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12080252 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11456 LINDY PI, CONI'RACFOR:K I CONSTRUCTION PERMIT NO: 12080252 ON'NEIVS NAME: WU ISIIAN AND MIN WANG'FRUS'1'Eli 1045 SYCAMORE.DR DA'Z'E ISSUE[):082312012 OWNER'S PHONE: 4082558890 MILLBRAE,CA 94030 PIIONF.NO:(650)8734878 ❑ LICE,NNSED CON"I'RACFOR'S DECLAARATIIIO'f N BUILDING PERNIIT INFO: BLDG r ELECT C. PLUMB r License Class � - e?, Lic.H '`T 3 1� 3 1 r F-1r y .1 NIECII RESIDENTIAL COMMERCIAL rContractoYt S • (\ A. �+-lC�ate 13 � y, hereby affirm that l am licensed under the provisions of Chapter 9 •JOB DESCRIPTION:SERVICE UPGRADE TO 200 AMPS (commencing with Section 7000)of Division 3 of the Business&Professions Code and Thal Illy license is in rut]force:nal effect. I hereby affirm under penally of perjury one Of the following two declarations: I have and will maintain it 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 Sq, Ft Igor Area: Valuation:$2500 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the per(0rnumce of die work for ehich this permit is issued. AI�N NMnnber;35624009.00 Occupancy T)pe: APPLICANTCIiRTI FICATION I certify that I have read this application and state that the above in(ornmion is correct.l agree to comply with all city and county ordinances mid stale laws rel acing PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby mahorize representatives of this city to enter upon[lie above mentioned property for Inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR inceinnify and keep harmless the City ofCupertino against liabiliticsJudgillents, Igo DAYS FROM LAST CALLED INSPECTION. 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 regulations per the Cupertino Municipal Code,Section Issued In Date F_Z 9.18. Signature Dale RE-ROOFS: ❑ ON'NEIR-11111 LDE R DECLARA'T'ION 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 1 hereby affirm that Ian csempt from the Contractor's License law formic of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole conmpensation, Signature of Applicant: Date: will do Ilse work,mid lime structure i5 not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). hereby affirm under penalty of perjury unc of the following three HAZARDOUS NLNT'ERIAI S DISCLOSURE declarations: I have rend the hazardous materials requirements under Chapter 6.95 of the I have and will Maintain a Certificate of Consent 10 sdf-insure for Worker's California I Icalth&Safely 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 I Icalth& 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 emit hazardous air Section 3700 of the Labor Code,for the performance of the work Ibr which this contaminants its defined by the Bay Area Air Qualily Management District I will permit is issued maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth&Safety Code.Sections 25505.25533,and 25534. 1 certify that in the performance of die 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 r u aSt lnorized agent: u1 _ Compensation laws of California. If,after making this cenilicatc of exemption,I Date: A* become _e-J 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. CONS'1 RUC`T'ION LENDING AGENCY I hereby aff tin that there is a construction lending agency for the performance of work's A PPT.TCNNf CERTI FICATTON for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and slate that the above information is Lender's Name correct.I agree to comply with all city and county ordinances mid state 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 sae indemnity and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may acerae against said City in consequence of the ARCHITE.CI"S DECLARATION granting of this pennil.