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11050045 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10230 DUBON AVE CONTRACTOR:RICHARD HARO PERMIT NO: 11050045 CONSTRUCTION OWNER'S NAME: YIU CHUN TSE&YUEN-YEE CHU 2150 MANGIN WAY DATE ISSUED:05/09/2011 E—/'sR'S PHONE: 4089105275 SAN JOSE,CA 95148 PHONE NO:(408)532-1755 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# :Z0 4 171 f— F rMECH RESIDENTIAL COMMERCIAL Contractor�2�e tea.r� j�� Date 5, S- 1 ) I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL TEMP POWER AT PERMANENT METER (commencing with Section 7000)of Division 3 of the Business&Professions LOCATION 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:$100 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34214050.00 Occupancy Type: 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 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,t applicant understands and will comply with all non-point source regulationsp the Cupertino Municipal Code,Section 9.18. Issued by: '"""— Date:J - y- Signature Date 5 'e3'11 L 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. 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, 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. 1 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 a 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,Sec ions 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 n or uthori d g -. become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 1 f 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 it -nify and keep harmless the City of Cupertino against liabilities,judgments, L and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with 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 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION MEP 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 �t1PEIhitINO (408)777-3228 •FAX(408)777-3333-buildinat7a.cupertino.org MISC ❑PLUMBING ❑MECHANICAL RIELF=CAL ❑MISCELLANEOUS PROJECT ADDRESS o23u P / *, � aPN ff OWNER NAME \ �/(�� PHONE &MAII [J /l - Z 7 a�f�,� mai 64" STREET ADDRESS /02 o Div CITY, STATE,ZIP CA 501 FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME RT Hor LICENSE NUMBER 5A 71 LICENSE TYPE BUS.LIC A ^��G7'-7� 06 J COMPANY NAME E-MAIL / FAX STREET ADDRESS 21:50 Ha hj t,,� t`J I , " CITY,STATE,ZIP � ` 4115-1 7 SJ PHONE�� ARCHTTECTIENGINEER NAME LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'SE OFor Duplex ❑ Multi-Family PROJECT IN wILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK TOTAL VALUATION: 0 By my signature below,I certify to each of the following: 1 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. I 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 buildin constructip . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant(AgenC ( ,- '`-- Date: SUPPLE INFORMATION REQUIRED e MEPMucApp_1011.doc revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10230 dubon ave. DATE: 05/09/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $100 "PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: PERMIT TYPE: WORK install temp power at permanent meter location. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $42 TOTALS: $42.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT LiOther Elec.Insp. 0.0 hrs $42.00 NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info, FEE ITEMS (Cee Resolution 09-051 Isf'. 1.-"I(1) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes Q No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg?Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50 Revised: 04/29/2011 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34214050 . 00 DATE ISSUED. . . . . . . : 05/09/2011 RECEIPT #. . . . . . . . . : BS000013395 REFERENCE ID # . . . : 11050045 SITE ADDRESS . . . . . : 10230 DUBON AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : YIU CHUN TSE & YUEN-YEE CHU ADDRESS . . . . . . . . . . : 10230 DUBON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : YIU C TSE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : YIU CHUN TSE & YUEN-YEE CHU ADDRESS . . . . . . . . . . : 10230 DUBON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 100 . 00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 100. 00 0 . 50 0. 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 .00 0. 00 1ERT<200 UNITS 1 . 00 42 . 00 0. 00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127.50 0 . 00 127.50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127.50 MC --------------- TOTAL RECEIPT 127. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER