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14100028 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7817 LUNAR CT CONTRACTOR:EVERSPRING PERMIT NO: 14100028 CONSTRUCTION INC OWNER'S NAME: CHUANG CHUN CHEN AND BINFU 1131 S DE ANZA BLVD DATE ISSUED: 10/06/2014 OWNER'S PHONE: 4088868346 SAN JOSE,CA 95129 PHONE NO:(408)446-8398 ti LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL 0 G INSTALL TEMPORARY POWER License Class Lic.# g(C)-g 9 J Contractor f:_;-0-46e%IKy7 &l34JC9trN'4D_`ate b 6 /'Y - 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:$200 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 APN Number:3 6220021 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 correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 �-S-O IT 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 +RO] ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, --- costs,and expenses which may accrue against said City in consequence of the granting of this perm . Additionally,the applicant understands and will c Date: with all non-point s urce regulations per the Cupertino Municipal C , ection 9 18. RE-ROOFS: Sign Date L�6 / 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 1,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 Ci pertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2"505,25533,and 25534. / Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a Date: 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 nPPLICA T IaN M E P COMMUNITY DEVELOPMENT DEPAR i NLN T• BUILDING DIV]S1GI. O0 10300 TORRE AVENUE• CUPERTINO,CA 95014-3250 (408)777-3228•PAX(403) i7-3333•buildinal3�cuoeno.ora eU���i ttit4 `� ❑ m I s pTbJ32,,-�G ❑A�C°r=1�iC.4L ❑Z£Ci'I2iCaL / (�I,.asC£/ k0 us PRO;C'E-DDF. SS -;�('7_' l N tt •G(J 1/l I `��R b�� �© `�v 2 I Cf�lll 061 C�U►� C' O'v.��NAME S, ==TADD?=- s I Cid, r,AT_,Zi?,. I FAX co:\?ACr IF3r j��� Qin. Cgdr1 I ?30ll. �5� 'bbZ''` & 2I B-111-4—TT c�;:i ADD? SS ,,,ll`7 1 TS•`�''Y��' ���'`�``T' t71-v v may,STSin ❑ mq=p •❑ OS`•��h—,/,G--' }a C0?. 4C'Oa2 ❑COh �,CO?tAC?.T ❑, es�.0—CT ❑? C^3�_: ❑ D1 u0?:�. ❑ _=.•:.it.Z 4CrOi2I:AN� yam, -1 liCi''SB TT[J1 p 60 ^ coI✓D��.YI �I� OC Cv,-�5'CrLNcZr�y =l ay U V / I Ftp STPD Z A7D?ass O t S' vt Z,*, S v9 I =1 STATE,ZIP SAS mos C�1 X1512 F � �� Z �l 1�CTuisCTlt dGiTu P TA]J= ( LiCTSE I,tUTr ER. I BUS.LIC'4 COAmA�TYA'AhS I �WiAII I FAX STB c T ADDRPSS I CITY,STA717,ZIP I PHOs us-=OF ❑-CTD or DTJ= ❑ MJL-,T•FA1,=Y I MOJr.CT Lh W3LDL-NTil ❑ YES I PR0'aCT LK ❑Yz-s I Is TM BLDG AM ❑1 S svr?DLnc ❑Col^,C:?.CLSL ARA p NO FLOOD?olti. ❑No zic=Hor m? ❑No DBSCPJFTION or WORK LI- Mmm M-11 : TOTE?VALUATIO\: _ = $y r,iy si_c•,s. Te _o;+',I cer i:5'to each of the following Iam the prope-ty e;;�er or au ho i�:3�nt to zct o �f/ wry O',imer's behali I have read osis applic«ion and trio info:_.,ztioa I have provid is correct I have-.ad the Descri?tion of Work and venfy it., aec-mrate. i z_ee to comply vrith zl applicable local Or diva-mes and state lz-ws relctli$t0 buildin-const JCi)On. I authior reDresentatives of Ci?�Bi?ino to BnieI i'�e zbov-.-ideP_t-ie pro• nsrpe:i -Apses. —' T S i:.'iat'_ire 01 ApDhcan V."�'2tnt: Date. Q v STPP-E-IJ�NTAL NrOR2,1ATI0NRE-QT D OU;-M RM Mi ZPhdisc.Epp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 7817 LUNAR CT DATE: 10/06/2014 REVIEWED BY: MELISSA APN: 362 20 021 BP#: *VALUATION: $200 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP1 USE: PERMIT TYPE: WORK INSTALL TEMPORARY POWER SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $48 TOTALS: $48.00 �,�� ;a.° ._� µaria G ,flee!, Plarr(he(", C'lrrttrh. ]'dura(`hec/, Elec.Plan Check 0.0 hrs $0.00 flay! f'e!iui1 Fee: 1'tumiz Az:rmir 1'ec: Elec.Permit Fee: IEPERMIT Jrlx lice Fr. L=r,>p ollwr Pdumhfnsr Other Elec.Insp. 0.0 hrs $48.00 11"Un3h. hisp. Tia<, In s'n Fey "- NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info. Plan Check EE ITEMrS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PciInid f'ertr. PME Unit Fee: $48.00 PME Permit Fee: $48.00 ('i}? trt c°liar? l'ra: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 =l Eib'C,I7;C'G L7k�l!t I'l(11 yt r�r/'G'f'.S. Travel Documentation Fee: ITRA VDOC $48.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item B1d-.Stds Commission Fee: 1BCBSC $1.00 r $190.50 $0.00 TOTAL FEE: $190.50 ,v Revised: 08/20/2014