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13060120 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22481 WALNUT CIR SOUTH CONTRACTOR WQ&—Tm BE PERMIT NO: 13060120 OWNER'S NAME: SIU RYANhc-�t�l �� DATE ISSUED:06/14/2013 OWNER'S PHONE: 4082674858 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALO License Class Ci—Lo �"Lic.# �� /� \S UNIT B-SERVICE PANEL UPGRADE 200 AMP Contractor �, �'�14.1�- 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:$1000 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 APN Number:35703047.00 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 00 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 DM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expe ses which may accn► ainst said City in consequence of the granting of s ermit. may the applicant understands and will comply Issued by: Date: with all non- o' t source regul=Date o Municipal Code,Section 9.18. ^l� RE-ROOFS: Signature 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) 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 hazalrdous 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 a Bay Area Air Q ality Management District I performance'of the work for which this permit is issued. will maintain compliance with the upertino M r pal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec'o s 5505,255 and 5 4. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: yl 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,atter 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 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \Q 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O CUPERTINO (408)777-3228•FAX(408)777-3333•building(a)cupertino.org \� MISC ❑PLUMBING ❑MECHANICAL 12fELECTRICAL []MISCELLANEOUS PROJECT ADDRESS �� %OUT" Q.1 t. APN# ()S c`, 1-1 OWNER NAME � �vl�� SIJ P O �`�� Q, EMAE-MAILyCCN �. 2 ( S\v`tAte4s440AL , STREET ADDRESS CITY, TATE,ZIP FAX e1l.Tu\dV CIA, - CONTACT NAME �2 P SIE E-MAIL J ETN IJ Y! STREET ADDRESS CITY,STATE,ZIP FAX \'1 vi �c-ts1N o(>v SIS 1 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICEN t(SkLIC SE TYPE BUS.LIC# COMPANY NAME E-MAIL � � �J1� FAX STREET ADDRESS ` CITY,STATE,ZIP t��T PHONE L 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 WHALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION 0WORK TOTAL VALUATION: RECEIVED Y: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on oper[y owner's behalf. I have read this application and the information I have p qZided is correct. I have re Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' g onstruction. I au rize resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: `l Date: �� `�� SUPPLEMENTAL INFO A REQUIRED OFFICE u OVER-THE-COUNTER E" ❑ EXPRESS U ❑ STANDARD U ❑ LARGE P. ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: 1$1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: p PERMIT TYPE: WORK service panel.upgrade 200 am SCOPE Xlech. Plan Check Phimb.Plum Check Elec.Plan Check 0.0 hrs $0.00 Nlech.Permit Fee: Plumb. Permit Fir(': Elec.Permit Fee: IEPERMIT Other Afech.)nap. Clther Plumh Insp. Other Elec.Insp. 0.0 hrs $45.00 Afech. Insp.Fee: Plumb. Pnsp.Fee: Glec,Insp_Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These&es are based on the prefindna information available and are only an estimate. Contact the Dept for addn'1 info, FEE ITEMS(Fee Resolution 11-053 E 7ff 11112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = amps Electrical Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $45.00 1BELEC200 Services PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 (;onsiruction :Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $1.00 cu $133.50 $45.00 OWN $178.50 Revised: 04/29/2013