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11010009 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10625 JOHNSON AVE CONTRACTOR:SKYLER CHANG&HUI PERMIT NO: 11010009 HUANG OWNER'S NAME: SKYLER CHANG&HUI HUANG 10625 JOHNSON AVE DATE ISSUED:01/03/2011 ( ?R'S PHONE: 4087779333 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION / BUILDING PERMIT INFO: BLDG ELECT PLUMB � License Class ;V) ) Lic.# MECH RESIDENTIAL COMMERCIAL Contractor /�/L1 p� Date 10-0 1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEMP POWER POLE-NEW CONSTRUCTION (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. Sq.Ft Floor Area: Valuation:$500 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. APN Number:37527014.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 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 b -" �� "` Date:/_�/// 9.18. 1 Signature Date Date I �, RE-ROOFS: L OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is 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). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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 Health& 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 for which this 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 p Health&Safety Code,Sections 25505,25533,and 25534. 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 O W or�au�thoo d��ageY t� f Compensation laws of California. If,after making this certificate of exemption,I � c�1lr�►t`i f/�' _ Date: jl 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save ir' -mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION i xnd expenses which may accrue against said City in consequence of the gnuaing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10625 johnson ave. DATE: 01/03/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: $500 ;PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex 1C17:`Il. PENTAMATION 1 REAP14 USE: 1-T O€ R.t h l_ PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $42 TOTALS: $42.00 Wch. Plan C:h�rck 1111frtth. Plmq C h"(A Elec.Plan Check 0.0 hrs $0.00 F/cch, I'c>rm;!f"c>r>: t'tr rrtl3. Pi.rmlf T'acr; Elec.Permit Fee: IEPERMIT Oflwr lkch. Tnsp. F-1 1- F-1 I Other Elco,Insp. L2.Oi hrs $42.00 11"(P, hill). t a< ( t rr;h. h 4j;. F""': 1,`iec fust,. Fce NOTE. Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Lee Resolution 09-05I Eff. FEE QTY/FEE MISC ITEMS I'ltrrr Check f�-�,�,. Suppl. P("Fee PME Plan Check: $0.00 Permit F cc: Supp/. last IFeo PME Unit Fee: $42.00 PME Permit Fee: $42.00 Corzsrf•rrcliorz TdV ,t<:oustical 12eviciv FeV, Work Without Permit? 0 Yes No $0.00 Planning Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SITBTOTALS: $127:50 $0.00 TOTAL FEE: $127.50 Revised: 12/07/2010 • Y CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37527014 . 00 DATE ISSUED. . . . . . . : 01/03/2011 RECEIPT #. . . . . . . . . : BS000012368 REFERENCE ID # . . . : 11010009 SITE ADDRESS . . . . . : 10625 JOHNSON AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SKYLER CHANG & HUI HUANG ADDRESS . . . . . . . . . . : 10625 JOHNSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DP CONSTRUCTION CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : SKYLER CHANG & HUI HUANG ADDRESS . . . . . . . . . . : 10625 JOHNSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 500 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 500 . 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 VISA --------------- TOTAL RECEIPT 127 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: v PERMIT# d OWNER'S NAME: PHONE# GENERAL CONTRACT BUSINESS LICENSE# ADDRESS: 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 Date Please check applicable subcontractors and complete the following information: 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 CITY OF CUPERTINO TEMPORARY PERMIT COF CUPERTINO PERMIT APPLICATION FORM APN # �. � Date: J �67 l� Original Permit# Building Address: Owner's Name: Phone #: S k-9�- 40 9 - -777-1 X 3 3 Contractor: Phone #: 40 6S:-5- D,//� Fax#: Contact: Phone #: 4o� - 6 ss-q Contractor License#: 0�,3 Cupertino Business License #: 2 X11/v Job Description: 7L yr p01___J4"p _f � N Valuation (cost of project): Type of Construction: LZLA Project S' • Over thle Counter Quantity Fee ID Fee Description Fee Group Permit Type 1TEMPPMT Temporary Permit Good B 1TEMPPMT (Flat Fee) for 30 days —Commercial only. 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 01/07/09