B-2017-1288l/
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1288
10490 DAVISON AVE CUPERTINO, CA 95014-4504 (369 26 034)
NEW MILLENNIUM
ELECTRIC
LOS ALTOS, CA 94022-
2912
OWNER'S NAME: LI YONGZHONG AND CHEN ZHONGYING
DATE ISSUED: 08/04/2017
OWNER'S PHONE: 650-224-0355
PHONE NO: (408) 375-8344
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-10 Lie. #829299
Contractor NEW MILLENNIUM ELECTRIC Date 12/31/2017
X BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
UPGRADE PANEL (200 AMPS) - SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
i. " 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
rformance 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'Co�dea, for the performance of the work for which this
permit is issued., Q Ci
Sq. Ft Floor Area:
Valuation: $3000.00
APPLICANT CERTIFICATION
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
APN Number:
Occupancy Type:
and state laws relating to; building construction, and hereby authorize
369 26 034
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, costs, and expenses which
'City
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant.understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
gnature
Issued by: Abby Ayende
Date: 08/04!2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
installed.
following two reasons:
All roofs shall be inspected prior to any roofing material being If a roof is
r. I, as owner of the property; or my employees with wages as their sole
installed without fust obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business &Professions Code)
2. I, as owner of ttie property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 814/201
I hereby affirm under penalty of'perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. I have and will, maintain a Certificate of Consent to self -insure for Worker's
Compensation, a's provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will 'maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505,2553S, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to became subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Mu ' ' hGede, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Co , e s 25505, 25533 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
er or authorized agen .
APPLICANT CERTIFICATION
Date: 8/4/2017
I certify. that I have read this application and state that the above information is
TR TI LE AGENCY
'
correct. i'agree to comply with all city and county ordinances and state laws
I hereby affirm that there nstruction ing agency for the' performance
relating!to building construction,; and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ'C.)
to enter"upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgmerits, costs, and expens'esr which may accrue against said City in
Lender's Address
consequence of the granting 'of this permit. Additionally, the applicant understands
and will'' ' mply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
I understand my plans shall be used as public records.
Licensed
Signature Date 8/4/2017
Professional
CUPERTINO
BIZO I I _t
M Emp
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 • building Qcuoertlno.org
❑ PLUMBING ❑ MECHANICAL ❑ELECTRICAL ❑,MISCELLANEOUS
PROTECT ADDRESS (� , - n
APN # 2-A —26-02(J /O
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHrrFcT ❑ ENGINEER ❑ DEVELOPER 13 TENANT
CONTRACTOR NAME ' ^ t r^+ /
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LICENSE NUMBER P1?A0-\
LICENSE IYPEQ
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ARCHITECT/ENGINEER NAME
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BUS. LIC #
COMPANY NAME ��
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ \'ES
FLOOD ZONE ❑ NO
JS TNT' BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
W t/Y 61 Q
VrJ '
TOTAL VALUATION: (� aj
RBCEIVED BY:
By my signature below, I certify,to each of the following: I am the property owner or authorized agent to act on the property owne s behal . I have read this
application and the information I have provided is 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 relatin- to building co on. I an rize representatives of Cupertino to enter the above ' en ' ed property for inspection purposes.
Signature of Applicant/Agent
S MENTAL INFORMATION REQUIRED
oFFcE USE otvLY
ca
❑ OVER THE COUIITER :'
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❑ STANNDARD
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❑ LARGE .
❑ MAJOR
MEPMiscApp_2011.doc revised 06121/11