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15050096 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10784 JOHNSON AVE CONTRACTOR:TITAN GENERAL PERMIT NO:15050096 CONSTRUCTION OWNER'S NAME: YINAN WANG 46509 MISSION BLVD STE 118 DATE ISSUED:05/15/2015 OWNER'S PHONE: 4088968822 FREMONT,CA 94539 PHONE NO:(408)883-8668 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL INSTALLATION OF TEMP POWER(100 AMP). Lice se Class Li .# o=Y� � Contractor' "* ' I hereby aff►rm that I am licensed'uiiile'r the provision 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 Aaformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1500 s ve 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:37531003.00 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 WITIIIN 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, Q t costs,and expenses which may accrue against said City in consequence of the Issued by: �,_v �/�sG�� Date' granting of this permit. Additionally,the applicant understands and will comply with all non-poin ce r tions per the Cupertino Municipal Code,Section 918. 4 5 RE-ROOFS: � at� All roofs shall be inspected rior to an roofing material being installed.If a roof is Signatu�es� P P Y g g ; i �� `�= L "✓" 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 A550 ,2553 ,and 25534. � C Section 3700 of the Labor Code,for the performance of the work for which this .-... -`_ �"" "' +Date: Owner or alrtho ized apciii ', _ 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 F -T ................. .....". GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC (408)777-3228• FAX(408)777-3333•building (cDcupertino.org CUPERTINO [—]PLUMBING P ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS (1 Do IVjI�o 0 V, / OWNERNAME PHONE t��J 09 -APffN#1,116 ff/9-�7 /E-MAIL �A 0111nAll Wall 0Q STREET ADDRESS oZ7� `-t-uta bi CITY, STATE,ZIP !I,, e( I rtA C� � -©I FAX CONTACT NAME Lit i PHONE E-MAIL l/ WWWn W � I'/r d ;j W/ CTTY,STATEFAXoSTREET ADDRESS d - ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrIECT ❑ENGINEER ❑ DEVELOPER. ❑TENANT CONTRACTOR NAME zp�/��I ,� rU GLICENSE NUMBERfq,Y)- Gnl� JfLICIEN�SEt�TYPE BUS.LIC# ! u COMPANY NAME l ( quE-MALFAXI4_do Q_ Y— Q U STREET ADDRESS CITY,STATE,ZIP � PHONN , 77 �(NhnL�apAw— jDd•eCA9�(�Z WJ Q ARCHITECT/ENGINEER NAME 1 e- Chet? +Iet? LICENSE NUMBER C Z BUS.LIC# COMPANY NAME /7�/�i.Cj SS(7c/�G�l l�s� G E-MAIL hm r�(y[ I 7{iia[(. Cd Gni FAX 44'4,4 /4' ,4-�"3?- STREET ADDRESS 2 2 (/ CITY,STATE,ZIP V �Q PHONE � `�'C�r�_j JL(� / Sara tQ�ye_ Siem ��e�i� d'�r�� K USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND El PROJECT IN El YES IS THE BLDG AN ❑YES BUH-DING ❑COMMERCW- URBAN INTERFACE AREA NO FLOOD ZONE ,�I NO EICHLER HOME? NO DESCRIPTION OF WORK TOTAL VALUATION: 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. read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building¢ ction. I autho ize representatives of Cupertino to enter the abo e-i de(tified property for inspection purposes. Signature of Applicant/Agent: ( Date: J SUPPLEM TAL INFORMATION REQUIRED i t K ' t r OVER THE-COUNTER �r � Ft �❑ EXPRESS�,�,,� f a-�. 71 v r +aa S4 a❑sSTANDARD'{`.�' txa`" ra3, v K ©` LARGE I S h � �❑ MAJOR a� c�.g x,� �s4� MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10784 Johnson Ave DATE: 05/15/2015 REVIEWED BY: Sean APN: BP#; `VALUATION: 1$1,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARY PENTAMATION 1 REAP14 USE: SFD or Duplex PERMIT TYPE: i WORK Installation of temp power 100 amp). SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $48 TOTALS: $48.00 s , Xfech. Plan Check Phunh.Plan{'heck Elec.Plan Check 0.0 hrs $0.00 iblech. Perini[Fee; Plumb. Permit Fee: Elec.Permit Fee: ]EPERMIT Other Hech.Imp. ED-L- Other Plumb Insp. Other Elea Insp. Ej hrs $48.00 'tech.hup. Fee: Plumb. hap. Fee:: Elec.Insp.Fee: 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 Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E{f. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Sulrpl..l'C'Fee PME Plan Check: $0.00 Permit Fee: Suppl. Ji/S,p Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes M No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $48.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp-Stds Commission Fee: IBCBSC $1.00 `SU BTOTALSc $190.50 $0.00 TOTAL FEE. $190.50 Revised: 05/07/2015