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10120066 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10737 LINDA VISTA DR CONTRACTOR:JSC CONSTRUCTION PERMIT NO: 10120066 AND GENERAL OWNER'S NAME: HENRY CHEN 2203 WOODLAND AVE DATE ISSUED: 12/10/2010 JWNER'S PHONE: 4084243842 SAN JOSE,CA 95128 PHONE NO:(408)221-1005 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class L^ Lie.# � l MAIN PANEL UPGRADE TO 200 AMP Contractor e l_' c T'P'L-Date 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. Sq.Ft Floor Area: Valuation:$1800 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:35607010.00 Occupancy Type: APPLICANT CERTIFICATION T' It I certify that I have read this application and state that the above information isPERMIT E F WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITH 180 DAYS bF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the P/1 0 granting of this permit. Additionally,the applicant understands and will comply Issu by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. J-0ROOFS. Signature i Date DG l�b—�� All roofs shall be inspected prior toofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this �) _�() - permit is issued. Owner or authorized agent: u� Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 lemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35607010 . 00 DATE ISSUED. . . . . . . : 12/10/2010 RECEIPT #. . . . . . . . . BS000012210 REFERENCE ID # . . . : 10120066 SITE ADDRESS 10737 LINDA VISTA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER HENRY CHEN ADDRESS 10737 LINDA VISTA DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4019 RECEIVED FROM . . . . : PAUL HARVEY CONTRACTOR RICHARD JOHNSON LIC # 30737 COMPANY JSC CONSTRUCTION AND GENERAL ADDRESS 2203 WOODLAND AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE (408) 221-1005 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 800 . 00 1. 00 0 .00 1 . 00 0. 00 1BSEISMICR VALUATION 1, 800 . 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 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: i PERMIT# OWNER'S NAME: HFr\jz N PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: 1 ,O CAC0-0('X CITY/ZIPCODE: ()t6� *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: V 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 SERVICE CUPEf�TINO PE IT APPLICATION FORM (_1 t Ki �2G-!:� 1012. MLO(P APN # Date: 016 .OU 0 - �O Building Address: 10 —7 —7 LO N [)A Owner's Name: Phone#: Contractor: Phone#:�'2;,i- 5 G Fax #: Contact: Phone#:ct) ^ S(off - 'a'AQ Fax #: Contractor License#: Cupertino Business License#: Job Description: U Qb AAA-IA) P R ti C' - Residential Commercial ❑ Valuation: ' n C) Project Size: Express K Standard ❑ Large Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P ICPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P ICPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09