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1505010101% CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22420 SALEM AVE CONTRACTOR: BG ELECTRIC PERMIT NO: 15050101 OWNER'S NAME: CHIEN CHARLES C T TRUSTEE & ET AL 1268 GLEN DELL DR DATE ISSUED: 05/18/2015 OWNER'S PHONE: 4088878661 SAN JOSE, CA 95125 PHONE NO: (408) 209-5933 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL SCI UNIT 3 - RE-WIRE ENTIRE UNIT 3, UPDATE ALL (E) License Class L Lic. # C1 7 D FIXTURES AND OUTLETS Contractor I+ Date I r I hereby affirm that I am licensed under the provision of C apter 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 Sq. Ft Floor Area: Valuation: $10000 performance of the work for which this permit is issued. I e and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32615017 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 180 DAY RMIT 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 ALLED INSPECTI N. 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 comp s / Date: with all non-point source regulations per the Cupertino Municipal Code, Section 918. r � � � 5 A 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 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, Sect' s 5505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this sp Owner or authorized agent: Date: 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 ................. . GENERAL PERMIT APPLICATION �� MEP AM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O` 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingQcupetno.org �J r +CUPERTIN.O.M1W ❑ PLUMBING ❑ MECHANICAL ISI ELECTRICAL ❑ 1,9SCELLANE0US PROJECT ADDRESS Z Z 4 Z ��11f1P��HO APN # 9 2-6 — ' OVVNERNAME IvC,l C�� f E-MAIL i— STREET ADDRESS 1nc`�1 t S GT C l� CITY, STATE, ZIP FAX 2- 1 ZL-) 54 ewi t�✓ C„c er-)ll' N 0 c CONTACT NAME &6+4 a�'/ J PHO NFZ _ 5-7 1 _ f STREET ADDRESSI Z 6 � C ` ` c� i' CITY, STATE, ZIP �`C N v 5't- Z S— FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT -9 CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESSt �LCH `r r ID a -`Pt CITY, STATE, ZZII ; e C/r 9,j Z PHO 4C3 Z� 3 3 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD o LI ❑ MULTI -FAMILY PROJECT IN WILDLAND ED YES PROJECT IN ❑YES IS THE BLDG AN El YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK CSN TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on a alf. I have read this application and the information I have provided i c e . I have read the Description of Work and verify it is ccurate. I agree to comply with all applicable local ordinances and state laws relating to g cos cf n. I authohze representatives of Cupertino to enter the above-ide tified property for inspection purposes. gent: Signature ofApplicant/ADate: 11-3— SUP!L3KENTAL INFORMATION REQUIRED xoic>gsEorL��',; gi'� OVERTIIECO TERM m 1,100 EXPRESS ' Al y,� 4x'�x r MIN" x MEPMiscf4pp_2011.doc revised 06121/11 wt CITY OF CUPERTINO WE FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE 22420 SALEM AVE UNIT # 3 DATE: 05/18/2015 REVIEWED BY: MELISSA ilia,ADDRESS: APN: 326 15 017 BP#: '`VALUATION: j$10,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Multi -Family Dwelling USE: >3iStorriis iies 0 Yes (D No PENTAMATIO PERMIT T PEN 1REAP1 A WORK UNIT 3 - RE -WIRE ENTIRE UNIT 3 UPDATE ALL E FIXTURES AND OUTLETS SCOPE Suppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID PlumbPlan Check QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Recep/Switch/Outlets 1BREMRECEP Other Elea Insp. 0.0 hrs $48.00 37 # $133 Fixtures, Lighting 1BREMFIXT Suppl. Insp Fee 7 # $72 PME Unit Fee: $205.00 PME Permit Fee: $48.00 Consfruetion .Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC 1 $205.001 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School rlictrhv otr 1. Thoao foot aro havod nn tho nroliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) Me& Plan Check PlumbPlan Check Elec. Plan Check 0.0 hrs $0.00 FL1ech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT Other iilech. Insp. Other Plumb Insp.Li Other Elea Insp. 0.0 hrs $48.00 ,.11ech. Insp. Fee: Plumb. hasp. Fee: Elec. Insp, Yee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School rlictrhv otr 1. Thoao foot aro havod nn tho nroliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp 1. PC Fee PME Plan Check: $0.00 Perinit Fee: Suppl. Insp Fee PME Unit Fee: $205.00 PME Permit Fee: $48.00 Consfruetion .Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: ` $ 348.30 $0.00 .TOTAL FEE. $348.30 Revised: 05/07/2015