12060117 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10305 FARALLONE DR C01N"17LeC`FOIk:MICI[AHL SI IINING PERMI"1'NO: 12060117
CONS'IRUC'1 ON INC
OWNER'SNA?IE: %EN000ANANDI EYANYAN 39120ARGON'tUl WAYSTT145 DATE: ISSUED:06/19/2012
OWNER'S PHONE: 4083602587 FRE,NONT,CA 94538 PIIONF,NO:(511)791-19101
❑ LICENSED CON'ERACI'OR'S DECLARATION � r (-
7 BUILDING PERMIT INFO: BLDG ELECT' PLUMB
License Class �j Lie '' Cjc,q h-/
11 k: r r r
Cll RESIDENTIAL COMMERCIAL
Conlraclor,4�/(�q4k/ )4 /@ Dae 6 /y /2
I hereby affirm that l am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INS I ALI."I I-NIPORARI'POWER POLI:
(commencing with Section 7000)of Division 3 of the Business&Professions
Cade 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 lite
performance of lite work for which this permit is issued,
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.kl Floor Area: Valuation:51500
Section 3700 of the Labor Code,Ibr the performance of the work for which this
permit is issued APN N it m her:36931012,00 Or a pit cvl'vlie:
APPLICANT CER-f[FICA-PION
I cert ilN that I have read Ili is application and stale that the above information is
correct. Ia,,ree to comply with all city and county ord iminces and stale laws relating PERMIT EXPIRES IF WORK IS NOTSTARTED
to hu i Iding con slRaainn,and hereby authorize representatives of ill is city to enter
upon the above mcnt ioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indeinn i ljand keep harmless the City ol'Cupertino against l iabi I i I ies.judgments. 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
urznling ol'this permit, Additionally,the applicant understands and will comply
with eh non-point Source regulations per the Cupertino Municipal Code,Section
9
Issued by' Date:
-I8.
r
Signature Date�[y_�/�i
RE-ROOFS:
❑ OWNER-BUILDER DF-CLARA7"ION All roofs shall be inspected prior to any roofing material being installed. II'a roul'is
installed without first obtaining an inspection,I agree ht remove all new materials lis
I hereby affirm that l am exempt from the Contractor's License Law for one of inspection,
the following Iwo reasons
L as owner of the property',or my employees with wages as their sole compensation, Signature of Applicant Date
will do the work.and the structure is not intended or offered for sale(Scc.7044,
Business&Professions Code)
L as owner of flic property,am exclusively contracting with licensed contractors to ALL ROOF COVE:RINGS'fO BE CLASS"A" Olt IIE:fl'TR
construct the project(Sce.7044,Business&Professions Code),
I herehy affirm under penally of perjury one of the following three HAZARDOUS MA ITRIALS DISCLOSURE;
decla ra lions: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate ol'Consent to self-insure for Worker's California Ilealth&Safely Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,its provided for by Section 3700 of the labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the I Icalth&
performance o1'the work for which this permit is issued Safety Code,Section 25532(x)should 1 store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by additionally',should I nue equipment or devices srhieh emit hazardous air
Section 3700 of the labor Code for the performance of the work for which this conlaminants as defnwd by the Ilan Arca Air Qualily Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the perinrmancc ol'1hc work for which this permit is issued.I shall Ilealth&Safely Code.Sections 25505,25533.and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent:
Compensation laws of California. II',after making this certificate of exemption,I Darr,
become subject to the Worker's Compensation provisions of the Labor Code,I must
lonliw 111 comply with such provisions or this permit shall be deemed revoked. CONS IIll!(']ION LEN DING AGEV"i
I hereby allinn that there is a construction lending agency Ibr tlw pertornuace of work's
APPLICANT CERTI FICA rf[ON for which Ihis permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and stale that the above information is Lender's Name
correct. I agree to comply with all city and county ordinances and stale laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
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 ARCHITECT'S DECLARA HON
granting of this permit.Additionally',the applicant understands and will comply I understand my plans shall be osed as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9-I8. Licensed Professional
Signature Date
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng:- Sub: Blk: Lot:
APN . . . . . . . . : 36931012 .00
DATE ISSUED. . . . . . . : 06/19/2012
RECEIPT 4 . . . . . . . . . : BS000017111
REFERENCE ID' # . . . : 12060117
SITE ADDRESS . . . . ..: 10305 FARALLONE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER ZENG QUAN AND HE YANYAN
ADDRESS . . . . . . . . . . : 10305 FARALLONE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : KENNY-CHANG LU
CONTRACTOR . . . . . . . : MIN XIE LIC # 29748
COMPANY . . . . . . . . . . : MICHAEL SHINING CONSTRUCTION I
ADDRESS 39120 ARGONAUT WAY STE 165
CITY/STATE/ZIP . . . : FREMONT, CA 94538
TELEPHONE . . . . : (510) 791-1588
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, 500 .00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 1, 500 .00 0 . 50 0.. 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1,.00 119 . 00 0 . 00 119 . 00 0.. 00
1EPERMITFE FLAT RATE 1 .00 44 . 00 0 . 00 44 . 00 0 . 00
1ERT<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 293 . 50 0 . 00 293 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------------ ----- --------------- --------------------
CREDIT CARD 293 . 50 VISA
---------------
TOTAL RECEIPT 293 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
- --- - ------------------------ -- ---- - - -------------------------- - -
402 TEMPORARY POWER
FMCITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10305 farrallone dr. DATE: 06/19/2012 7V717E7W7ED BY: bobs.
