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14090109 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10238 COLD HARBOR AVE CONTRACTOR:NICE&RIGHT PERMIT NO: 14090109 CONSTRUCTION INC OWNER'S NAME: SHENG-CHIEN TSENG P O BOX 2285 DATE ISSUED:09/17/2014 OWNER'S PHONE: 4088028596 CUPERTINO,CA 95015 PHONE NO:(408)861-0928 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL / _ INSTALL TEMP POWER License Class 1r8 //L��ic//.��# R�-( �� 0,11 Contractor 41��KI(57-117: Date n 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:36909036 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above information is PERMIT IRES IF V RK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT 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 DAY FRO AST 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 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 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 25505,255133,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this ¢�ftp,( DaJ Z/�i permit is issued. Owner or authorized agent: ` i 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� l y m 'KEP GENEL PERT APPLfCA i[Qty r,0\ 4 COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION \v 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408) 777-3228•FAX(403)777-3333-buildinQe-CUDe CMO.orO. mist;(�� tJc�'i`i?TtE�EC3 \ �IPLL1✓�3i1TG ❑I��Ciii�I�7C.4L ELECTRICI.I.. ❑I'MCC-ILL-�ANEOUS Oki STS' I�TJDP cS Cri 1', STAT-,Zu I FAX C01v:ACT XAhs I P TE I ]JkT1 S T R ti hDDR SS CITY,STA-TE,Zi I FA-X Oa nit ❑ OR 1� •SL�T�T L� 0V'!.n-2z ACEN COh'?kCTOR ❑CommkCTORfiChT ❑ lacm—mCT ❑rT'cl,--R ❑ D�lr LO?= ❑ = iT? C0117171/1c,OR NA1✓S - I LICEN, r ERC l�� I L1C�SE 1 I BUS.LIC r COs✓AIRY HAI�i^ I E-I✓d.II. T FAX ig 7cea d—re , ll �. ST T ADDP= I .CITY,STA /4 I Pi30?L ARChTi G ��R1�A1JL I LiCEhSEI.UE�ER I BUS.LIC' COMPF?,TYAk1 I E N�kII I FAX STRte"T ADDRESS I Cay,STATE,ZIP I PHONTTB SSSE OF ❑sm of DUPLEX 13 M-mn-mZLY I PROJECr LN WII.DLAIQD ❑ YES ( PROJECT IN ❑Yrs I IS T n:BLDG/LTS ❑1 Fs BT-MDT-Ra ❑COYjV2z CI.aL IMB taI J1.-1-MR.-FACE AREA ❑ *.O FLOOD Zor.. ❑1"o -ICF -1z a0111-0 ❑ >o DSSCP.IPTION OF WORK TOTALVpTUr'.lION: �v '�"�^-�'_��.'..;.�-c�- �r�":�,�-�_=-__ -'•i`��f'-.,�__� - t By ny sierlaure below, Ce l: fo each o-the followuing: I am the propel owner or authorized went to act on the property ovmer's behalf. I have read this application and the information I have pro;=ids ormct I have read the Description of Work and ceriy it is accurate. I agree to comply vrith all applicable local Ordinances and state lad's relati na to build• e co I15 .7Ction. I aU` i L:e representatives Of CUpei in0 to enter the ab led DrOpeii}'-0r LSpeCtion purposes. S i--ature of Applicar t;Agert: Date: ENTAL LhrOt��;�A RE• U=D 1vj'—FP11,iscA.pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10238 Cold Harbor Ave DATE: 09/17/2014 REVIEWED BY: Sean APN: BP#: "VALUATION: $200 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION USE: pPERMIT TYPE: 1 REAP1 WORK Tem orary power 100 am SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $48 TOTALS: $48.00 ^x>; �u ,* has _ � k 1,11(7b. Alon Ch«(,,� Elec.Plan Check 0.0 hrs $0.00 F/111111 111cPesnti[Fee Phfrah. Pew n;f 1,ee. Elec.Permit Fee: IEPERMIT C1.acr'11c ?l. Inv, Otte hlurib/rup, 0 Other Elea Insp. 0.0 hrs $48.00 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 addn7 info. FEE ITEMS (Fee Resolution 11-053 Ef. 711113) FEE QTY/FEE MISC ITEMS .5'ttppl. 1't.'Fc PME Plan Check: $0.00 Permit F,�e: PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes F No $0.00 Travel Documentation Fee: ITR,4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $190.50 TOTAL FEE: $190.50 Revised: 08/20/2014