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12060131 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 20921 DUNBAR DR CON'FRACfOlt:TIL DEVELOPMEN I& PERNII"INO: 12060131 CONSTRUC'T'ION INC O\YNER'S NANIF-: SI IIUAN LBR 6172 BOLLINGER RD SfE 151 DATE ISSUED:06/21/2012 OWNER'S PI TONE: 4087689766 SAN JOSE.CA 95129 PHONE NO:(108).779.2831 on LICENSED CONIBACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lie.p 8 7� r r r \ MECII RESIDENTIAL CONI:NFRCL\I. Contractor U 6— Date (-/9-1 L 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INS"I ALL."I EMPORARY POWER (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penally 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 pro,ided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.FI Floor Area: Valuation:S1000 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 APN Number:32630163.00 Occupancv Typt. APPLICANT CF:R'1'IFICA'rION I certily that I have read this application and stale that the above information is correct_I agree to comply with all city and county ordinances and stale laws relating PERMIT EXPIRES IF WORK IS NOT STARTED 7th building construction.and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes- (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the gruming of thispennon. Additionally,the applicant understands and will comply /7 with all non-point source regulations per the Cupertino Municipal Code,Section Issued by- / Date: 9.18. Signature / C Date // Zi RF:ROOFS: ❑ OWNER-Rt1ILDER DECLARATION, All roofs shall be inspected prior to any roofing material hcing installed II a root'is installed without lint obtaining an inspection. I agree to remove all new materials for hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following h,a reasons: I,as owner of Elie property,or nn'employees with wages as their sole compensation. Signature ol'Applicant: Date: will do the work,and the stmcuoc is not intended or offered for sale(Sce.7044. Business&Prolessions Code) L its owner of the property.am exclusively contracting with licensed contractors to ALL ROOF COVERINGS'10 BE CLASS"A"OR BE 1-1 ER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm tinder penalty of perjury one of the following three HAZARDOUS,MATERIALS DISCLOSURE: declarations: I Imve read the hazardous materials requirements under Chapter 695 ol'tile I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534, 1 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 l Iealth& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emil hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance it ith the Cupertino Municipal Code.Chapter 9.12 and the P'u.nnit is issued. Health&Safely Cade,Sections 25505,25533,and 25534. 1 certily dun in the performance til the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Owner I r ulhnr`, a il: Compensation latus of California. If,after making this certificate of exemption.I Date: become Subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked CON'SIItUCI'ION LEN DING AGE:V I I hcrcbv aRinn than there is it construction lending agency lir the perlhrniance of hvurk's APPLIC:\NT CERTIFICATION' for which this permit is issued(Sec.3097,Civ C'.) I certify that I have read this application and state[hat the above information is Lender's Name 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 Lender's Address Upon the above mentioned property lot inspection purposes.(We)agree no save indemnity and keep harmless the City of Cupertino against liabilities,judgments. costs,and expenses which may accrue against said City in consequence of the :\RCIII'fE:C"I'S UECL:\Ii:VPION ,,ranting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18, Licensed Professional Signature Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32630163 . 