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13090206 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18624 LOREE AVE CONTRACTOR%.1 ;;QBE DLTRRMINE PERMIT NO:13090206 OWNER'S NAME: SONG JAIGAK AND KWON SOONHYE 18624e/e all t , DATE ISSUED:09/26/2013 OWNER'S PHONE: 4083653806 PHONE NO: LICENSED CONTRACTOR'S DECL r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class ( .,to LieA O 7 Y WtUA� � '� MECH� RESIDENTIAL� COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions o10f Chapter 9 JOB DESCRIPTION:REPLACE EXISTING MAIN ELECTRICAL PANEL WITH A 200 (commencing with Section 7000)of Division 3 of the Business&Professions AMP PANEL Code and that my license is in full forceand.: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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2000 permit is issued. APPLICANT CERTIFICATION APN Number:37525072.00 Occupancy Type: 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 the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Add' nally,the applicant understands and will comply 180 DA S FROM LAS - LLED INSPECTION. with all non-point rc 1Z. Ve ertino MunicipQJode, tion / 9.18. � Issued by: l // Date: Signature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sce.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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as d fined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compli a with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health afe e,Sons 25505,25533,an 25534. 00 Compensation laws of California. If,after making this certificate of exemption,I 00 become subject to the Worker's Compensation provisions of the Labor Code,I must Own r el forthwith comply with such provisions or this permit shall deemed revoked. Date: CONS UCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional GENERAL PERMIT APPLICATION MEP 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 `PERT1'" 408)777-3228•FAX(408)777-3333•buildina(a)cupertino.org MISC Lj PLUMBING ❑MECHANICAL JJ'FLECTRICAL []MISCELLANEOUS PROJECT ADDRESS APN# OWN FRNAME 'j��t O, , PJ PH � f' .�/i.,J�� yL L E-MAIL STREET ADDRESS A�y'�L � f� Ci p STAT ��`JtA, 9S_6 _6 y FAX CONTACT NAME p l ,(� P' U 4 n E-MAIL STREET ADDRESS /, t/1 TATE, FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 1J CONTRACTOR ❑CONTRACTOR 1AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAMEWi �� j S LICENSE NUMBER LICENSETYPy �/ BUS.LIC# ,, i-1 COMPANY NAME ,A E-MAIL C ! FAX STREET ADDRES CTA PHO ARCHITECT/ENGWEERNAME LICENSE NUMBER BUS.LIC# `1w1 COMPANY NAME E-MAIL FAX i STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or 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? ❑NO DESCRIPTION OF WORK A , TOTAL VALUATION: � .._ E�II ED$ k � By my signature below,I certify to each of the Ilowing: •tile.prop wrier or authorized agent to act on the property owner's ehalf. I have read this application and the information I have pro a is rrec aveYead the Inscription of Work and verify it is accurate. I aLgree to c ply with all applicable local ordinances and state laws relating to b c t' authori r resentatives of Cupertino to enter the ab vpde 'fie pr for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION�RE UIRED e� LaMITI% y MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 18624 lorre ave DATE: 09/26/2013 REVIEWED BY: its I APN: BP#: *VALUATION: 1$2,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: p PERMIT TYPE: A WORK replace existing main electrical panel with a 200 amp panel SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 200 Amps $47 TOTALS: NEW.` z Mech. Plan Check Phonb. Plan Check Elec.Plan Check 0.0 hrs $0.00 Lli>ch.P'ernriz Fee: Plumb.Aermit Fee: Elect.Permit Fee: 1EPERMIT FCJ her A ech.InspL.. Other Plumb Insp. E1--L- Other Elec.Insp. 0 hrs $47.00 11ech.Insp. Fee: Plumb. fnsp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These -fees are based on the prefindna information available and are only an estimate. Contact the De t or addn7 in o. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Suppl. .K'T'ee PME Plan Check: $0.00 hermit.Fee: Suppl. Insp P'ee PME Unit Fee: $47.00 PME Permit Fee: $47.00 (.onstruction :Ttire: Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 ,Idvanced PhMning 1;*ees: Travel Documentation Feer ITRAVDOC $47.00 A Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $1.00 $186.50 $0.00M! 'y $186.50 EMIR,o. � W, Revised: 08/01/2013