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10050107 CITY OF CUPERTINO BUILDING PERMIT COr TRACTOR:TBD-TO BE PERMIT NO: 10050107 BUILDING ADDRESS: 883 S TANTAU AVE DETERMINED DATE ISSUED:05/11/2010 WNER'S NAME: LIN PAN&LIHUI WANG PHONE NO: OWNER'S PHONE: 4086746658 ❑ LICENSED CONTRACTOR'S DECLARATION JOE DESCRIPTION: RESIDENTIAL COMMERCIAL SERVICE PANEL UPGRADE,REWIRE WHOLE HOUSE License Class Lie.# Contractor 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 Valuation:$5000 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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 APY Number:37538043.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF 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 DAYS FROM 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 Is!tied by: Date: 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. RE-ROOFS: nature Date Al I roofs shall be inspected prior to any roofing material being installed.If a roof is in:tailed without first obtaining an inspection,I agree to remove all new materials for impection. `® OWNER-BUILDER DECLARATION Si;nature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I nave 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 n aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: H ealth&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 n aterial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the a r contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. A ill maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25 5,255`33,/and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by V 7. (�N 0 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent. Date: 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 CONSTRUCTION LENDING AGENCY 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 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.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 *�building construction,and hereby authorize representatives of this city to enter rn the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION .aemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 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 -icensed Professional 9.18. V 0 Signature GZIr L "/ Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 37538043 . 00 DATE ISSUED. . . . . . . : 05/11/2010 RECEIPT #. . . . . . . . . BS000010383 REFERENCE ID # . . . : 10050107 SITE ADDRESS . . . . . : 883 S TANTAU AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LIN PIN & LIHUI WANG ADDRESS 883 S TANTAU AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : LIN PIN CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1. 00 1 . 00 0 . 00 0 . 00 1BREMFIXT NO. FIXTURES 1 . 00 63 . 00 0 . 00 63 . 00 0. 00 1BREMRECEP NO. OUTLETS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0 .50 0 . 00 0 . 00 lEPERMITFE FLAT RATE 1 . 00 42 . 00 42 . 00 0 . 00 0. 00 1ERT<200 UNITS 1 . 00 42 . 00 42 . 00 0 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 42 . 00 0 . 00 0 . 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT 232 . 50 127 .50 105 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CASH 105 . 00 105 . 00 --------------- TOTAL RECEIPT 105 . 00 CITY OF CL PERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM � s a--7 APN# Date: Building Address: � g3 T'ar61/1L Ave- Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work onl Yes ❑ No If es. rovide letter from HOA Owner's Name: ; 14i ,n,A �,n Phone#: Contractor: I , Phone: 6 Sb) 44q-- /�6 3 Fax: Co tractor License#: 9 17 Cupertino Business License#: Contact: Phone: Fax: Residential Q Commercial ❑ r�� I Job Description: Y � �� S�`V� Com, Building Permit Info: Bldg ❑ Elect �/ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, I-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B [ 1 — ' - Valuation: � Square Footage: Project Size: Express [gandard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 CITY OF CUPERTINO CInOF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stuc=co application 1 WINREP Replacement vindows/sliding glass B door (ea 8 wi:idows) 1WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) / IEPERMITFEE Electrical Pennit Fee E / 1MPERMITFEE Mechanical P,:rmit Fee M 1PPERMITFEE Plumbing Pennit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-standalone / 1BCBSC Cal Bldg Star dards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Com ercial B 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of:)-