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13050158 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1148 STAFFORD DR CONTRACTOR:JOHNSTON ELECTRICAL PERMIT NO:13050158 CONTRACTOR OWNER'S NAME: JEUNG ALBERT M AND VALERIE M T 1302 LINCOLN AVE STE 204 DATE ISSUED:05/22/2013 OWNER'S PHONE: 4084463577 SAN JOSE,CA 95125 PHONE NO:(408)266-0236 ❑ EI LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Glass C/U Lic.# ' � UPGRADE(E) 100 AMP PANEL TO 200 AMP PANEL,SAME J LOCATION Contractor Date S Z.2 (z I hereby affirm Mill am licensed under the provisions of 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. Sq.Ft Floor Area: Valuation:$900 1 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 APN Number:36207007.00 Occupancy Type: permit is issued. .APPLICANT CERTIFICATION I certify:that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correctA agree to comply with:all city,and.county ordinances and state laws relating WITIIIN 180 DAYS OF PERMIT ISSUANCE OR to building construction;and hereby authorize representatives of this city to enter upon,the'above mentioned property.for inspection purposes. (We)agree to save 180 DAYS CALLED INS; ION. indemnify and keep'harmless the City of Cupertino against liabilities,judgments, costs,and expenses which ay accrue ' st said City in consequence of the �•7j /3 granting of this.permit::A do y; applicant understands and will compI Ile Dater with all:non point source e faf perthe Cupertino Municipal Code, ection 9.18. RE-ROOFS: Signature Date 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm.that I;am exempt from the Contractor's License Law for one of the following two reasons:, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will.maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the B Are it Quality Management District I performance of the work:for which this.permit is issued. will maintain compliance with the Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section ,25533,and 25534. Sectwri 3700 of the Labor Code,for the erformance of the work for which this Owner or authorized ager Date p. ' 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 CONSTRUCTION LENDING AGENCY become,subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith'comply with such provisions or,this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANTICERTIFICATION Lender's Address 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 tbe;above mentioned property for:inspection'purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keeprmless ,hathe City of Cupertino against liabilities,judgments, costs and:expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit,"Additionally,the applicant understands and will comply with l noourc n-point se .gulations per,the Cupertino Municipal Code,Section Licensed Professional 9 18al�' Signature Date i CITY OF CUPERTINO ElFEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1.148.STAFFORD DR DATE: 05/22/2013 REVIEWED BY: MELISSA APN: 362 07 007 BP#: *VALUATION: $900 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK UPGRADE E 100 AMP PANEL TO 200 AMP PANEL SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services IBELEC200 200 Amps $45 TOTALS: $45.00 Ltech.Plan Check Phnnb.Plum 7(C�hech Elec.Plan Check 0.0 hrs $0.00 Xlech.Permit.Fee: ermitFee: Elec.Permit Fee: IEPER1l11T. C)ther•;Meeh.Inan. Other Plumb Insp. Other Elec.Insp. 0.0. �s �45-00 Tech.Insp.fee: Plumb. Insp.Fee: flee.Imp.fee: NOTE:This estimate does not include fees due to other Departments(L a Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelhiniina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/121 FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl.PC F, PME Plan Check: $0.00 Permit.Fee: Suppl. Insp Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Construction :Tczx: Administrative Fee:. IADMN $42.00 Work Without Permit?'. ®Yes (E) No $0.00 Advc,,tncedPlanning Nees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item BldRStds'Commission Fee: 1BCBSC $1.00 $178.50 $0.00 $178.50 Revised: 04/29/2013 GENERAL PERMIT APPLICATION �`7 MEP LEI COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 . o� CUPERTINO (408)777-3228•FAX(408)777-3333•building(cDcupertino.orct 47 MIsc ❑PLUMBING [:]MECHANICAL LECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS `'1 APN# 3(02- CG I- - 0 O OWNER NAME PHONE ilegE-MAIL STREET ADDRESS t J CITY,STATE,ZIP FAX CONTACT NAME Y PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX D0 STREET ADDRESS CITYSTATE ZIP (�A PHONE , I d4? L/ iiv :lam -sa P ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? DESCRIPTION OF WORK G S�� " 4�91 TOTAL VALUATION: Y: By my signature below,I certify to each of e f ing: I am the property owner or autho ' agent to act on the property owner's behalf. I have read this application and the information I have prov correct. I 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 b ' construction. I authorize representatives of Cupertino to enter the Zabve-iden ified property for inspection purposes. Signature of Applicant/Agent: Date: a� /� SUP LEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W OVER-THE-COUNTER EXPRESS x U W ❑ STANDARD Cq Uzz a ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11