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11050186CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6057 SHADYGROVE DR I CONTRACTING, -I ELECTRICAL I PERMIT NO: 11050186 I OWNER'S NAME: ZHENGTIAN GU 1819 POLK ST STE 236 DATE ISSUED: 05/23/2011 ER'S PHONE: 4089902799 I SAN FRANCISCO, CA 94109 ! PHONE NO: (415) 573-5522 I ❑ LICENSED CONTRACTOR'S DECLARATION License Classsc- i( () Lic. # ! 3 �. q O Contractor iI IJ h� i` L. L, ' Ka N!/ Date L i 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 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. Signature �� Date L OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with Iicensed 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 1 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 inify and keep harmless the City of Cupertino against liabilities, judgments, 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. Signature Date BUILDING PERMIT INFO: BLDG r ELECT PLUMB f— MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: INSTALL EVC CHARING STATION INCLUDES NEW 30AMP BREAKER Sq. Ft Floor Area: I Valuation: $1200 APN Number: 37540005.00 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: Date: 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 Appl 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 a thorized 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona 5 ITEMS OF 10 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37540005.00 DATE ISSUED.......: 05/23/2011 RECEIPT #......... BS000013537 REFERENCE ID # ...: 11050186 SITE ADDRESS .....: 6057 SHADYGROVE DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ZHENGTIAN GU ADDRESS 6057 SHADYGROVE DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: ROBERT F WHITEAKER CONTRACTOR .......: ROBERT WHITEAKER LIC # 32218 COMPANY ..........: A-1 ELECTRICAL CONTRACTING, IN ADDRESS ..........: 1819 POLK ST STE 236 CITY/STATE/ZIP ...: SAN FRANCISCO, CA 94109 TELEPHONE ........: (415) 573-5522 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 1,200.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BREMMISC EACH 1.00 126.00 0.00 126.00 0.00 1BSEISMICR VALUATION 1,200.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 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 ---------- 211.50 ---------- 0.00 211.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 423.00 --------------- 423.00 REFERENCE NUMBER -------------------- #1326 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO FFF FQT><MATnR _ RTTTT,IIING DIVIRION APPLIANCE / EQUIP TYPE ADDRESS: 6052 shadygrove dr. DATE: 05/23/2011 REVIEWED BY: bobs. UNITS APN: BP#: "VALUATION: J$1,200 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p # PENTAMATION 1 REAP7 PERMIT TYPE: WORK install evc charging station include new 30 amp breaker SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Apparatus 1BREMMISC 1 # $126 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $126.00 Stronn Motion Fee: IBSEISMICR Elec. Plan Check 10.0 1 hrs $0.00 Elec. Permit Fee: 1EPERMIT I Other Elec. Insp. 1 0.0 1 hrs 1 $42.00 1 1 7/1 Ir V. TG,...,. f ,... .. ., G.......1 n.. if. Cnntart tilo Dont for Qddn �l info. FEE ITEMS (Fee Resolution 09-051 Eff. 7;'1;101 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $126.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes G No $0.00 A Travel Documentation Fee: ITRA VDOC $42.00 Stronn Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 1 SUBTOTALS: $211.50 $0.00 TOTAL FEE: $211.50 Revised: 04/29/2011 i� �� t vte ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org CUPERTINO l o o�7 PROJECT ADDRESS J _ APN # Ll 0 0 (� 5 OWNER NAME Z C CT 1 l N PHONE (i )O i L V E -MAI Y STREET ADDRESS r Jv, Com, ST FAX CONTACT NAME bP ( �� '16An PHO r j- 7 E-MAU, I STREET ADDRESS [ f(/� � I / 1 CITY UTE, ZIP � y FAX ❑ OWNER ❑ OWNER -BUILDER CJ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBS LICENSE TYPE, u BUS. LIC #-22�-7 �I I COMPANY NAME E-MAIL FAX STREET ADDRESS C/f ` D( u f CITY, STA ,ZIP ` PHONE r r_) J ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi -Family PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No STRUCTURE: ❑ Commercial ❑ SOLAR PANELS 1 ❑ ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: DESCRIPTION OF WORK 7—,q 1 ( ? V G�� 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. 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 onstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL TION REQUIRED t>v.f� tFSE©IQIkIt PVApp_2011.doc revised 03/16/11 J LUPI FMINO NnY PROJECT DATA - RESIDENTIAL Cot�tM BUILDING VELOPMENUDERTINO T BUILDfN�GrDIVISI�N - CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISu�tPrROVED 10300 TORRE AVENUE - CUPERTINO, CA 9531*32tbf plans and specificabior - MUST bQ kPnt at the (408) 777-3228 - FAX (408) 777-3333 - buildin A�?06�E constriction. It is,unlawful to aja:..c- u;,y " I INS or alterat'Ons on F£:li ne, or to deviate therefrom, without app; oval from the Building Official. Floor Area: First Floor: Second Floor: Garage TOTAL: Existing Proposed s.f s.f s.f s.L s.f s.f. s. . Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y N Governing Codes: 2010 California Building Code (based on the 2009 International Building Code) 2010 California Residential Code (based on the 2009 International Residential Code) 2010 California Plumbing Code (based on the 2009 Uniform Plumbing Code) 2010 California Mechanical Code (based on the 2009 Uniform Mechanical Code) 2010 California Electrical Code (based on the 2009 International Electrical Code) 2010 California Energy Code 2010 California Green Building Standards Code Cupertino Municipal Code ProjectData-Residential.doc revised 03/09/11 C