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14070084 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18650 CYNTHIA AVE CONTRACTOR:HOMESTEAD PERMIT NO: 14070084 CONSTRUCTION INC OWNER'S NAME: LI KUO TSAI AND LIU PEISHAN 10080 STERN AVE DATE ISSUED:07/18/2014 OWNER'S PHONE: 4088871382 CUPERTINO,CA 95014 PHONE NO:(408)255-8999 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL INSTALL TEMPORARY POWER License Class f'j Lic.4_4e_/6 3 3 Contractorf(Z©�` f�,Date 71 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:$150 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:37522028 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 WITBIIN 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 FROM LAST CALLED 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 Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 918. Signature Date / �A6All roofs shall be inspected aterial 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this , Dater( Owner or authorized agent: permit is issued. 1 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 918. Signature Date GENERAL PERMIT APPLICATION EP 4' COMMUNITY DEVELOPMENT DEPARTI'viENT•BUILDING DIVISION O 10300 TORRE AVENUE- CUPERTINO, CA 85014-3255 (406) 777-3228- FAX(408)777-3333•buildino(a7cuoe�ino.ora \ m I S []PLUI6BRgG - ❑MECHAIQIC&L OELECTRICAJ- ❑l'usc LLA1.tOUS O v 1h J2 fihl �v f/^ / I PHOATf<j.� `2 �pV , I -N km S ritEET P DRESS ' CII Y, STATF,, _ZIP. L� I FAX CO:\?hCr K.s ( P30hTfh / 0 — J (J --j ST Lui ADP iS 2 CITY,STA—1--,ZIP FA'•^ ❑ OVIt'Ft ❑ OV?=,-B-LMZBti ❑ 0-ANT ACENT vcll•'ipAcTop ❑COKIR0.CTORAC AT ❑ A cmmg= ❑ENGR r= ❑ DE1m-0? R ❑T= Qu CON7RACTORIiA-- I LICMISENUIJM'R I LICENSE TYPE I hNYNBUS.LIC r coIJ' AME m - }} E-1JidB I FAX ST F7 ADDRESS IM Y,STAT$ZIP A�ChTTECT GIT��R1hA1✓E I LICBNISEWUIJ?ER. I BUS.LICV COMPANY NAIL E-I✓iAjL ( FAX STREBT ADDRESS CITY,STATE,ZIP PHONTTE USE OF ❑SFD or DUPLEX ❑ MJM-FAL. Y I PROJECT LTQ WIIALANM ❑ YES I PROJECT D" ❑YF-S I IS TIM BLDG AT' ❑YES BUILDING: ❑COYMERCIAL URBAN I1.EtFACE AREA ❑ NO FLOOD ZONE ❑I'O EICffi-fit Hollm? ❑ ?"0 DESCRIPTION OF WORK TOTAI.VALUATION". By my signature below,I certify to each of the folloy,ing: I am uhe property oc••ner or authorized azeat to t'e property o�im is be If. I have read this application and the information I have provided is correct. I have read the Description of Rrork and ve iy it is accu-ate. I agree t comp "th all applicable local ordinances and state laws relatuls to building consu acti . I au horze representatives of Cupertino to enter the above-identified op- for inspection puposes. S i--nature of Applicant'Agent: Date: SUPPLE NTAL LNFORMATION REQTJ=D _M � - � ' •�--0��z�P,xE�s�-��� MORE. vbmz— WIN- ��M 1✓EPA 'sc�4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 18650 cynthia ave DATE: 07/18/2014 REVIEWED BY: MELISSA APN: 375 22 028 BP#: *VALUATION: $150 'PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION 1 REAP14 USE: SFD or Duplex PERMIT TYPE: A WORK INSTALL TEMPORARY POWER SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $48 TOTALS: $48.00 lil01M NO !'Fzinrta. Penn f_fx:ch Elec.Plan Check 0.0 hrs $0.00 F117-7 „„,. ;I Fee: ��la�x ��.- of�-�,r,; Elec.Permit Fee: IEPERMIT Urr�et Plumb tnsr. Li L Other Elec.Insp. 0.0 hrs $48.00 1,tec(r Itzttl.1°<�<;: 1'ilw1b. hisp. Fee: l��e�°. Is t. t� s:: 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 preliminary information available and are only an estimate. Contact the Dept-for addn'l in o. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS 11jan "heck PME Plan Check: $0.00 i'b ivn,rf Fce: I- SuPPI, Zi�s >Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 C 0tr.5•tr uc'tion 7'a:3: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Feer ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldy- Stds Commission Fee: 1BCBSC $1.00 $190.50 $0.00 TOTAL FEE: ' $190.50 MAE ,.a. Revised: 07/10/2014