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15080217CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10149 S TANTAU AVE CONTRACTOR: UNITED SITE SERVICES PERMIT NO: 15080217 OWNER'S NAME: WANG R TRUSTEE & ET AL 50 WASHINGTON ST STE 1000 DATE ISSUED: 08/31/2015 OWNER'S PHONE: 9252500674 WESTBOROUGH, MA 01581 PHONE NO: (508) 594-2504 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL INSTALLATION OF TEMP POWER (100 AMP). 3tr-� "> 7 License Classy 7 Lic.# l Contractor 6141;1eQ : '/�O 5 ./;eDate r te( 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 Sq. Ft Floor Area: Valuation: $500 erformance 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 APN Number: 37507018.00 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 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 FROM LAST CALLED 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 Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 4/ RE -ROOFS: SignatureDate 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) 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 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 25505, 25533, 25534. Section 3700 of the Labor Code, for the performance of the work for which this � Owner or authorized agent tiDate: 't 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(a1cuoetno.oro ❑ PLUMBING ❑ MBCHANicAL ZtLECTIUCAL 7 ❑ MISCELLANEOUS PROJECT ADDRESS 10/4/9 5r �Q CSE' ��C I APNn �%� .67 OWNERNANIE J 6 .8 d 4'ej �I �� PHONE G�2� �S�' �/O/! (� E-M.AM 4Rwr,/(i+ STREETADDRESS j)� CITY, STATE,ZIPrL �/, /jam I FAX C�Z5-_ I d��v/ CONTACT NAME -r" -MAIL ce �i7� PHONE r7 c6 _0(,74 STREET ADDRESS -goA M CITY, STATE, ZIP nC�7 FAX ❑ 0) �%`rER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARa=I CT ❑ ENGA'EER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA> S ls�Ei »✓'l� LICENSE NUMBER ``i� t� 7 � �' LICENSE TYPE r;_/ 6 J 6 ✓�f,�c/L BUkIW A�2w /o / L L COMPANY NAME , All / GT- J �JI�G /C I E-MAIL FAX STREET ADDRESS e0 , )6O �) / /Q,P Iva CITY, STATE, ZIP 5,4� J0 C�i r"L G C� P OD --5 2Z-2 Z � 5 G ARMTECT/ENGRAZEER NAME LICENSE NUMBER BU/S. LIC,". COMPANY NAME E-MAIL FAX ----- STREET ADDRESS CITY, STATE, ZIP PHONE USE OF PSFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES BUILDING: ❑COMMERCIAL URBANI rERFACEAREA jA NO FLOOD ZONE NO IS THE BLDG AN ❑ YES EICHLERHOME? RNO DESCRIPTION OF WORK PO/6 /6 s.. TOTAL VALUATION: By Iny signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I haver e Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ' in.- construction. I aurizVejentatiof Cupertino to enter the above�i}tifigdd city for inspection purposes. Signature of Applicant/Agent: !d Date: SUPPLEMENTAL INFORMATION REQUIRED 41 MEPYisc4pp_2011.doc remised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ka,ADDRESS: 10149 S TANTAU AVE DATE: 08/31/2015 REVIEWED BY: SEAN UNITS APN: BP#: "VALUATION: $500 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex Amps PENTAMATION PERMIT TYPE: 1 REAP1 WORK INSTALLATION OF TEMP POWER 100 AMP). SCOPE to/rpl. Insp P'c c APPLIANCE / EQUIP TYPE FEE ID Plumb. Ilan Chec% QTY UNITS BP FEES Elec. Permit Fee: ]EPERMIT Temporary Power 1ERT<200 Other Elea Insp. 0.0 hrs $48.00 100 Amps $48 ci"19111 1 ee. to/rpl. Insp P'c c PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E�': 7f /1/13) haech. Plan Check Plumb. Ilan Chec% Elec. Plan Check 0.0 hrs $0.00 �ilecii , „ � if Fee: Plumb. I', Elec. Permit Fee: ]EPERMIT titlter.4�1cch. Inst. )tirerPluraah lt� p, Other Elea Insp. 0.0 hrs $48.00 ` Insp. Fee: PME Plan Check: $0.00 NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E�': 7f /1/13) FEE QTY/FEE7 MISC ITEMS Plan Check l ee: �'itppl. P(' Fee PME Plan Check: $0.00 ci"19111 1 ee. to/rpl. Insp P'c c PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (F) No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $190.50 $0.00 TOTAL FEE: $190.50 Revised: 07/02/2015