12040085CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 933 DUDD RD
OWNER'S NAME: XU BIN AND ZHUANG LANA L TRUSTEE
OWNER'S PHONE: 4088326675
❑ LICENSED CON'TRACTOR'S DECLARATION
License Claasss� _- (0 L,icc..4 q,5/� 23 3 3
ContraclorClYLf YL. ire OVIL- —E'" Date(' 2-
1
1 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insurc 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
Section 3700 of the labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 cityto 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 may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regal tons per the Cupertino Municipal Code, Section
9.18.
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contactors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penally of perjury one of the following three
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I cenil'y that in the performance of the work for which this pemtit is issued. I shall
not employ any person in any manner so as to, become subject to the Worker's
Compensation laws of Califomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or [his permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 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 Iiabililies,judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this peril. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
CONTRACTOR: GARZA ELECTRIC INC
PERMIT NO: 12040085
2423 KLEIN RD
DATE ISSUED: 04/162012
SAN JOSE, CA 98148
PHONE NO: (408)238-2739
r
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BUILDING PERMIT INFO: BLDG
ELECT PLUMB
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: SINGLE FAMILY DWELLING SERVICE PANEL UPGRADE
TO
200AMP AT RIGHT I IAND CORNER AT THE REAR YARD
Sq. FI Floor Area: I Valuation: $2000
APN Number: 35611005.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:'� Date: 7'
RE: ROOFS:
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.
Signature of Applicant: Date:
AL1, ROOF COVERINGS TO BE CLASS "A" OR BF-TFER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safely Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air oualily Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Ileallh & Safety Code, Sections. 25505, 25533, and 25/5/,3,4. ^7
Ow /authori 9&eq' pate: /M/
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
I understand my plans shall be used as public records.
Licensed
CUPERTINO
12,0`(
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950143255
(408) 777-3228 • FAX (408) 777-3333 • building(G.cuoertino.Grn
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USE OF sm-OUPIFR ❑ MULTAFAAILY
BUILONG: ❑DOAa�R
PROTEGE IN WBDIAND ❑YES
URBAN rNrERFACE AREA � NO
PX=CT IN ❑ YES
FLOOD ROME ❑ NO
ISTHEBLDGAN ❑YES
EICHLER HOMM ❑ NO
DESCRIPTION OF WORK
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TOTAL VALUATION:
RECEIVED BY:
By Dry signature below, I c#tify to each of the follawiag: I am the property owner ar authorized agent to act an the property owner's behalf. I have read this
application and the ir¢brmariI have p 'tied is td have read the Description of Wark and verify it is accurate. I agree to comply with all applicable local
ordinances and sbm laws relmg g coos on. I authoria representatives of Cupertino m enter the abave-i tified perry far inspection pu@oscs.
Sigaara a of ApplicaottAgene Dae:
SUPPLEMENTAL INF TION REQUIRED
o "USE ONLY
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❑ STANDARD
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❑ LARGE
❑ MAJOR
MEPM scdpp_2011.doc revised 06121111