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13080015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10425 WUNDERLICH DR CONTRACTOR:AVA CONSTRUCTION PERMIT NO:13080015 OWNER'S NAME: CHANGHONG LIN 21060 HOMESTEAD RD APT 216 DATE ISSUED:08/02/2013 OWNER'S PHONE: 4088490408 CUPERTINO,CA 95014 PHONE NO:(408)387-0999 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE] License Class Lie.# TEMPORARY POWER Contractor'�a 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 o pensation,as provided for by Section 3700 of the Labor Code,for the ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$100 d 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:37516032.00 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:nd 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 FR LLED 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 Iss granting of this permit. Additionally,the applicant understands and will comply ate: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. a�;7 RE-ROOFS: Signature Date 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 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 25504,25533,and 25534.Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: Gkn 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. IC 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 c\ ME P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �" 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MISCCUPER 1-31 (408)777-3228•FAX(408)777-3333•building(cDcupertino.orn \ ❑PLUMBING []MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# / r D e c b J OWNER NAME G / V` PHO � �r- / dv O� C V� STREET ADDRESS CITY,STATE,ZIP ff FAX CONTACT NAME C PHO E-MAIL STREET ADD 42�c ml STATE,ZIP C' /D ) FAX ❑OWNER 11OWNER-BUILDER13OWNERAGENTXONTRACTOR ❑CONTRACTOR AGENT El ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA hMC t� C�LICENSE NUMBER�r,.��.` LICENSE T E BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 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 WH.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO n, DESCRIPTION OF WORK TOTAL VALUATION: 00 By my signature below,I certify to each of th owing: I am the property owner or authorized agent to act o e pro o s behalf. I have read thus application and the information I have prod ed is orrect 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 buil ction. I authorize representatives of Cupertino to enter the abgvw-i tified property for inspection purposes. Signature of Applicant/Agent: Date: A� 2 SLrPPLEMENTAL INFORMATION REQUIRED f OFFICE USE ONLY W ❑ OVER-THE-COUNTER ❑ EXPRESS x v ❑ STANDARD V ❑ LARGE a, ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10425 Wunderlich drDATE: 08/02/2013 REVIEWED BY: melissa APN: 375 16 032 BP#: *VALUATION: $100 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 REAP1 WORK tem ower SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $47 TOTALS: $47.00 Mech..Plan(C,heckPlumb.Plan Check Elec.Plan Check 0.0 hrs $0.00 ,tech. Permit Fee: Plumb.Permit Fee: Elect.Permit Fee: IEPERMIT L ;ilecFi.Insp. Other Plumh Insp. 07-- Other Elea Insp. 0.0 hrs $47.00 . Insp.Fee: Plumb. hap.Fee: Glee.Insp.Fee: NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan ('heck Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit.Fee: Sulpl. Insp Fee PME Unit Fee: $47.00 PME Permit Fee: $47.00 Conoraction Tax: Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $186.50 $0.00 $186.50 Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone:408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ! Z .,�. �r`�.�� PERMIT# OWNER'S NAME: C-k�,�� PHONE# GENERAL CONTRACTOR: C BUSINESS LICENSE# ADDRESS: 2 6(9s 7 q� CITY/ZIPCODE, C4AJIC q-io rL *Our municipal code requires all businesses working in the city to have a City,_.of.Cupo;=business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL. BE-'SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSIN CENSE. Inot u ' g any subcontractors: � �✓/J 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