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14050138 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19240 TILSON AVE CONTRACTOR:EVERSPRING PERMIT NO: 14050138 CONSTRUCTION INC OWNER'S NAME: BENG-TAK TING 1131 S DE ANZA BLVD DATE ISSUED:05/23/2014 OWNER'S PHONE: 4085062610 SAN JOSE,CA 95129 PHONE NO:(408)446-8398 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL //-�� NSTALL TEMPORARY POWER License Class 15 Lic.# ��lJ 3 Contractorf ly6z'e',Pp1—7 �y�7� fjate d ou I L( 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:$500 1 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:37540057 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 WITIIIN 180 DAYS OF PEWaT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter Kbem upon the above mentioned property for inspection purposes. (We)agree to save 180 DA D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgcosts,and expenses which may accrue against said City in consequence ogranting of this permit. Additionally,the applicant understands and will complyate:with all non-point source regulations per the Cupertino Municipal Code,Se9 18. Signature Date S 2? /� All roofs shall be inspected prig 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,Sectioijs 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent- Date;57'3/I 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 NERAL PERMIT APPLICATION `O _ GE � COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408) 777-3228•FAX(408)777-3333•buildino{a,cuoertino.org M I S (Ck CUP tti INO PLUMBING OMECHAMCAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS i n��^ —P(s /�„e C AAb CA q5 0(¢I APx# OWhTI:RNAME 'Tj -l'GM�IN/ IlY` `-(V l I PHONE 4-6 J �v`2WIl7 ENAII b 11 cJ kb'i'h�N 1.Ww, STREET ADDRESS ' _` �-f'�sl x,r„ CI Y, STATE.ZIP.T"/'4 e�N C/1 [!j 9 0 I l f� FAX CONTACT xAA� 1` /CVS PHONE OV-06 (.( V-J 6 Zb�J E-1vLAII 7� STREET ADDRESS I/I��(� 1 Jl, CIIY.STATE ZIP�//' „(_N / (� Q /,f FAX ❑ OVTtR ❑ OLX'�- -`BCUIIAER ❑ OgMTERV A`GEN'T ❑ CONTRACTOR ❑comuCTIoRRAcorr f' ❑ AR l/C�TE' c:T 1❑VENIGD'aR ❑ DEVELOPER ❑TENANr COI.4TRACTORNAME 84- ICK T5ao LICENSE NUMBER UV oal 3 LICENSETYPE BUS.LIC 3 COMPANYNAME TIPX� YI Wltil-6c+vK E� 'W s rl C�01nu� Al+.Gt7YV1 FAX STREET ADDRESS 11431CVS fie , .$1ud - ,STATE ZIP �C" �U�1 cp !1 C3 I��I PHONE l�)� _2J Z 2 O ARCHR'ECT/ENGINEER NAME LICENSE NUMBER ,` t BUS.LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SM.DUPLEX ❑ MULTI-FAMILY I PROJECT TN WILDLAND ❑ YES I PROJECT IN ❑YES I IS THE BLDG AN ❑YES BUILDING: ❑COMil,1ERCIAL URBAN II.*rERFACE AREA ❑ NO ROOD ZONE ❑NO EICHLER HOTS? ❑ NO DESCRIPTION OF WORK - TOTAL VALUATION: By my signature below,I certify to each of the ' g: I am the property owner cr authorized e e o�� ve read this application and the information I have provid is c e t. I have read the Description of Work and verify it is acr-0a e. agree to comply vrith all applicable local ordinances and state laws relating to building cow orize representatives of Cupertino to enter the above—identified roperty�/for inspection purposes. Signature of ApplicantlAgent Date: �/a 7-�d l r SUPPLEAf INFORMATION REQUIRED ME M�fea 013-M O�ESt TI :C�L3sR UMC;�JO?,RESS 1M E W- hi M MIN _ IVIASfljt� � V-,FPAdisc.4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19240 TILSON AVE DATE: 05/23/2014 REVIEWED BY: MELISSA APN: 375 40 057 BP#: *VALUATION: $500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 REAP1 WORK INSTALL TEMPORARY POWER SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $47 TOTALS: $47.00 .. I" .'i i`�ai ire _ - ., _ ,.rv'• WE sl r , l ec1r. Mari C'h<ec k 11hu,rh. Plan C'ho'ck Elect.Plan Check 0.0 hrs $0.00 .,>cf:. I''errarit Fees Phonh. Perm:l T`ee: Elec.Permit Fee: IEPERMIT C),hErr Ire:,. Trr.� Other Plumb lrls°p Other Elec.Insp. 0.0 hrs $47.00 l'ltuuC',. hisp. 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 mina information available and are onlyan estimates Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 11-053 E : 7/1/131 FEE QTY/FEE MISC ITEMS Plan PME Plan Check: $0.00 Pe- PME Unit Fee: $47.00 PME Permit Fee: -T-T $47.00 C onsi°r i,'clion TUX: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 '#rri°c�ract�c. J'c�rrrrir�; Ire��.s': Travel Documentation Fee: ITRAVDOC $47.00 Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission.Fee: IBCBSC $1.00 N, J' $186501 $0.00 TOTAL FEE: $186.50 a +: Revised: 04/01/2014