13010017CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10140 BYRNE AVE CONTRACTOR: ZV CONSTRUCTION INC PERMIT NO: 13010017
OWNER'S NAME: YU -JEN WANG 909 SAN RAFAEL AVE DATE ISSUED: 01/02/2013
OWNER'S PHONE: 7343899563 MOUNTAIN VIEW, CA 94043 PHONE NO: (650) 213 -6512
❑ LICENSED CONTRACTOR'S DECLARATION
License Class i Lic. #
Contractor) (' �'� Lr I E N Date L
I 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.
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 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 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 liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
grantin ermit. Additionally, the applicant understands and will comply
with II non -po' source re u ations per the Cupertino Municipal Code, Section
9.18.
Signature Date Z" ^
❑ 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)
l; as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty 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 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 Worker's
Compensation laws of California. 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 this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I 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 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 regulations per the Cupertino Municipal Code, Section
9.18. \ _ ----, )
Date
BUILDING PERMIT INFO: BLDG T— ELECT I— PLUMB r-
MECH r— RESIDENTIAL I— COMMERCIAL f—
JOB DESCRIPTION: INSTALLALTION OF TEMPORARY POWER POLE (200
AMP)
Sq. Ft Floor Area: I Valuation: $500
APN Number: 35716046.00 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: _ /�= ,l t� �G C Date:
3
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:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I 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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building0cuoertino.org
F-IPLUMBING 7MECHANICAL WILECTRICAL ❑MISCELLANEOUS
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❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME . -i
LICENSE NUMBER e y
LICENSE TYPE `
BUS. LIC #
COMPANY NAME
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PHONE
ARCHrrECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME '
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STREET ADDRESS
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USE OF SFD or DUPLEX ❑ MULTI - FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA NO
PROJECT IN ❑ YES
FLOOD ZONE 110
IS THE BLDG AN ❑ YES
EICHLER HOME? or O
DESCRIPTION OF WORK
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TOTAL VALUATION: 1 —
RECEIVED BY: /
By my signature below, I certify t�ii con e following:
application and the information I hed is corre
ordinances and state laws relating on.
Signature of Applicant/Agent:
I pro rty owner or authorized agent to act on the property owner's behalf. I have read this
have r the Description of Work and verify it is accurate. I agree to comply with all applicable local
epresentatives of Cupertino to enter the aboye-jdenti ed proper ty for inspection purposes.
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Date: 2
SUPPLE INFORMATION REQUIRED
OFFICE USE ONLY
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MEPMiscApp_2011.doc revised 06121111
/ 7
WN CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS. 10140 Byrne Ave
DATE: 01/02/2013
REVIEWED BY: Sean
UNITS
APN:
BP #:
*VALUATION: $500
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
Amps
PENTAMATION 1REAP14
I PERMIT TYPE:
woRK
Installation of temporary power 200 amp).
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Temporary Power
1 ERT <200
200
Amps
$45
PME Unit Fee:
$45.00
PME Pennit Fee:
$45.00
F71
Administrative Fee: IADMIN
$42.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
F
A
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
T-1 Elec. Plan Check 0.0 hrs $0.00
. Elec. Permit Fee: IEPERMIT
Other Elec. Insp. F0.0 I hrs $45.00
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
T11ot.. # osn 1 T/ - f — — hnaod nn fho nra /%n1lnary )nfnrma/!n" avallahlo a"d aro nn/v an owimatO_ Cantart thB Dent for addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Ejf. 7111121
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$45.00
PME Pennit Fee:
$45.00
F71
Administrative Fee: IADMIN
$42.00
Work Without Permit? 0 Yes (j) No
$0.00
A
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$178.50
$0.00 TOTAL FEE:
$178.50
Revised: 10/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 - 777 -3333
JOB ADDRESS: N ' C
ale- , Ci.
PERMIT #
OWNER'S NAME: '` ;&, -.
PHONE # SU 113 6S7
GENERAL CONTRACTOR:
9 u' l C f j C 'c:
BUSINESS LICENSE #
ADDRESS: ()0` <*"
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CITY /ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date