12030050 CITY OF CUPERTINO BUILDING PERMIT
BUILDINCADDRES4 21888GARDENVIEW LN CONTRACTOR:SU JUI-CHENG AND TSAI PERMIT NO: 12030050
SHU-HU(
OWNER'S NAME: SU JUI-CHENG AND TSAI SHU-I(U1 21888 GARDrNVIEW LN DATE ISSUED:03/122012
OWNER'S PHONE: 4082558988 CUPERTINO.CA 95014 PHONE NO:
❑ / O LICENSED CONTRACTOR'Sr r
M1IECH RESIDENTIAL COMMERCIAL DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class —( Lic.4 R A2—V F r
G
Comrtctor EP11St (,toy- Z-G Date -)?J lit 1 1
hereby affirm that I.am licensed under the provisions of Chapter JOB DESCRIPTION:UPGRADE RESIDENTIAL PANEL TO 200AMP
(coin mencing with Section 701111)of Division 3 of(lie Business&Professions
Code and tat my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenificme of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfomhmnce of the work for which this permit is issued. Sq.Ft Floor Area: valuation:$1000
1 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
permit is issued. AI'N Number:32619093.21888 Occupancy Type:
APPLICANT CERTIFICATION
I cenify that I have read this application mid slate unit[lie above infontmion is
correct.I agree to comply with all city and county ordinances mid state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,aid hereby authorize representatives of this city to enter
upon the above mentioned property kir inspection purposes. (We)agree to save WITHIN t80 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City ot'Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this fiction. Additionally,[lie applicant understands mid will comply �5/ / �z
with all non-point source regulations per(lie Cupertino Municipal Code,Section Issued by: ✓��/,,V � 7 G/7-Z Date: 3-
9.18.
Signature 1, li-H> O �' Dam (a L 0-
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
1 hereby affirm that I am exempt front the Contractor's License Law far one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages i s their sole compensation, Signature of Applicmt Date:
will do the work,and the structure is no intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct die project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the fallowing three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 2.5.505.25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
perfbmmnce of the work for which this permit is issued. Safer'Code.Section 25532(a)should 1 store m-handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the perfonnanu of the work for which this contaminants as defined by the Bay Area Air Ouality Management District 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code.Chapter 9.1_and the
Health&Safety Code Sections.58(15.25513,and 25534.
1 cenify that in the performance of doe wort:for which this permit is issued,(shall / _ ytl�
not employ any person in tiny manner so as to become subject to the Worker's OwSor authorized agent 1 r L
Compensation laws ofCalifomia If,afleratakingthisceniticaeofexennption,I Date: 7
become subject to the Worker's Compensation provisions of the Labor Code,1 must
forihwith comply with such provisions or this permit shall be deemed revoked. CONSTRl1MON LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of mork's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the al,ove information is Lender's Name
correct I agree to comply with all city and county ordinances mid state laws relating
to building construction,mid hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnity mid keep harmless the City of Cupertino against liabilities,judgments,
costs,mid expenses which may accrue against said City in consequence of line ARCHITECT'S DECLARATION
graming of this permit.Additionally,the applicant understands and will comply I understand my plans shall he used u public records.
with all non-point source regulatims per lite Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32619093 .21888
DATE ISSUED. . . . . . . : 03/12/2012
RECEIPT # . . . . . . . . . SS000016240
REFERENCE ID # . . . : 12030050
SITE ADDRESS . . . . . : 21888 GARDENVIEW LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SU JUI-CHENG AND TSAI SHU-HUI
ADDRESS . . . . . . . . . . : 21888 GARDENVIEW IN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CHAO X ZHOU
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : SU JUI-CHENG AND TSAI SHU-HUI
ADDRESS . . . . . . . . . . : 21888 GARDENVIEW LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -------- ---
-ADMIN HOURS 1 .00 41 .00 0 .00 41.00 0 . 00
1BCBSC VALUATION 1,000 .00 1 . 00 0 .00 1 .00 0 .00
1BSEISMICR VALUATION 1,000 .00 0 . 50 0 .00 0 . 50 0.00
1EPERMITFE FLAT RATE 1 .00 44 .00 0 .00 44 .00 0 . 00
-ERT<200 UNITS 1 .00 44 .00 0 .00 44 .00 0 . 00
1TRAVDOC FLAT RATE 1 .00 44 .00 0 .00 44 .00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 174 .50 0.00 174 .50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 174 .50 VISA
---------------
TOTAL RECEIPT 174 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
Im. ADDRESS: 21888 Gardenview Lane DATE: 03/12/2012 REVIEWED BY: Sean
APN: BP#: "VALUATION: $1,000
*PERMITTYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARYSFD or Duplex PENTAMATION 1REAP2
USE: PERMIT TYPE:
WORK Upqrade residential panel to 200 amp.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1ERT<200 100 Amps $44
TOTALS: $44.00
tfitb.PlanCb.ck Plwab. PlanClurk Elec. Plan Check 0.0 1 hrs $0.00
Nech.F1.r wi PC(! Plumh Pamir Fee: Flee. Permit Fee: IEPERAUT
Orlin•Uedr. lase. Other Plumb 1);;p, 011ier Elea lnsp. 0.0 his $44.00
i!ar Innp. Pec• Plunrb.Garp.Fee;' 81w./neje Feer
NOTE: This estinwte does mit include fees due m other Departmems(i.e. Planning,Public ll arks. Fire,Sanitun'Seger District,School
District,etc.). Thr a ees are based on the prelininarj in ornwtion available and are onlv an estinwte. Contact the Dept for addn'l info.
