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14090186 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20669 SHELLY DR CONTRACTOR:T (j-4VO-✓ PERMIT NO: 14090186 �LCII�G OWNER'S NAME: LUU KENNETH K AND LI-VINH PHAMET AL DATE ISSUED:09/26/2014 OWNER'S PHONE: 4082523370 PHONE NO: .4 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL UPGRADE(E)EL PANEL TO 200 AMPS,SAME LOCATION. License Class aj02 Lic.# q4LSM _ COPPER RE-WIRE INTERIOR HOUSE Contractor r �Date 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7000 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:35911025 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 W F PE 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 18 R CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judg costs,and expenses which may accrue against said City in consequen the d ate: granting of this permit. Additionally,the applicant understands and wi comp Issue with all non-point sourc a ulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signat ate t 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) 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. 1 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,Sectio 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age t: ate: 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 F GcNEP,.4L PERMIT APPLICATION �►" P01 E P _ COPJlTUUNI i`i DEVELOPMEN i DEPAR�IditR i • BUILDING DMSION 10300 TORRE AVENUE• CUPER T INO, CA 95014-3255 `�� (408) 777-3228 F,• (4G8)ii7-3333•buildino(o7cuc� no.ora \ 140 ` MIS (; ❑PLL?ATG ❑Ivr�C°r41�iCL Z�CTRiCar nl��S�CEL�Ai��OliS ohmtS6?- 7 0 Si c�'fADDE ESSI CITY, Z2.- I Ff COIvikCT XL1,r PHONEI =1JEn. r 4.09 674 14ZCo cSDP I CiIl,r.S'a ZL' -y '� FfX d 0 OV-.Z •❑ 11 04,E A.am,i Co?.-.?-4C'OR ❑c02 rp-1.CTCm A. ❑ f�C-:QCT ❑ ❑ D��?tet ❑ cov-,?kcrORl,f1zE I L"C:N's—ZsAZllrlBm I L]C�'�Sa i?� I SUS.LIC r cowl j\Y1 air^ . I =1�gII FAX f DDP:SS I CITY,STATE,ZiP P?OhL 2 Z l7 .•�C?u� /a GIh'uP 1�f�Jr I LiCe'hSEIQG� uZ. 13US.ISCr COI✓Pf l�'Y 1dA r= I ir]J��S I FAX ST?xsT Al)l)F SS I CITY,STAT a,ZIP I FsiO VSB 0: A4,D orDiJPie:.. I mm-FAmmy I P80JBC7 L*i WZDLA.N'D ❑ YES I PP.Ojr.CT A ❑YES I IS Tia:.BLDG f`N ❑ y S HLZTJI G (❑COhJs.P.CLAL LMB AN II.�IFACB AP.EA ❑ NO ZOOD?.Ole ❑ h0 tiC�MM- Holla? ❑ l O DESCP.IPTION Or WORK 70-1-A-T VALUATION: By my sir.;=.,,re below,I Ce;t+y to ea h OS the Iollo-wLrz I arn the property mvmr or auihor iz--d Pgtni i0 flCi Dn the propefty wmnei s behalf. I have read il,1s applic=-ion and the information I have provided is corect I ha,-,,--,---ad the Description of W ork and ver,v it is accurate. I agree to ce-lply-Mth all anplica-ble local Ordin&']Ce5 and s`ie lad's ielatL•]E` H construct i th -' 9DreSentati es ofC 1ptrtino to enter he above-idfi=lledd DryOpfor Ls'?ec:6on purposes. S S_:lat'1re Of:_ppliCanii? ^i - Date ✓✓ 1 (� S'UPPLEI`r—,P NTALEZFORAL4TI0TI REQUAD ��__� m _ �= ' -jam _. W. 61 � f >r' WE p�_201_1.docrevised06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20669 SHELLY DR DATE: 09/26/2014 REVIEWED BY: MELISSA APN: 35911025 BP#: "VALUATION: 1$7,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 REAP WORK UPGRADE E EL PANEL TO 200 AMPS SAME LOCATION. COPPER RE-WIRE INTERIOR HOUSE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1ERT<200 200 Amps $48 Recep/Switch/Outlets 1 BREMRECEP 40 # $148 TOTALS: $196.00 ;ci,. Plr:rr;C,"i2e ck Pl wib. Plan C hec>A Elec.Plan Check 0.0 hrs $0.00 f,er nfr I,1-e, Elec.Permit Fee: 1EPERMIT 0riR "�. �r,,>= Clrh�r P/um?t0 0.0 hrs $48.00 7rs�5. Other Elec.Insp. Plwa lb.1ns�. NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These _f -fees are based on the relimina information available and are onlyan estimate. Contact the Detor addn 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS I'lun ,5'uptol. PC=PIX, PME Plan Check: $0.00 7 PME Unit Fee: $196.00 PME Permit Fee: $48.00 {:C�Jt�PrttCfiot2 /tr:�: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ®Yes 0 No $0.00 tlFi'r,8rt(.'t:tt('I='IN?fP7rPt.;Fees: Travel Documentation Fee: 1 TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $338.91 $0.00 TOTAL FEE: $338.91 Revised: 08/20/2014