00 DATE ISSUED. . . . . . . : 06/21/2012 RECEIPT # . . . . . . . . . : BS000017134 REFERENCE ID # . . . : 12060131 SITE ADDRESS . . . . . : 20921 DUNBAR DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . : : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SHIUAN LEE ADDRESS . . . . . . . . . . : 20921 DUNBAR DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : TR DEVELOPEMENT CONTRACTOR . . . . . . . : PAUL YANG LIC # 29369. COMPANY . . . . . . . . . . : TR DEVELOPMENT & CONSTRUCTION ADDRESS 6172 BOLLINGER RD STE 151 CITY/STATE/ZIP . . . : SAN JOSE, CA 95129 TELEPHONE . . . . . . . . : (408) 329-2631, 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 1BUSLIC FLAT RATE 1 . 00 119. 00 0 . 00 119 . 00 0 . 0.0 1EPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00 IERT<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 e AMOUNT REFERENCE NUMBER ----------------- --- ------------ -- ------------------ CHECK 293 . 50 2067 --------------- TOTAL RECEIPT 293 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------- --- -- -- - - 402 TEMPORARY POWER CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20921 dunbar dr. DATE: 06121/2012 REVIEWED BY: bobs. APN: BP#: .0 &O/Z -VALUATION: j$1,000 'PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION USE: pPERMITTYPE: 1REAP1 WORK install temp power. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERTc200 100 Amps $44 TOTALS: $44.00 v„d,. t'lrr„ r In r k 1,11"W, P/m.01or6 Elec. Plan Check 0.0 hrs $0.00 I1.•clr 1'rnni,/2�.•_ l'Iweb. Permit l4el Elec. Permit Fee: IF!'EnMIT r$1,(”Mv.h. bisp ndu-' l'Ir,ml,In"p. Other Elec. Insp. 0.0 hrs $44.00 11,e)' Ai gyp. lh're' Plumb_ bnp. I(". Fhv. 1"'p. 14x: NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc. . These fees are based on rite prelimina information available and are only an estimate Contact lire De t or arldn7 info. FEE ITEMS (Fee Re.solulion 11-059 Eff 711111) FEE QTY/FEE MISC ITEMS Plan ('1w(k l•rc: .�11p/)l. PC l rc PME Plan Check: $0.00 �u/qp/ 111'sp /.c,r• PME Unit Fee: $44.00 PME Permit Fee: $44.00 const)nrtiun l.u': Administrative Fee: (ADMIN $41.00 Work Without Permit? 0 Yes E) No $0.00 ,I rlrnn(eil Plalmir/�" F,rCS. Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131d]" Stds Commission Fec: IRCBSC $1.00 SUBTOTALS: 1 $174.501 $0.001 TOTAL FEE: $174.50 Revised: 06/30/201q2/) GENERAL PERMIT APPLICATION vMEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 950143255 �/ M I CUPERTINO (408)TT/-3228-FAX(408)T77-3333•buildina(a),cuoerdno.orD la(/l!/o� / sc []PLUMBING! OMFCRAMCAL Int FLAL ❑MISCELLANEOUS PROJECTADDRESS l7(f N# 3 OWNER NAMEIn PHONE L CJL D _ /y, C� 00 STREET ADDRESS�O CITY. TSL@ 0 FAX CONTACT NAME ' PHONE` O (I_ ��. �y� EMAII. STREETADDRESSI CITY, T$ ZB j FAX p- l.lVl� 1 Y_ - �� 1 . OwNFA ❑ Ow?E -BUDDER ❑.OWXER AGRrT ❑.coKmACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGDIEER 11 DEVELOPER ❑ TENANT CONTRACTOR NAME PaLj .LICENSE NUMBER ' Q l LICENSE TYPE BUS.LICM3� COMPANY NAME ,�Tov _.- JS yNc �¢ UUU 00 JJJ FAX (��`/7 ST=ADDRESS 6 l 12 /l•` �Z(/t,• slB.l . . 'CITY.STATE,Z@ �� Q PHONE/7=Ly ARCHTTECTIENGINEER NAME 7T LICENSENUMBER /-")�/\ BUS.TIC# COMPANY NAMEE-MAIL FAX STREET ADDRESS CITY,STATE ZIP PHONE USE OF 0sFn.ouPLEx ❑:MULTI-FAMD.Y j PROTECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUDAING: ❑COMMERML URBAN DITERFACE AREA ❑ NO FLOOD LANE ❑NO E]CW.FIt HOME? ❑ NO DESCRIPTION OF WORK vv �✓ TOTALVALUATION: (J'� RECEIVED BY: rj OSI 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 provided is coriecLL I have read the Description of Work and verify it is accurate. I agree m comply with all applicable local ordinances and state laws relating to building ctionl, o enn t.'M of Cupertino to enter the abo g-id tifiedpropet� For inspection puI'jsoses. Signature ofApplicandAgm Date: SUPPLMAIEWAL OURMATIONREQLJUCED OFFICE USE ONLY N LJ OVER-THE-COUNTER ❑ EXPRESS Y U N ❑ STANDARD U < ❑ LARGE L ❑ NWOR MBPMircApp_2011.doc revised 06/21/71