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15030095CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7449 STANFORD PL CONTRACTOR: GRAND NEST PERMIT NO: 15030095 CONSTRUCTION OWNER'S NAME: YU LIXIN AND QUAN SA 13428 CHRISTINE DR DATE ISSUED: 03/16/2015 OWNER'S PHONE: SARATOGA, CA 95070 PHONE NO: (408) 891-8059 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL �ll License Class Lic. # 1 INSTALL TEMPPOWER �� Date 5 I ra [a --- Contractor lf/� 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: ave 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: $500 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35932038.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 WITIiIN 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 D ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, fDIT costs, and expenses which may accrue against said City in consequence of the Issued b Date: I& /a granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 9 18. f n / Signature l� Date 1 v �� 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. Dater Owner or authorized agent: 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 918. Signature Date CUPERTINO GENERAL PERMIT APPLICATION ,d MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildingO)cupertino.org ❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS MISC PROJECT ADDRESS n .� �! AEN # OWNER NAME PHONE //O �� U E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT "❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER / r/ , (' J LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SED .,DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: / G� G�- T .` �GEIVED�� ,-�,r.� _ 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 to buildin c truction. I authorize representatives of Cupertino to enter the above-identifiedp'rroperty/ for inspection purposes. Signature of Applicant/Agent: Date: 0 SUPPL ENTAL INFORMA ION REQUIRED' ' � � " I �,�� OVER THE COUNTER r v - A�. `. EXPRESS �� STANDARD r MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO Im FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $48 TOTALS: 1�,Q $48.00 payv Mech. Placa Check Plumb. Plan Check Elec. Plan Check0.0 hrs $0.00 tlech. Permit f'ce Plumb. Permit Fee: Elec. Permit Fee: 1EPERMIT 0!her _11cch. fnsP. Other Plumb Insp.Li Other Elec. Insp. Lod hrs 1 $48.00 Mecir. Lrrsl�. Fee: Plumb. hasp. lee: lace. hasp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ These fees are hosed an the nreliminary information availahle and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf 711113) ADDRESS: 7449 stanford pi DATE: 03/16/2015 REVIEWED BY: Mendez Plein Check Fee: APN: BP#: `VALUATION: $500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1 REAP1 PERMIT TYPE: WORK install temp power SCOPE Szq)171. Insp Fee APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $48 TOTALS: 1�,Q $48.00 payv Mech. Placa Check Plumb. Plan Check Elec. Plan Check0.0 hrs $0.00 tlech. Permit f'ce Plumb. Permit Fee: Elec. Permit Fee: 1EPERMIT 0!her _11cch. fnsP. Other Plumb Insp.Li Other Elec. Insp. Lod hrs 1 $48.00 Mecir. Lrrsl�. Fee: Plumb. hasp. lee: lace. hasp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ These fees are hosed an the nreliminary information availahle and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf 711113) FEE QTY/FEE MISC ITEMS Plein Check Fee: .5uphl. P(1' Fee PME Plan Check: $0.00 Permil Fee: Szq)171. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: -FT Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 Advanced Plarming ]Fees_ Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 mom $190.50 $0.00 L FUE: $190.50 Revised: 02/14/2015