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10040020 --------� 7 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:ELBERT CHEN PERMIT NO: 10040020 BUILDING ADDRESS: 10385 MENHART LN DATE ISSUED:04/05/2010 10385 MENHART LN OWNER'S NAME: ELBERT CHEN PHONE NO: CUPERTINO,CA 95014 VER'S PHONE: 4082563779 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL Contractor Date JOB DESCRIPTION:ELECT PANEL UPGRADE,SERVICE UPGRADE 240VOLT I hereby affirm that I am licensed under the provisions of Chapter 9 100AMP EXTERIOR BOX (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. Valuation:$1500 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Section 3700 of the Labor Code,for the performance of the work for which this Occupancy Type: permit is issued. APN Number:37515047.00 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 PENT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of(We) city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE. OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAY OM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply < r/d with all non-point source regulations per the Cupertino Municipal Code,Section J Date: Issued by: 9.18. Signature Date__— .RE-ROOFS- 1T11 DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is e all new materials for 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 remov the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: ad the hazardous 5 of the I have and will maintain a Certificate of Consent to self-insure for Worker's IhaverCalifornia Health&Safety Code,Sections 25505525533,and 25534.Chapter 9I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants 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 k for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the wor not employ any person in any manner so as to become subject to the Worker's r v Compensation laws of California. If,after making this certificate of exemption,I Own r thd agent: Date: become subject to the Worker's Compensation provisionsof the Labor Code ,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION ove information is I hereby affirm that there is a construction lending agency for the performance of work's he ab for which this permit is issued(Sec.3097,Civ C I certify that I have read this application and state that t .) lating Lender's Name correct.I agree to comply with all city and county ordinances and state laws re to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save lnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 I understand my plans shall be used as public records. 9.18. .-'-> ate Licensed Professional Signature "-" 'r �� CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 5 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37515047 . 00 DATE ISSUED. . . . . . . 04/0002000 RECEIPT #• • " ' . 10040020 94 REFERENCE ID # • • SITE ADDRESS 10385 MENHART LN SUBDIVISION • • • . . CUPERTINO CITY . . . . . . . . . . . IMPACT AREA . . . . . . OWNER ELBERT CHEN ADDRESS 10385 MENHART IN CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM ELBERT CHEN CONTRACTOR LIC # *OWNER* COMPANY ELBERT CHEN ADDRESS 10385 MENHART LN CITY/STATE/ZIP CUPERTINO, CA 95014 TELEPHONE . . . . . . . . UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL FEE ID ---------- --- --- -------- ---- 0 .00 0 . 00 --- -----TION---- --------0 1. 00 0 .00 1 . 00 1BCBSC VALUATION 1, 500 .00 0 .00 0 . 50 0 . 00 1, 500 .0 42 . 00 0 0 .50 0 . 00 1BSEISMICR VALUATION 0 .00 42 . 00 1EPERMITFE FLAT RATE 1.00 0 .00 42 . 00 0 . 00 1ERT<200 UNITS 0 .00 1 .00 42 . 00 1 . 00 42 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE _ -- ---------- -------- 0 . 00 127. 50 -----0 . 00 127 . 50 TOTAL PERMIT : AMOUNT --REFERENCE_NUMBER METHOD OF PAYMENT -------- ------ -------------- 127 .50 MC CREDIT CARD TOTAL RECEIPT 127 . 50 cb t`ti ¢`q CITY OF CUPERTINO CUPEY OF GENERAL BUILDING PERMIT APPLICATION FORM Date: 5 I .Z 01� Building Address: 3 V C U I Mailing Address (if different from building address): Are Hazardous Materials being used as part of this projectletter ? Yes No HOA: Exterior work only) Yes ❑ No If es, roviP one# from HOA Owner's Name: C kI e Phone: Contractor: Fax: C7 W�'V Contractor License#: Cu ertino Business License#: phone: Contact: Fax: Residential Commercial Job Description: Zkkv V (DU Building Permit Info: Elect Plumb ❑ Mech ❑ Bldg ❑ Occupancy Type: Type of Construction(Usage Class): II/III B, IV-HT,V-B r t L 1-A, 1-B ❑ IUIII/V-A ❑ Square Footage: Valuation: Major Project Size: Express ❑ Standard E] Large E] J ElJ Green Building: L- a levant portion of the Green Buildi�&he sheet indeEED x. & attach it Gre or if applicable, include m plan sePoints AcFor hel , www.buildit reen.or Revised 07/14/09 CITY OF CUPERTINO OF GENERAL BUILDING APPLICATION CITYCUPERTINO FEE SCHEDULE Fee Description Fee Permit Type Quantity/Sf Fee ID Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco a plication 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1WINMEWSTR New Window-structural shear B wall/maso (includes lan ck fee) 1 EPERMITFEE Electrical Permit Fee E l 1MPERMITFEE Mechanical Permit Fee M Plumbing 1 PPERMITFEE g Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no EMP) B when not over counter) hourly-stand alone Cal Bldg Standards Commission Fee B ALL PERMIT / 1BCBSC TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B / 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B I �� 2 5of5 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child)will perform: A. All the work authorized by this permit B. — A portion of the work C. _ None of the work If B or C is checked,com lete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B — A portion of the work (complete section below) Contractor Address/City Phone # State License # Type work to beperformed 3 — I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Address/City Phone Number Type of work to be PersorVFirm erformed ............................................................... I declare under penalty of perjury that the above is true and correct: 1 have read and understand the Owner-Builder Information(reverse side). Date: Property Owner's Signature: Permit# Job Address: U3 s l�2�vi Imo►. Ute�.�t,�n v_ An chan es to the information Provided on this form shall be submitted to the Ci of Cu ertino Build Department. Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: C 0�, � Mv4" �.� �o PERMIT# OWNER'S NAME: ��1oav1— C.hr,in COTTOPHONE# BUSINESS LICENSE# GENERAL CONTRACTOR! R: ADDRESS: 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)HAVE OBTAINED A ] HCITY OF CUPERTINO UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTOR BUSINESS LICENSE. i S 7-0 I b I am not using any subcontractors: 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 Date Owner/Contractor Signature