FEE ITENIS (Fee Resolution 11-053 LIT 711//1) FEE QTY/FEE MISC ITEMS
Plan Check Fie;
Suppl. PCFre
PN,IE Plan Check: $0.00
Permit Fee•
Suppi 1144 ree
PME Unit Fee: $44.00
PME Permit Fee: $44.00
Construction Tax:
Administrative Fee: 1ADAIIN $41.00
Work Without Permit? 0 Yes Q No $0.00
RdrauceJ Planning Feed:'
Travel Documentation Fee: ITRA t%DOC $44.00
Strong Motion Fee: IBSEMt11CR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $174.50 $0.00 TOTAL FEE: $174.50
Revised: 1/19/2012
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 M ' /�
CUPERTINO (`08)777-3228 • FAX(408)777-3333• buildln0(r.cuoertno.ore v\
❑PLUMBING ❑MECHANICAL ❑WSCELLA
ELECTRICAL. NEOUS
XPROIECTADDRESS 218$8 QaNden✓ie�✓ln. Cupe%tyro, cA�G! A"N' C g
OWNER NAME '-I- Chen -PHOC 2 4� Ogp q E1 ju;cl,en - Su ® hIgI�CO .
J UI � `r J Or00
STRFETADDRESS CITY, STATE,ZIP, FAX
CONTACT NAME PHONE E-MAIL:
STAEETADORESS CCTV,STATE- ZIP FAX
DOWNER ❑ OWNER-BIIBDFR ❑ OWNEAAGENT ❑ CONTRACTOR ❑CONtRACTORAGENT ❑ ARCHn ECT ❑ENGINEER ❑ DEYE3OPER ❑TENANT
CONTRALT00.NAME d/Qo X10n 1�.1ON GCENSE XUNtBEt g62-08'8 UCENSE TYPE ACL'O BITS.CIC#
COMPANY NAME EaSLA —IQY� /Pc(yi/IC A EMAIL I>nuYB/P�rC'G`�D �YH/70I� FAX
SiREETADDRESS 2.q-47 "TH Ave - r rc'C Cry,STATEZIP PHONE
AACFGTECC/F7JGINEER NAME LICENSE NUMBER BUS.LIC N
COMPANY NAME' E.MAII. FAX
STREET AODRFSS CITY,STATE ZIP PHONE
USE OF 121PD m DUPLEX ❑ MULTI-FAMB.Y PRDTECT IN WILOU.ND ❑ YFS PROTECT IN ❑YES 115 THE 9IDG AN El YES
BUBDING: ❑COMMERCIAL. URBAN INTERFACE ARTA ❑ NO FUDOD ZONE ❑ NO EICHLFA HOM.FT ❑NO
DESCRIFTION OF WORK
V YQL✓2 e(ft iC2C /OQO QII GSI 0 '6U loO
J( TOTAL VALUATION: RECEIVED BY:
/ \ By my signature below,I certify to each of the following: I am the property owner or authorized agent on act on the property owner's behalf. I have;cad this
application and the information I have provided is cortccL`}have read the Description of Work and verify it is accurate. I agree m comply with all applicable local
ordinances and sate laws relating m building com= n. I authorz enatives of Cupertino to rntR the above-identified property for inspection pu(poses.
Signature of ApplicanNAgcn[ - Dare:
SUPTLENfENTAL INFORNWRON REQUIRED OFFICE USEONLY
m OVER-THE-COUNTER
❑ EXPRESS
Y
U
❑ STA.NDAAD
U
3
❑ LARGE
L ❑ MAJOR
MEPM1sc4pp_2011.doc revised 06PI111