12010005 CITY'OF CUPERTIN.O BUILDING:PEIZMlY ,
'BUILDING',ADDRESSs 11691,TIMBER SP.RING,'1CT CONTRACTOR':MR'ELECTRIC PERMIT N0: 12010005
OWNER S NAME;'SWEE LN2218 OLD'MIDDLEFIEL_D WAY DATE ISSUED:01[03/20.12
OWNER'S,PHONE: 408373438$ MOUNTAIN`VIEW,CA.95014, PHONE NO:(408).725 8380
❑ LICENSED CONTRAGTOR•S°DECLARATION BUILDING PERMITINFO: BLDG ELECT PLUMB ly€
License Class L.-10 ,Lic.# �t3776'7 l �-
MECIf RESIDENTIAL ""'" COMMERCIAL ,
•Contractoralo`r�rcv. •t/�cr�`cc.i Date; 1 3 iZ
y eosed under,th'e;provrsion-s.of,Chapt'er9 GARAG>,:LOCAL
JOB DESCRWTION;,INSTALL.ELECTRICALVEHICAL CHARGING'STATION AT
1 hereb affrmthat l-am lie
(commencing with Section 7000)ouijivision-3 of6the,Business,&_Piebfessioos
Codiiand:that my license is;inrfuli'force,and,cffect.
.1 hereby`airiirm underpenalty,of,peij:ar'y one.of the,following iwo;declarations:
Yhaye,and will maintain a Certificaie:of consent to self-,insure for Worker's
Compensation;',,as provided for by Secti&0700 oftlie Labor-Code,,for!ihe
performanceofthe:work for'which this pennifis issued.
I havb4hd will,maintain Workers Compensation Insurance;,as'provided;6r'by Sq:EGFloor>Area:. Viiluation:'$1200
;Section 37,00%of the Labor Code,for the peiformance of the work,forwhichdhis
peririitdisissued. -
APN,Number:;36654086100 Occupancy Type:
AT
PLICANT'CERTIFICATION
certify that`Chavelread this applieation anddstate:that the above inforination:is
correct.;I agree"to;comply wAh!aWcity and county ordinances(and state liws;relating,
to,building construction and hereby autfionze;representatives of this,city,to enter PERMIT,EXPIRES IF'WORK IS NOT STARTED
.i
mdemn
indemnify and keep harmless he Cifoof'Cu etrtino aramst90i1hiesgr ud�menu; wIT IN�ig� I)E�YS Q�' PERMIT ISSUANCE OR
u
y tl' p g J g_
costs and,expense"s which may accrue against said City m.consequence,of the
grantmgofthis'permit:, Additionally,,the apphcant,undersfandsand'will'comply 1.180,DAYS-FROM LAST CALLED INSPECTION.
wIith all;non-poini,source.'regulahonssper the Cupertino Nfunicipal Code,Section
9.18 Issued b Phte: �r
,Signature Date I 3
0 _ `OWNEWBIIIL`DER DECLARATION, RE'=ROOFS:'.
All roofsyshall be insp&ted'priorto any roofing material beirg,installed..lf"a roofis
Therebyza(firm ttiaul am,exemptifr"om.ttie Contractor's L'icenstLaw for one of ]nstalle `d;without.first;obtaining`an:inspectiop;lagree fo�rernove.all new materi'als;for
`the following two reasons: inspection. -
1,as owner ofithe;property,ormy employees with wages•astheir sola"compensation,
.will do'theework,and;the,structure is nota-inteniied'or'offered.for'sale(Sec_7044, Signature of Applicant; Date:
Business:&Professions Code)
1,as owner of the property;am;exclusively contracting with"licensedcontractors to
construct°:the project,(5&c 7044,Business&Professions;Code). PALL_Ff06V,'(,:OV ERINGS TO BE CLASS"A"OWBETTER,
I hereby affirm under penaltyof perjury,one of-the followinWthree
declarations: HAZARDOUS MATERIALS DISCLOSURE.
