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12020116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1054 COLONY HILLS LN CONTRACTOR:VOL"I L ELEC'I'MC PERMIT NO: 120201 16 OWNER'S NAME: BEN-CHUNG&KUO SZU-WEN CHENG 6245 LEAN AVE DATE ISSUED:02/27/2012 OWNER'S PHONE: 6502789403 SAN JOSE,CA 95123 PI►ONE NO:(408)835-3866 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT } PLUMB C lc� License Class Lic.4 �72, ` / MECH RESIDENTIAL COMMERCIAL Contractor �)(�Z��f-y�� Date Z 1 hereby affirm that I am licensed under the provisio s of Chapter 9 JOB DESCRIPTION: ADD DEDICATED 120 VOLT FOR FUI'URI.SUMP PUMP IN (commencing with Section 7000)of Division 3 of the Business&Professions CRAWL SPACE. 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$300 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:359028039.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnily and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-posit source regulations per the Cupertino Municipal Code,Section 9.18. Issued Dater�Z2. �2� Signature Date 2 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed- If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection, I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant Date: Business&Professions Code) _ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to selfinsure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall health&Safety Code,Sections 25505,25533,and 25534. 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 Owner t`/1 authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnity and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1054 colony hill In. DATE: p2 7I REVIEWED BY: bob s. A��i --- APN: BP#: `VALUATION: $300 ;1PERNHT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRINiaRY SFD or Duplex PENTANIATION 1REAP1fl USE: PERMIT TYPE: WORK add dedicated 120 volt for future sump pump. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Recep/Switch/Outlets 1BREMRECEP 1 # $44 TOTALS: $44.00 Elec.Plan Check 0.0 hrs $0.00 Etec.Permit Fee: I EPERMIT rtLiOther Elec.Insp. fl.0 firs $44.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Server District,School District,etc.). These ees are based on the relimina information available and are onl•an estimate. Contact the De t Loraddnl info. FEE ITEMS (Fee Resolution 11-053 Ef/: 7%1%11) FEE QTY/FEE MISC ITEMS f.. .. F .. <'.3{ PME Plan Check: $0.00 %jcP 7i , is . PME Unit Fee: $44.00 PME Pennit Fee: $44.00 Administrative Fee: ]ADMIN $41.00 Work Without Permit? Yes E) No $0.00 Travel Documentation Fee: I TRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS $174.501 $0.00 TOTAL FEE: 1 $174.50 Revised: 1/19/2012 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . . 359028039 . 00 DATE ISSUED. . . . . . . : 02/27/2012 RECEIPT # . . . . . . . . . : BS000016114 REFERENCE ID # . . . : 12020116 SITE ADDRESS . . . . . : 1054 COLONY HILLS LN SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BEN-CHUNG & KUO SZU-WEN CHENG ADDRESS . 1054 COLONY HILLS LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MATE SABICH CONTRACTOR . . . . . . . : MATT SABICH LIC # 31809 COMPANY . . . . . . . . . . : VOLTZ ELECTRIC ADDRESS . . . . . . . . . . : 6245 LEAN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 835-3866 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 .300 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BREMRECEP NO. OUTLETS 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 1BSEISMICR VALUATION 300 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 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 MC --------------- TOTAL RECEIPT 174 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 512 FINAL HANDI-CAP Building Department City Of Cupertino Lo 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: - PERMIT# t OWNER'S NAME: PHONE# GENERAL CONTRACTOR: _ ��, ' BUSINESS LICENSE# ADDRESS: Z Y �, CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCO TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: z ' Signature ate Please check applicable subcontractors a complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date GENERAL PERMIT APPLICATION kEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 950143255 CUPERTINO (408)777-3228•FAX(408)777-3333- buildingQcupetno.Org misc C}��///n ❑PLUMBING ❑MECHANICAL CTRICAL ❑MISCIIIANEOUS M01ECT ADDS ¢' ` C APN# 2 OWNER NANe�J J/', i PHONE E-MAIL J - i ..C. ,j.. SLREb-I ADDRESS d CITY,STATE,ZIP �> , i FAX CONTACT NAME PHONE E- STREET ADDRESS CITY.STATE ZIP _ FAX I f ,L:Z,," c�a - 4, ,1.T ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT M ACTOR ❑CONTRACTOR AGENT ❑ ARCH]TECT ❑ENGINEER ❑ DEVELOPER ❑ 'TENANT CONTRACTOR NAME I )� S/_ ` LICENSE LISETYPE BUS.LIC C �I�D COMPANY NAME / E-MAIf FAX f -/CL i"� STREET ADDRES ` A CITY,STATE,ZIP �- _- 1 PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.IJC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STA'L'E,ZIP PHONE USE OFITS-FD or DUPLEX ❑ MULTI FAMILY PROTECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑C.OMNERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK / U v ��C �CyV e✓ t' r's /Viy: (pr✓, ) y „�Vr� :l�r.� 0d3 1 TOTAL VALUATION: �(;�;ti i;v RECEIVED 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 owner's behalf. I have read this application and the information I have pro 'ded is correct.,have read the Description of Work and verify it is accurate. I agree to cotrrply with all applicable local ordinances and state laws relating to buil g construction:`I authorize representatives of Cupertino to enter the above-identified property for inspection pudposes. Signature of Applicant(Agent bate: SUPPLENENTAL INFOFM ATION REQ=D OFFICE USE ONLY LI-OVER-THE-COUNTER c ❑ EXPRESS x U w ❑ STANDARD G ❑ LARGE a ❑ MAJOR MEPMiscApp_201 Ldoc revised 06/21111