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14050149 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10408 JOHNSON AVE CONTRACTOR:DWK CONSTRUCTION PERMIT NO: 14050149 OWNER'S NAME: TZY JYE CHERN 18665 LOREE AVE DATE ISSUED:05/27/2014 OWNER'S PHONE: 4155592882 CUPERTINO,CA 95014 PHONE NO:(408)996-1186 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO• BLDG r— ELECT F PLUMB F License Class Lic.# MECH r— RESIDENTIAL F COMMERCIAL r Contractor Date I hereby affirm that I am licensed.under the provisions of Chapter 9 JOB DESCRIPTION INSTALL TEMP POWER (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hercbv 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$350 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37526051.00 Occupancy Type: APPLICANT CERTIFICATION I ccrtfy 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date' 9 18 Signature Date RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: wiI I 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: Compensation laws of California. If,after making this certificate of exemption,I Date: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that 1 have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION oranung of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9 18 Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10480 JOHNSON AVE CONTRACTOR:DWK CONSTRUCTION PERMIT NO: 14050149 OWNER'S NAME: PAM CAMPAGNA 18665 LOREE AVE DATE ISSUED:05/27/2014 OWNER'S PHONE: 4155592882 CUPERTINO,CA 95014 PHONE NO:(408)996-1186 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL �/'7 INSTALL TEMP POWER License Class,/.,Li"c.�#1 ��a� / Contractor, Sr rv�-Y I y Date -� 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:$350 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:37526042.00 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 DTLAST 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 OCALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the / 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. RE-ROOFS: Signature Date 2-7-- 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 1,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(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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:�y� 2 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 APPLICATIONMEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �U C. p1>r Ei`i'C t4 O (408) 777-322 a. 8-FAX(408)777-3333•building cupertino.org MISC ❑PLUM,MrNTG ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECTADDRESS 080 ohnszy" APN4 c0 6`,f b 0VNrNER NAME ^�,n p/fes PHONE L�rsJ r� E-N 4II STREET ADDRESS i1 �� D hnso� /V G I CITY, STATE,ZIP / 1 FAX CONTACT NAME r&rMa5 n/� PHONZ STREADDRESS Lome- A e6 � • CITY,STATE, � FAX ❑ owma ❑ awNER•BUIDER ❑ 01ANTRAGENT CONTRACTOR ❑CONMUCTORAGENT ❑ ARCc7ITECT ❑ENGiN= ❑ DEVELOPER ❑TENM\7 CLICENSE NUMBER LTCENSETYPE � BUS.LIC COMPANY N. 67Y11-9- E-Ivi SII K C.vi/ `G� ® ��� AX STREET ADDRESSt - s-LZ rve I CITY,STATE ZIP PHOT ARCHITECUENGINEER NAME LICENSE NUMBER !�/ I BUS.LIC 4 COMPANY NTTAME E-I km FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIIDL AND ❑ YES I PROJECT IN, ❑YES I IS ITIE BLDG AN ❑YES BLIILDTNG: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK le Pmlar ." F - TOTAL VALUATION: 7!5( �.� ECEI�rEDB a�5�1 `' $x By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property 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 tgbui ing construction. I authorize representatives of Cupertino to enter the above-i entified ro erty for inspection purposes. Si-nature of Applicant,'Agent: Date: S > SUPPLEMEI\TTAL INFORA2.ITION REQUIRED ��-oFTZCELrsT�*.•L�� ���- 00 F f "� 10--nii ma T '^n C W ` - i."`3F3. A00 s _ MEPAlisa4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10480 johnson ave DATE: 05/27/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: $350 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: p PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $47 TOTALS: $47.00 {,fc,c1r, ;',.�,r('!/""/ Phlinh. Plan C hecA Elec.Plan Check 0.0 hrs $0.00 ble 11 1''errrrid Fee Phimb. Pe/nit 1,ee: Elec.Permit Fee: IEPERMIT Lt7t1?57 dcof"r, t s�1�. E f1h.rr Plaint)tns°ls. Other Elec.Insp. 0.0 hrs $47.00 S-lei'a. fn,. J.'z�� f'itt�;tf>, /;rslt. ear: 1,/r;e. hp. 1, NOTE: This estimate does not include fees due to other Departments(i.e.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 Dept/or addn7 info. FEE ITEMS (Fee Resolution 11-053 ET 7/1113) FEE QTY/FEE MISC ITEMS 1,161Y1 .7?,t (F: F(t C: PC l`ee'r' PME Plan Check: $0.00 PME Unit Fee: $47.00 PME Permit Fee: $47.00 C,cinso',.ac'tion Tax: Administrative Fee: ]ADMIN $44.00 Work Without Permit? 0 Yes 0 No $0.00 �,Id'ullcc'ui I'/u7ning;