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06100044 CITY OF CUPERTINO BUILDING DI VISION PERMIT 0WT0 ItMATI�N BUILDING ADDRESS: JOHNSTON ELECTRICAL CONT tr4f AD' 0 610 0 0 4 4 22106 DEAN CT PERMIT ISSUE DATE OWNER'S NAME: JIAN HE 1302 LINCOLN AVE, STE 204 1OZ06/2006 SANITARY NO. CONTROL NO. INE: (408) 266-0236 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1 o p LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing 2 71 with Section 7000)of Division 3 of the Business and Professio Co and my license is 'oy in full force nd r ELECTRICAL PANEL UPGRADE 125 AMP j ? License Lic.# t p Date Contractor i e ARCHITECTS DECLARATION C U 1 understand my plans shall be used as public records ,a I- Licensed Professional y OWNER-BUILDER DECLARATION 2<2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 703 1.3,Business and Professions Code:Any city or county e which requires a permit to construct,alter,improve,demolish,or repair any structure $1700 Z y prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation FE that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq ut_ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APMN P Occupancy Type not more than five hundred dollars($500). ❑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 Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for We.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J I have and will maintain a Certificate of Consent to self-insure for Workees Compcn- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worke' Cyf, ompensation Insurance carrier and Policy number arc: Carrier.��nT YC�9_1L\� � Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Qforthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 4 1 hereby affirm that there is a construction lending agency for the performance of pw> the work for which this permit is issued(Sec.3097,Civ.C.) L4 Q Lendcr's Name =z Lender's Address U 0 I certify that I have read this application and state that the above information is (L ► correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspccuon purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,cos n expenses which may in any way accrue against said City U z in consequenclogthe gran' g of this permit. Date r"h APPLICANTER ANDS AN I COMPLY WITH ALL NON- OI Issued by:E 1 Re-roofs Signature p rcant/ConKW arc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove :mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. LH- Yes have mad the hoz ws materials rcyuiremcnts under Chapter 6.95 of the Califor- &Safety Cade, ctions 25505.25533 and 4.I understand that if the building curve y have ant,Lha ' is y rcs iIny tonotify the occu tn t ccn which st x t orw i u a Ccrtificatc of ayp� d4Signature of Applicant Date 7 All roof coverings to be Class"B"or better r a orized agent Datc CITY OF CUPERTINO n 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35709033.00 DATE ISSUED. . . . . . . : 10/06/2006 RECEIPT #. . . . . . . . . : 36337 REFERENCE ID # . . . : 06100044 SITE ADDRESS . . . . . : 22106 DEAN CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JIAN HE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2723 RECEIVED FROM . . . . : JOHNSTON ELECTRICAL CONTRACTOR . . . . . . . : BRIAN JOHNSTON LIC # 23411 COMPANY . . . . . . . . . . : JOHNSTON ELECTRICAL CONTRACTOR ADDRESS . . . . . . . . . . : 1302 LINCOLN AVE, STE 204 CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408)266-0236 c,E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 64.29 0.00 64 .29 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 64.29 603 TOTAL RECEIPT 64.29 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL .................................ykif.........................------...................... ............. '�� '�0��30�20UB1$�:3� �Itli� 4U8 T77 3333 CITY CUPERTINO 001/001 CITY OF CUPERTINO CUPEI�TINO PEPJMn APPLICATION FORM ��A/ CutTINNO APN# 3,,5/ C> *' D'i'm`: Addms-, Mining Address(if from buildia; ): 2Z1C�3 � R r owls Namc: Phi#. � �y I 0 (Ac*,\ Contact: ` ]Phone: 4A U�S X�L,'01. cvpertino Iftumnam I i cen8at. \\ Fax:L4". Building Permit info: �_ Bldg ❑ Eled Phrmb ❑ MechJob Description- ❑ Rewd l 'n 1 �� c�1 I 1 ❑ Sq.Ft.Floor Area: SgXt-: 0cwpawCast of Project: 1100 100 Y = Te of on: Please chak tris box if the project is a 7n C r 1 �.a-story : 0 project size: Standad JZ lAaW ❑ Major❑ Fee ID Fee Dnw Fee Grr BAPPLOTHER Otter Appfimes MECHAMCAL BBOIIERl Boiler<_I 000 Btu NWiC IANICAL 5130ILFR2 Boik r>100K to 500K Btu MPCHM(CAL BBOILER3 Boiler>500K 101M Biu MECHANICAL BBOIIER4 Boilw>1M to 1.75 M Btu MECHANICAL BBOII.ER5 Boiler>1-75M Hm MECHANICAL BCONSTAX Consftuction Tax BUIL DIvG BCONSTAX BURDTIG BWNSTAXBQ Con.Taos for BQ Zone BLTUDNG BCONSTAXH Hate]and Motel BLM DIYG BCONSTAXR Canstax Rcsi/Mobile BUILDIYG BELEC1000 Elm 600V<—IOOOA ELECTRICAL BEI.RC1001 Else 600V>1000A LLEMW CAL BELFX300 Eke Svcs 600V<--200A 13LECTRI CAI. BENERGY Emu BUIL DIVG BENERGVADD Energy Add Multi BUMD1 VCI BINVESTIGA Investigation fee BUIId7NG 1 of 3