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-paint source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date -2--0 $ 0 GENERAL PERMIT APPLICATION C COMMUNITY DEVELOPMENT DEFARTMENi• BUILDING DIVISION MEP 10300 TORRE AVENUE •CUPERTiNO, CA 95014-3255 M MMISC CUPERTINO (408) 777-3228 • FAX (408)7777-3333 • buildinC(CDCUDeruno.orO �I ❑?LLrN9D•IG I�NEC1=aN/C.L j��LEC�IC—I L:�CiSC=L�*IEOUS ?RGi-_ri-:'DR=S �(� I .iN: 2r(o_ �`� c, OW`NERNAAL S/ H/A-rJ �vIr,� FROM= �o& /�S,9v S�=ADDIZSS I I�Sb L IIJ b� L I CITY, SLANT' CONTAC,- NAM=_ I FHONE MA? S'i R?=:ADDA35S .,,� Caa.T STA-= I FAX ❑ OwNER.RUODEt ❑ OWN A=T C('1 pNF•AACT00. ❑CON,-ii =R A=- ❑ ARCvT_r ❑E-G= ❑ DEVa.OPa ❑ T•cNANr CON-,ICTOR NAAff L = LBE64 - CETP_ BUS.LC B 8 (j COMPANY NAME ` ', i , I E-MAIL I FAX`l-•SU - 6 7 3-y-D'7'� b,?=ADDRESS / / 1 CTFY,sur L � X . ARG:Ti�r4G - I UCLNSE\RAO3ER BUS.LCB CONSPANY NAAE'' I E-N.AII. I FAX SfRPFF ADDRESS I CITY,STA-,L PHONE u OF SFDaDLTLZX ❑ M --FAAMY PROJECT,NW I-AAM ❑ YES' I FRCfEc.,a1 (3 YES I IS THE SLOG.W ❑ ys atI Na: ❑COW'MRCLAL bA Dr c0.PACE AREA ❑ NO FLOOD ZANE ❑NO EC:1 HoM ❑No DSG713-ION OF WORK Cl'�t�'✓`E ��C-'"(12lc,tl-L REN TOTAL VA-UArION: '1 SAO• � � I RECE-- BY: 3y my sip.a_-e below,I eT:y W each of the tol!owing: I aro;he orooc-y owns,or ac;herir_d 2g-m-, o ac:on;he orope..y owner's bihaH. I have read this' anpucadon.and the information I have provided is come-, I have read the Descipton o;Work and verify it is acs..-ie. I apse io comply with all applicable local ar�ravices and scats Taws te!adng In,bui!ding corsn;cdon. I xuthonu¢prescadvcs of Caper-'.=c:c^,,the abc'!-id=6:':e3 pm e.-1 for inspection pu�escs. Sigaamm of ApplicntlAgenC Dz;a: SUFPL'c?vIENTaL INFOTk7L4T7-ON REQUIR=D OFFICE USE ONLY ❑ OVER-THE-COUNTER ❑ EXPRESS U J ❑ STANDARD V ❑ LARGE ❑ NWOR 2k PMuc!pp_2011.doc revised 06111111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 11456lindy pl. DATE: 08/23/2012 REVIEWED BY: bob s. :21 APN: BP#: 'l'ALUATION: $2,500 *PERMIT TITE: Electrical Permit PLAN CUECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1REAP2 USE: PERMIT TYPE: WORK service upgrade to 200 amps. SCOPE APPLIANCE./EQUIP TYPE FEE ID QTl' UNITS 13P FEES Services 1ERT<200 200 Amps $45 TOTALS: - $45.00 ,Meth. Plan Check Plumb. Plan Check Elec. Plan Check 1 0.0 1 hrs $0.00 Alech.Permit Fee: Plumh.Permil Fee: Elec. Permit Fee: IEPERAtT of u'-Afech.Insp. Daher 1'lumh Insp. Li I Other Elec.Insp. 0.0 hrs $45.00 Adech.Insp. Fec: Month. hasp.Fee: Elec.tap. Fee: NOTE: This estimate sloes nor includejees due to other Departments(i.e. Planning, Public Works, Fire,Samimry Sewer District,School District,etc.). These feLv are baser/on the prelinfinarl information available and are onh,an estinmte. Contact the De t or adeln 7 info, FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. bap Fee PML' Unit Fee: $45.00 PM8 Permit Fee: $45.00 Consnvction Tat: 177 Administrative Fee: IADAHN $42.00 Work Without Permit? O Yes (F) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA VDDC $45.00 i Su'one Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item I31de Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $178.50 $0.001 TOTAL FEE: $178.50 Revised: 07/01/2012