IAPN: BP#: �0GjQ1 'VALUATION: $1,500
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1REAP14
USE: PERMIT TYPE:
WORK install temp power pole.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Temporary Power 1ERT<200 100 Amps $44
TOTALS: $44.00
/7„n , /2.” N...0. P/unCh,,A Flee. Plan Check 0.0 1 hrs $0.00
Jhah. 1'.•rwrO l'i•.•r _
1'6urrh. Poma Pccc Elec. Permit Fee: IEPERMIT
u br, Vn d,, Lwp Orhrr Plump lnsp. Other Elec. lnsp. 0.0 hrs $44.00
,Urr lr ln,p. l rr' Phrurb. hnP. /"L. FLs. la,p. l;r'
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the relimina information available and are onl•an estimate Contact the Dept for addn7 info.
FEE ITEMS (Fee RcsulWinn 11-053 lilt 7/1.111) FEE QTY/FEE MISC ITEMS
Plum ( lhrk I.rr-
PME Plan Check: $0.00
l'rrwN Pili'-
yup/,l. 111.1i., IrCC
PME Unit Fee: $44.00
PME Permit Fee: $44.00
C',ntcn nrrinn Trac:
Administrative Fee: IADMIN $41.00
Work Without Permit? O Yes (F) No $0.00
'Irh'unr cc/Ph ming F
Travel Documentation Fee: 1TRAVDOC $44.00 A
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
131de, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $174.501 $0.00 TOTAL FEE: 1 $174.50
Revised: 06/30/201
//1,G 6 L
1-2q�,
GENERAL PERMIT APPLICATION EP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 950143255 � '
CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(cDcuoertino.orD sc
h,\`0 6,0117
PLUMBING ❑MECHANICAL ELECTRICAL EINUSCELLANEOUS
PRDTECTADDRESS /T�'W` 4/Z P APN4 � j / 6
OWNER NAME 2LN CJ & AN F-r 41V PHONE 14O` '3 —,fir E-MAIL
STREET ADDRESS CT', STATE,ZIPS (fee
PY/7,1/y C FAX
i 3 orRAuaNt? Dr Lea 46
CO 1 NAMEE
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PHONE MAB.
STREETADDRESS C CTTY,STATE. ZIP FAX
9—OWNER ❑ OWNER-BIBIDER ❑ OWNER AGEINT 14-�ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCFDTECr ❑ENGINER ❑ DEVEI,OPEt ❑TENANT
CONTRACTOR NAME C (- _SH (1 LICENSENUMBER' Y� LICENSE TYPE BUS.LICK ��U�
COMPANY NAME I 4 E-MAIL FAX // o
STREET ADDRESS V��I.YU wp � ,C L}(CTTY.STATE,ZIP _ Z, I�U/11 CN (?( _PHONE4
�__... F'T 7
ARCNITECIYFNGBNEEIt NAME LICENSE NUMBER BUS.LIC R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SM.DUPLEX ❑ MULTI-FAMLLY PROIECTPIWIDLWU ❑ YES PROTECT IN ❑YES 6THE BLDG AN EJ YES
'BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLRHOME. [3 NO
DESCRlPnON OF WORX
u—x 057-
TOTAL
5TOTAL VALUATION: O� RECEIVED BY:
By my signature below,I certify to each of the following: I am the property awna or authorized agent to act on the prop er's behalf. i have read this
application and the information I have provided ilsorrect,4 have rad the Description of Work and verify it is accurate. I agree Pcomply with all applicable local
ordinances and state laws relating m buildin nstructiauthorize representatives of Cupertino to enter the above-i emi6ed PC.—.y;or inspection puiyoses.
Signature of Applicaut/Agenn Date:
SUPPL ORMATION REQUIRED OFFICE SEONLY
OFD-THE-COUNTER
❑ EXPRESS
u
❑ STANDARD
V
❑ L. CE
` ❑ MAJOR
MEPMIscApp_2011.doc revised 06/21/11