEE QTY/FEE MISC ITEMS 1,1C117 Ow";A 1`E'': St1op/, PC Fcc PME Plan Check: $0.00 Per n if Fcc: stfppl. Illy Fc-" PME Unit Fee: $42.00 PME Permit Fee: $42.00 ()nO'nc[107 TUA Work Without Permit? 0 Yes G No $0.00 ( lawilfig Travel Documentation Fee: ITRA VDOC $42.00 A .Stroll -�fmojl 1�e c�: Select an Administrative Item Bldp Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.001 $0.00 TOTAL!FEE: ` $127.00 Revised: 8/17/2010 l - CITY OF CUPERTINO CITY OF CUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN # `f Date: Z C'--1 D C Building Address: �� ('M G h ��1�1.t; �` ; ,� (� _C A_ G, ) �, 2 � �'� Mailing Address (if different from building address): �• 4 Are Hazardous Materials being used as part of this project? Yes No ftwn:e:r's A: xterior work only) Yes ❑ No ❑ If es, rwride letter from HOA Phgne#: Ng _ 6a q S . N00, e: �r3 04 �, _��., n P hone: .. 8 ac S Contractor: ntractor License#:ertino Business License#: �-- . Phone: ` �(� Contact: All r�/1 K W A N A L Fax: Residential Commercial Job Description: t, —e i ca V\ � �t Lo Z4I %O V� Building Permit Info: / Bld ❑ Elect Plumb ❑ Mech ❑ g Type of Construction (Usage Class): Occupancy Type: R^,73 II/III/V-A ❑ I EI B, IV-HT,V-B [ Y- 1-A, 1-B F0 Square Footage: Valuation: Project Size: Ex ress Card ❑ Large❑ Major ❑ Green Building: Please complete relevant portion of the Green B- ' ding/L EED Checklist& attach it to the application or if applicable, include in plan set & the sheet index. 'oints Achieved: For help, contact Build it Green at www.builditgreen.orrF, Revised 07/14/09 CITY OF CUP ERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: 0'1APN: BP#: 'VALUATION: 1$1,400 *PERMIT TYPE: Electrical Permit PLAN CHE CK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex / / / PENTAMATION 1 REAP11 USE: 1 L(lilh' I i;h.: t: PERMIT TYPE: WORK SCOPE I APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Fixtures, Lighting 1BREMFIXT 1 $63 Recep/Switch/Outlets 1 BREMRECEP 1 $42 TOTALS: : $105.00 . e��n^^r RAY. }, k k' fin..`p k~' :r 3 r a �, 'p u d✓"r"i k. �"# p q y�r' b�i, x )'�Gf Q '� sr"k F. J, P1nu Chc a 1, Elec.Plan Check 0.0 hrs $0.00. 11,"r1b P...-r,nir!,>< /,'r;,,,/ P'.")w�r 1"A'. Elec.Permit Fee: IEPERMIT O,hr-, t/;.;�,. /„+y, Olhcv 1'1,.;�,,r,/,,;�, Other Elea Insp. EHI hrs $42.00 h 1n,1: 1'+•c' Plumb. 1,i.rP. 1,70(.In.t/, /;cc NOTE: These fees are based on the preliminaly information available and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS(Fee Resolution 09-051 Ej '%1 10) FEE QTY/FEE MISC ITEMS ['/,J! l?c'ck I-t, s1/pp[ PC. 1'cL. PME Plan Check: $0.00 Pcr,rw Fc c: SI(ppl Ino , f-C” PME Unit Fee: $105.00 PME Permit Fee: $42.00 C Ull,�l,7ii'tlClti 1�(}.0 sir utt�Irerr/Rc'i ic'r,: Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRAVDOC $42.00 Strr,?fti t1olic„l FCc.. Select an Administrative Item Bldp,Stds Commission Fee: IBCBS'1C $1.00 ;?, ry 11 M usdfx r}4`x* TAL►7r" .a n $190.00 0.00 $190.00 $ A'I' � . Revised: 8/17/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 CONTRACTOR/SUBCONTRACTOR LIST Fax: 408-777-3333 JOB ADDRESS: ZC 8$ - p l L t-¢N L&Vg -e- -Z`--j7BUSINESS ERMIT# OWNER'S NAME: i 1(/I/A -1 A HONE# qO - l GENERAL CONTRACTOR: /IIeQ - ;W&�— LICENSE # ADDRESS:22 y3 Lu �,( ��xP -il - ITY/ZIPCODE: Z ct i 'Y►� pl L� *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 NTRACTO RS OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors,-.--- ubcontractors - 2�- G Signature Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing 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 OwneTT-Ebntract ignature Date