_ 9 _
Ifiave and will maintain a•Certificate ofConsenEto self=insure,�for Workers 1 have read'the hazardous,materrals�re mrements under'Ch"apter, 6.95 of t-he
Compensation,�as prodide'd;fo-r by Section;3700 of tFie,Labor-Code;,forthe: California,Health&Safety.Codei Section's 25505,25533,�and,35534. I will maintain '
performancetof the.work-forwhich"this permit is',issued. complrancewith'the;Cupertin6,M1unicipal Code;Chapter 9.12 and the:Health
Safe Code,Section 25532 a s
lhave and will maintain Worker s Compensation Insurance,as provided for by ty O; houl_d,l store or handle hazardous,material.
Section 37,00 of the Labor Code,for the performance of,the work,for-which:this Additionally;should I use equipmeot.ordevices which emit hazardous.air
— contaminants as defined tiy""the Bay,Area,Air QualityManagement DrstrVit , ill
1 certify that=in the perform- ofalie;work,forw_hrchthrs. ermi[ers maintain compliance with the,Cuperiino Municipal.Cocle„Chapter 9.11and the
P issuedI shall it
erimt is issue
„ .Pf _ P Health&`Safe dCode Secii6ps,,25505 25533,v nd'2504.
;not employany,personi,n any manner,so4s,to,.becorrie�subject t6theVorke-Cs
Compensation Iaws'of California If,after making this certificate ofezemption,.1 Ow r or�h-rize- akent:
'becomesubject to the WorkeC Compensation provisions;ofthe Labor Code,I,must ,Dater .� I.Z
forthwith co-mply.With such provisions:or this permit shall be deemed revoked.
CONSTRUCTION LENDINGAGENCY
APPLICANT.CERTIFICATION thereby,;ai irm;thaf ihere,is a construction lending agency forthe performance Hork's
Pcertify`that'1 have read this application and statc,ihatthe above information is for which j its permit is-;issued(Sec.309.7;Civ C.)
correeLl agree to�comply with all city;and countyordinances,and state laws relating, 'Lender's Name
to building�construetidn,and'h''erebyaauihorize.representatives ofthis•c'ity to enter
upon the.above-mentioned`Property forinspection,..purposes'._(We) s A
agree to'save Lender' ddress
indemnify,and keep.harinless;the Ci,ty:of'Cupertino against liab'ilities,�judgments,
costs and expenses which may,accrue agamst said City,inconsequence of fhe ARCHITECT'S''DECLARATION
grandri&f this permit:Additionally the,applicant.understands,and;vAII comply
with all non-point source regulations perthe Cupertino Municipal Code_ ,Section• I understand,my plans shall,be'used as'public•records;
9'.1.8.
Lice osed'P.r6&ssionaI
aSignature °Date
n
:CITY-OP CLTPERTINO.
FEE ESTIMATOR-:BUILDING DIVISION
ADDRESS: 1169:1'timberspring`ct. DATE- 01/03/2012 REVIEWED BY: bob:s.
APN: BP#: 5 "VALUATION: $1,200
rPERM1T TYPE: Building Permit PLAN CHECK',TYPE: Alteration /Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: SOLAR-RES
WORK installe,.v. charging station at garage local.
SCOPE
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NOTE: This estimate does not.include fees due to,other'Departmeiits(be.Planning,Public Works,Fire,Sanitary.Sewer District,School
District;etc,). Thesefees are based on the. relinina information available and are only an estimate. Contact the De t oraddn'l.in o,
FEE ITEMS-(I:ee Resolutions 11-.053& 7711%1.1) FEE QTY/FEE, MISC ITEMS
Plan Check.Fee: $0.00 0 # Alternative Energy System
Suppl. PC Fee: Q Reg. ® OT 0:0 firs $0.00 $100:00 1CHRGSTA EV Charging Sfaiion
PMEPlan Check: $0.00
Permit Fee: $0.00
Suppl. lnsp.,Fee:Q Reg. 070T Q,Q hrs $0.00
PME-Uni't.Fee: $0.00
P.ME Permit Fee: $0.00
Work Without Permit? ®Yes '(D No $0.00
/Advanced,Planning Fee: $0.00 Select allon-Residential
Building or Structure
'Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative'.1tem
Bldg_Stds Commission Fee:' IBCBSC $1.0.0
SUB..TO�3T, AS. ..,. 3 ,TOTAL.3FE
E, =$1:50 $1.00.00 ' '
$1;01:'50
Revised: 12/04/2011