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14090012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10590 LA RODA DR CONTRACTOR:TES COMPANY PERMIT NO: 14090012 OWNER'S NAME: CHAU JOEY AND CHANG SHIH-CHI 3549 CECIL AVE DATE ISSUED:09/03/2014 OWNER'S PHONE: 4088889668 SANTA CLARA,CA 95050 PHONE NO:(408)605-2297 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 200 AMP PANEL UPGRADE License Class /mac..��ff —/ 0 7 — L-i-c # � c 7 7 � � Contractor d /yP V / � Date /3 I hereby affirm that I 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:$2500 I&ha aintain Worker's Compensation Insurance,as provided for by 3 00 of the Labor Code,for the performance of the work for which this APN Number:36933019 00 Occupancy Type: s ssued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITI-IIN 18 YS 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 D FROM LAST CALLED INSPEC I N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the / Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point sour gulations per the Cupertino Municipal Code,Section 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. I 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 Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5,25 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater 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 APPLICANT CERTIFICATION 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 the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the 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 all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date GENERAL PERMIT APPLICATION �- ` COMMUNITY DEVELOPIJENT DEPARTMENT• BUILDING DIVISION U U� r 10300 T ORRE AVENUE• CUPERTINO, CA 85014-3255 (408) 177-3228•FAX(408)777-3333•buildino.QcuDe rtno.ora m I1 C U E�'i=r'iT f L�I4 ❑PLLNu31NG ❑h Ci�i"-1�ZCAL `� ELECTRICA.L �j❑h25CELLAX-EU0S FP a;crADOPLSs o�`g d L, K- / D IM l/r. I RP>` �� / G 1 O'v11��lit, Joe- P.DDP=- S I CM, STATE,Z2. I FAX COlvikCT N `c. AA)L) Y; 7—+0 ip-,,o,\-z/J e0 6��/ /I t-1✓kT� STF.w�ii.kDDRr.S3 3�--//Q 0-4�-c/` A- W CTY,S'i AT"=,Z� FAX ❑ '❑ OWI=,•BL-1LDML ❑ OV, AG=[.Z COhTPkCTOR ❑COTrft4CT0RAlY-'Ar ❑ fiRC'TT=CS ❑ENG�L.R ❑ D:1 0? ❑ CON/,cromvh I � Dlq-///� v /L, I LIC'r1�SETYPP� //�13US.LIC: COIJiAhTYhAI� � � G(yZ I t-I.ib-II. / 7 "' I tAx STREM7 ADDRESS /�M� �5 I CI-i 1,STAT":.,ZIP I PHONE �RCAITECTGiT�'R TZ?il/J3 I LICn'hSE 1.TI�1 SER I BUS.LIC CONPf?�'Y I�.klJ,b' E-1✓ikII. ( FAX STRu"r ADDRESS I CIIY,STATE,ZIP I PHONE USE OF ❑SFD or DUPLE ❑ lzml-FAIZLY I PROJEE=W WILDLA D ❑ YFS I PROJECT im ❑YES I IS Tri BLDG J N ❑1 FS BUILDINGp COYNERCIAL 1JRBAN N-MRFArM AREA p NO FLOOD ZOhL El No zIG�S .Hoh ❑ )"'0 DESCRMnoN Or WORK ,f� Cl a-�,, 4,tig1 v 2,00 /+"/0, TOTALVpTUATION: O• �F'v x us` I� " >��.w� By my signa«re below,F#to each of the following: I am the property owner or authorized anent to act on the property 0,%Nmer's ave read this application and the info-nation I have provided is correct I have read the Description of Work and verify it is accsate. I a_*ee t ply v2th a!1 applicable local o:diilances and State lah's relating to building C etion. I' thorize MD!^`eS'.�\'es of CLper tlno to eater the above-ident-ed prop='�,for inspection Durposes. S imnatare of A pplicant/Aee^t: Date: 3 �� SUPPLEM-ENTAL LNTO TION RE UIltED x, T• �` �3�2 u 3t�EN - z — - _ 7--PAlisc.4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10590 LA RODA DR DATE: 09/03/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$2,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP USE: PERMIT TYPE: WORK 200 rnp panel UPGRADE SCOPE Mvol . }'Icrn C/,�-Lt Elec.Plan Check 0.0 hrs $0.00 M,ron;l Fee: Ph,,Mb. T'ermi( ee Elec.Permit Fee: IEPERMIT Cir'=,c'T:fe'crZi. fr�s;> 0111ur-AW-ab Insp. ELI Other Elec.Insp. 0.0 hrs $48.00 lc,,h fn,ip. I'Turu7). Insp. Fee: l,i2r.Imp - NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees 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 f 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 200 amps Electrical Suppl.PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 $48.00 IBELEC200 Services PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 G Advanced Plannim Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: ITRAVDOC $48.00 Building or Structure i Strom Motion.Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Feer IBCBSC 1 $1.00 �> L $142.50 $48.00 TOTAL FEE: ` $190.50 4. Revised: 07/10/2014