13050039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10104 IMPERIAL AVE CONTRACTOR:MAINE ELECTRIC INC PERMIT NO:13050039
OWNER'S NAME: JIANJUN ZHANG&ZUO HUN MANG 599 LEISURE ST DATE ISSUED:05/06/2013
OWNER'S PHONE: 4084899932 LIVERMORE,CA 94551 PHONE NO:(925)443-3377
❑ ► LICENSED CONTRACTOR'S DECLARATIONr
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Li..#
�� jb�[13
MECH r, RESIDENTIAL r— COMMERCIAL�
ContrAtor �iZ Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 125 AMPS SUB PANEL&SUB FEED WIRE
(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 followingfiv"clarations:
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. Sq.Ft Floor Area: Valuation:$0
I have and will maintain Worker's Compensation Insurance,as.Rt9xidtddor by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. a-- APN Number:35722007.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequent;e,of the
granting of this permit. Additionally,the applicant understands and will comply /
with all non-point source regulations per the Cupertino Municipal`Co de;Section Issued by' Date'�l� 1,r39.18. T
Signature o Date 66"6K! fi
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION " '"" 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
I hereby affirm that I am exempt from the Contractor's License-Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,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: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,•forthe 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
Health&Safety Code,Sections 25505,25533,and 25534.
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 Ownerpr authorized a n : 5 6 L3
Compensation laws of California. If,after making this certificate of exemption,I V 2 Date:
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
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 Lender's Address
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 ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,.Section
9.18. Licensed Professional
Signature Date
GENERAL PERMIT APPLICATION
MER .-
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
! 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a)cupertino.org misc
CUPIE=RT,INO
500
PLUMBING.' : ❑MECHANICAL IMELECTRICAL ❑lMIISCELLANEOUS
PROJECT ADDRESS i A Bt L' V r APN#
OWNER NAME .14
'4 � ��1"Cry' I PH�2/7ONE .MAIL
STREE ADD S C STATE ZIP FAX
CONTACT NAME!i11 PHONE EMAIL
S fREET ADDRESS CITY,STATE,ZIP FAX
CTOR
❑OWNER QWNER-BUILDER- ❑OWNER AGENT TRA
N ❑CONTRACTOR AGENT ❑ ARCHITECT 11 ENGIN ❑
EER ❑ DEVELOPER TE/NANT
NAME OZO BUS.LIC#CONTRACTOR P
COMPANY NAME E-MAIL FAX
STREET ADDRESS, CITY,STATE,ZIP PHO
• X 15 R :ST b of Cir 99/5,5 . yZSi '
ARCHI I ECT/kNGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME I I EMAIL FAX
STREET ADDRESS 1 CITY,STATE,ZIP PHONE
DUPLEXm, 01 MULTI-FAMII.Y PROJECT IN WILDLAND ❑ YES F701ECrJN
❑YES IS THE BLDG AN ❑.YES
BUIIDING .! ❑COM MEkCIAL ': URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? [3 No
DE'SCRIMONAPIYORI�'! �[}-
125 S� /L(GL AtJ-1) Su / EEZ W/Pt- b -
ii
� !
TOTAL Al
BY Im slgnatuia,below,I certify..each of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this
applrcahon and the ifi$' tion I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to complyiwith all applicable locat
ordrrtances and'siate laws felatinglto building construction- I authorizerepresentatives of Cupertino to enter the above-I entifi d property for inspection purposes..:,
Signature ofApihbant/Agent.. 1 I i ' Date: �V
' I i{SUPPLEME AL INFORMATION REQUIRED
-
I1' 1
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
x' ADDRESS: 10104 imperial ave. DATE: 05/06/2013 REVIEWED BY: bobs.
APN: BP#: 13 O 500 `VALUATION: 1$3,394
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION 1 REAP2
USE: p PERMIT TYPE:
WORK re lace sub panel.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services IBELEC200 100 Amps $45
TOTALS: LL $45.00
ME �:
Xlech. Plan Check Phimb,Plan Cheek Elec.Plan Check 0.0 hrs $0.00
vleclt.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee: 1EPERMIT
F
Afech.Insy). Other Plumb Insp. Other Elec.Insp. 0.0 hrs Insp. Fee: Plumb. Insp.Fee:: Iaec.Insp,Fere:
NOTE:This estimate does not include fees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onlyan estimate Contact the Dept or addn'l'in o.
FEE ITEMS (Fee Resolution 11-053 E . 7Tf 11112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Perinit f'ee:
Supp/. Ins( Fee._
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes (F) No $0.00
�tdv�atzcecl/'Icrnrzing I�'ees:
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$178.50 $0.00 - $178.50
Revised: 04/29/2013