14040139 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10435 STERLING BLVD CONTRACTOR:JACK CHANG PERMIT NO: 14040139
CONSTRUCTION
OWNER'S NAME: WU ANDREW AND LU MEI HUI 10220 STERLING BLVD DATE ISSUED:04/21/2014
OWNER'S PHONE: 4084102728 CUPERTINO,CA 95014 PHONE NO:(408)517-8878
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
License Class_ Li`c'.#�
2 TEMPORARY POWER POLE
Contractor r U M/I J,Yoe 4' 71 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
rf ance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$200
e and will maintain Worker's Compensation Insurance,as provided for by
S c ion 3700 of the Labor Code,for the performance of the work for which this APN Number:37526014 00 Occupancy Type:
pe it 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 WITBIIN 180 DA IT 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 D OM MILLED INSPECT ON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Z
granting of this permit. Additionally,the applicant understands and will c Issu
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date y� l 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 DI LARATION
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,Sections5505,25533,and 2 34. /
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ate: G
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 A ENCY
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
0\
GENERAL PERMIT APPLICATION � MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION l/
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0�
(408)777-3228•FAX(408)777-3333•buildina(a.cupertino.org \� MISC
OUp'I`E2T%NO `
PLUMBING ❑MECHANICAL ECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS T� ) _ } jgL APN# .1 F: + z + 039
OWNERNAME �� C• N PHONE E-MAII-
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STREET ADDRESSCTTY,STATE,ZIP AT `, FAX
CONTACT NAME '4� 0-or/-' 2 E-MAII
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STREET ADDRESS #79 k-1114
,1 r CITY,STATE,ZIP IsAd z) � FAX
❑OWNER ❑ OR'IER-BUILDER ❑ OWNER AGENT gt CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME IN LICENSE NUMBER LICENSETYPE BUS.LIC 6o Z6� 8
COMPANY NAMEC� ^ E-MAIL FAX
JJ
STREET ADDRESS ' CITY.STATE ZIP � S T PHONE�YL�?��,'1�V 2Q�
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ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YESFIISICBIEP
THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL TURBAN INTERFACE AREA ❑ NO FLOOD ZONE El NO HOME? ❑NO
DESCRIPTION OF WORK E..
Zp
TOTAL VALUATION: Zoo. -
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By my signature below,I certify to each of the following: I am the property owner or authorized agent o act o r o ehalf. I have rea I
application and the information I have provided is.correct. I have read the Description of Work and verify it is accur a ee to comply vzth all applicable local -
ordinances and state laws relating to build
' construction. I authorize repres tatives of Cupertino to enter the above-ide 'feed operry for inspection purposes.
S i gnature of Applicant/Agent: / Date: fl`/
SUPPLEMENTAL INFORMATION RE D � oOWN—
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��OVERTH1iCOI7NT�R��� �'
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MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10435 STERLING BLVD DATE: 04/21/2014 REVIEWED BY: MELISSA
APN: 375 26 039 BP#: *VALUATION: $200
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP1
USE: PERMIT TYPE:
WORK TEMPORARY POWER POLE
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Temporary Power 1ERT<200 100 Amps $47
TOTALS: $47.00
i
d-.
�f cta. Plan Check A111111. Plan C hee` Elec.Plan Check 0.0 hrs $0.00
L1�>car. F'e raait Fee; Pump. Per mit Pec: Elec.Permit Fee: IEPERMIT
oihc v A ec h. Ins`,- 0ther I'lunib jn'�T). Other Elec.Insp. 0.0 1 hrs $47.00
S1c:"ef.ImP, !x:e: Ph rn7z h?"p. Fee: Iaec.Ins,') tae
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prelimina information available and are only an estimates Contact the Dept-for addn 7 info.
FEE ITEMS(Fee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS
Plan Check r."c,e
Suppl. P( F,t e
PME Plan Check: $0.00
PME Unit Fee: $47.00
PME Permit Fee: $47.00
C`onsiaaction Tay.
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ® Yes (2) No $0.00
,Iclvuncer l P/a'nnin,�,r 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 , TOTAL FEE: $186.50
Revised: 04/01/2014