13060006 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10494 N STELLING RD CONTRACTOR:ONE HOUR HEATING PERMIT NO:13060006
AND AIR
OWNER'S NAME: XIA ZHAO 1400 PETALUMA HILL RD DATE ISSUED:06/03/2013
OWNER'S PHONE: 6505202976 SANTA ROSA,CA 95404 PHONE NO:(707)545-1800
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALEI
License ClassCtO C Zo Li..# W6—! [ 'T 125 AMP PANEL UPGRADE
—
Contractor Date3. _
I hereby aoifinwa m licensed under the provisions of Chapter 9
(comme 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:53000,
Ihave 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 APN Number:32630100.00 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 DA F M 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 theG 31..
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
= with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/_2 RE-ROOFS:
Signature Date (7 7 3 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.
❑ OWNER-BUILDER.DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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)
1,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(x)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,Sectio 505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date•6-`3-Y3
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 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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
GENERAL PERMIT APPLICATION
MEP
[is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ��
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinaCU)cupertino.ora 0misc
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
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USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK V_ WLC ,`SOZ MRO 'P L O r7'""d.n P
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TOTAL VALUATION: ✓� RECEIVED BY: ILI
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the properig 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 traction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: 6 -3-13
MENTAL INFORMATION REQUIRED OFF_tkASE ONLY
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MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10494 N STELLING RD DATE: 06/03/2013 REVIEWED BY: MENDEZ
APN: BP#: "VALUATION: $3,000
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP2
USE: PERMIT TYPE:
WORK 125 AMP PANEL UPGRADE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services IBELEC200 125 Amps $45
TOTALS: $45.00
WE
k,ch.Plan Check Phimb.Plum Check Elec.Plan Check 1 0.0 1 hrs $0.00
Altech..Perwit Fee; Plural}.Permit Fee: Elec.Permit Fee: IEPERMIT
Other;L9ecrh.Insp. Other Plumb Insp. Lj Other Elec.Insp. Li hrs $45.00
Allech. Imp. Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onlyan estimate. Contact the Deptor addn'1 in o.
FEE ITEMS(Fee Resolution 11-053E . 7ff 11112) FEE QTY/FEE MISC ITEMS
Plan Cheep Fee:
Suppl. PCT-ee .
PME Plan Check: $0.00
PeYtnit Fee:
Suppl. Insp 17ee
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Construction :Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? ® Yes e) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $45.00 i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
_
$ 78.501 $0.00 �E $178.50
Revised: 04/29/2013