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11090154 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7530 BOLLINGER RD CONTRACTOR:G.M.ELECTRIC PERMIT NO: 11090154 OWNER'S NAME: XIE YING AND XU YI 535 BOBBY'S LN DATE ISSUED:09/21/2011 OWNER'S PHONE: 4085062121 HOLLISTER,CA 95023 PHONE NO:(408)592-5306 LICENSED CONTRACTOR'S DECLARATION ( F/ v BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C�(� Li,.# ? SO 0 MECH RESIDENTIAL COMMERCIAL Contractor�IO I C Date 9 , a/, go[/ 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SINGLE FAMILY DWELLING SERVICE UPGRADE (commencing with Section 7000)of Division 3 of the Business&Professions **SEE NOTES** 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 Sq.Ft Floor Area: Valuation:$2200 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number:35924005.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued b --� -� Date: Si nature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Ovvprrorauth iz agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, c—ts,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit.Additionally,the applicant understands and will comply all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35924005 . 00 DATE ISSUED. . . . . . . : 09/21/2011 RECEIPT #. . . . . . . . . : BS000014820 REFERENCE ID # . . . : 11090154 SITE ADDRESS . . . . . : 7530 BOLLINGER RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER XIE YING AND XU YI ADDRESS 7530 BOLLINGER RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GARY L GARCIA CONTRACTOR GARY GARCIA LIC # 31311 COMPANY G.M. ELECTRIC ADDRESS 535 BOBBY'S LN CITY/STATE/ZIP . . . : HOLLISTER, CA 95023 TELEPHONE (408) 592-5306 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 2, 200 .00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 2,200 . 00 0.50 0. 00 0 .50 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 174 .50 0 . 00 174 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 174 .50 MC --------------- TOTAL RECEIPT : 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7530 bollinger rd. DATE: 09/21/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$2,200 °PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK sfd service upgrade. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $44 TOTALS: $44.00 --[Elec.Plan Check 0.0Trs $0.00 - Elec.Permit Fee: IEPERMIT Other Elec.Insp. 0.0 hrs $44.00 NOTE. This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Theseees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn 7 info, FEE ITEMS (Fee Resohytion 11-053Iff' 7'1/11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 7F Administrative Fee: ]ADMIN $41.00 Work Without Permit? Q Yes E) No $0.00 Travel Documentation Fee: ITRAVDOC $44.00 StronL Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: $174.50 Revised: 09/02/2011 I � � C), GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333• building(d)cupertino.org MISC PROJECT ADDRESS ❑PLUMBING ❑MECHANICAL LECTRICAL []MISCELLANEOUS �� S 3 0 APN#t r U if r OWNER NAME PHONE..h�� E-MAIL i ry STREET ADDRESS_ v ' C CTG( IP ! rATF FAX CONTACT NAME v� EMAIL Cf Pxo d - Q STREETADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT ONSCTOg , Ll;E NUMER 0 LICIISE TYPE BUS.LIC# a� f. COMPANY NAME _ E- r G �FjA.X GS 3 6jl-`13.3 STREET ADDRESS CP STA/ lZIP �6" PHONE2`3S 0 1t/ t— O � � c5�f/ CG"•. �Q d — J /�i' S�d(U ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 4afFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK G J dC m cs Qeft -2 TOTAL VALUATION: �L G V RECEIVED BY: 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 correct.j have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to uilding construction`I thorize repre5entatives of Cupertino to enter the above-identified property for inspection poses. Signature of Applicant/Agent: Date: SUPPLE NTAL INFORMATION REQUIRED OFFICE USE ONLY ' OVER-THE-COUNTER Y ❑ EXPRESS U w ❑ STANDARD U ❑ LARGE c. ❑ MAJOR 1EPMscApp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 [;-:U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: .2 5 3 d d t i c r p PERMIT# OWNER'S NAME: `f`ti ; E PHONE# O - �� a- �� Q GENERAL CONTRACTO : cI BUSINESS LICENSE# ADDRESS: S 3 `S �. r r,- 50 CITY/ZIPCODE: 7-5-C 3 *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: U -Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Ih 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