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14070086 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 903 S STELLING RD CONTRACTOR:DIANLI CHEN PERMIT NO: 14070086 CONSTRUCTION OWNER'S NAME: LI WANG 10181 EMPIRE AVE DATE ISSUED:07/21/2014 OWNER'S PHONE: 4087686291 CUPERTINO,CA 95014 PHONE NO:(408)888-2898 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ /' 1, w/ INSTALL TEMPORARY POWER POLE License Class_ Lic.# t0 1 Contractor )r2w_ ,, ,t 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:$200 ave 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:35906015 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 D ERMIT 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 +R LED 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 t granting of this permit. Additionally,the applicant understands and will corn ssue with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature Date2�/O(()!�� 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) 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. �j�r Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:- W 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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 ' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 98014-3255 c13p'tA'{'ihCO (408) 777-3228• FAX(408)777-3333-buildino(ari .cuoeno.ora M I S (0 \, ❑PLUbSn TG ❑MECHAI TICAL ❑ELECTRICAL_ ❑MIS CELLLAIQEOUS PROTsCf ADDRESS PNT -� -yLI 45-9 _°IIO of ,I ov'-TER&'Aha PHONB E-✓ lr/\t"j/Its /U/2;4)U9-1 4e- 4�-62.1 ) STREET?.DDPMS C '\ S S r I CITY, STATE,Zip. .. L) C I FAX 0 Fn CONTACT Nr C, c� G//(,j, PHONTE�� _ j Ea✓err STP.EErADDRESS > ( CITY,STATE, ZIP FAX ❑ OWJ,-m ❑ o-m ER-B=mt ❑ O1A1,`ERACaTI C01vIR4CTOR ❑CON KACTORAGEAT ❑ ARMTECT ❑ENGTUT.-R ❑ DEVELOPER ❑TENATTr COI7P,kCTORNAN,b �IQ�J 4 I uca"'SENMaER ��/� I LICEI SE7YPE I BUS.LIC0 COIJ"PNYNAt✓� 'D,'��✓1.1 lt�tv`� «vl VWaL�`tpl" I E1JAII I FAX STF--EE7ADDRESS i i 14{ I .CITY,STATE,ZIP p/7I PHONE r�C2Q:nil ARCHITECTIEINIGINEERNAME 1 I I LICE1111SENU111BER I BUS.LIC 9 COMPANY NANM E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SM or DUPLEX ❑ MULTI-FAIZLY I PROJECT W WMDLAATD ❑ YES I PROJECT A ❑YES I IS TfM BLDG AN ❑YES BUJNG: ❑COMMERCIAL URBAN ATrRFACE AREA ❑ NE O FLOOD Z01 TS ❑NO EICiI ER HOl�? ❑ ' IIA0 DESCRIPTION OF WORKIS"2^ P 2 TOTALWLUATION: By my signature below,I certify to each of the following: I am tete property owner or authorized agent to act the�Operty o';mner' ehalf. 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;vith all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the abov-identified property for inspection purposes. S i Mature of Applicant/Agent: Date: 7�f! SUP E3MENTAL INFORMATION REQU=D WISF CE rs ral� _ � r 1q. ss — F - r -mom!fix !WEPhlisc4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 903 S STELLING RD DATE: 07/21/2014 REVIEWED BY: MELISSA APN: 359 06 015 BP#: 'VALUATION: $200 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Du lex PENTAMATION 1 REAP14 USE: p PERMIT TYPE: WORK INSTALL TEMPORARY POWER POLE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $48 TOTALS: $48.00 k Wi=n Wit, 40 eta 1"sr:t{yrcr f'fiawrb. Platt Ch("c-i, Elec.Plan Check 0.0 hrs $0.00 Fees F'lumh. J'e:rsn;t Tee, Elec.Permit Fee: 1EPERMIT -E3 -I- C1?Ire T'1>+� i�Irr,r��. El----------I- Other Elec.InspCC: . 0.0 hrs $48.00 -1 f'Ir!0, hisp. I E,�,: 1_r`<�e-h t NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13) FEE QTY/FEE MISC ITEMS Plarl1 `ltl'�pl. P(I. F ce' PME Plan Check: $0.00 /`'i'e PME Unit Fee: $48.00 PME Permit Fee: $48.00 T-7:1 Uol� ,5P71.rciloi7 TUX: Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 Travel Documentation Fee: 1TRAVD0C $48.00 i Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg*Stds Commission Fee: IBCBSC $1.00 ALS.•K $190.50 $0.00 TOTAL FEE: $190.50 Revised: 07/10/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: S 5Y-V-1Q�t4A PERMIT# OWNER'S NAME: PHONE# ' GENERAL CONTRACTOR: 7ia i.,,e 1 04&4 BUSINESS LICENSE# ADDRESS: to(,8/ jre CITY/ZIPCODE: ttit *Our municipal code req res all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED+A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 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 OwIrer/Contractor Signature Date