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15060110 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1032 WESTLYNN WAY CONTRACTOR: ffr r_li5t"C�t_ PERMIT NO: 15060110 $ ,` AiAF— OWNER'S NAME: ZHENG SHANSHAN ET AL 5040114g_ Qd�9S - � DATE ISSUED:06/16/2015 OWNER'S PHONE: 3019204134 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL A '[0 UPGRADE EXISTING PANEL TO NEW 200 AMP PANEL License Class Lic.# Contractor �;(,�G��� Date U 1 hereby affirm that I am licensed under the provisions if Ch Ater 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. i 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:$2100 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 APN Number:35927004.00 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 WTTBIN 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 180D FROM LAST CALLED INSPECT 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 Date• granting of this permit. Additionally,the applicant understands and will comply Issued by: (0/lb with all non-point sourc lations per the Cupertino Municipal Code,Section 9.18. / � f RE-ROOFS: Signature Date 1 c 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 1 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 1,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) 1,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 Munici al Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 5533,an 5534. Section 3700 of the Labor Code,for the performance of the work for which this 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 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 ....._............._......._... GENERAL PERMIT APPLICATION 150610(1,0 . COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION m mEP 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTfN© (408)777-3228 • FAX(408)777-3333 • buildina(cDcupertino.org ❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS / ��J /�/L �f / �,r( Y J,)q 0 0 U APN OWNERNAME , .7 ) PHO E-MAIL STREET ADDRESS /�2 {) /,j ,!s( CITY, STATE,ZIP )�fN a !� FAX CONTACT NAME y/ /^ PHONE �' E-MAIL STREET ADDRESS J�I C CITY,STATE, ZIP FAX ❑ CWNER ❑ OWNTER-BUILDER ❑ OWNER AGENTT M1 cc)NTRACTOR ❑CONTRACTORAGEI T ❑-ARCHITECT ❑ENGINMER ❑ DEVELOPER ❑ I NANNTT CONTRACTOR NAME Vie ,y1 /moi LICENSE NUMBER /` LICENSE � BUS.LIC 4 COMPANY LAME 6 1-at-& ( � E-MAIL `r FAX (, STREET ADDRESS VIC -9 CITY,STATE,ZIP ARCMTECT/ENGINEER NAME C• LICENSE NUMBER l -r BUS.LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FADU.Y PROJECT IN WILDLAND ❑ YES PROTECT IN ❑ YES IS THE BLDG AN ❑ YES BUIIDA'G: ❑COMMERCIAL URBAN INTERFACE AREA ❑ No FLOOD ZOITE ❑ NO EICHLER HOME? ❑ Iv0 DESCRIPTION OF WORK 1A V 644W 111 6- TOTAL VALUATION: �#�ECEIV'EDBI Y Y certify property p p rty owner's behalf. I h- B m signature below,I certi to each of the following: I am theowner or authorized agent to act on the roe ave 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 building ctio I orize representatives of Cupertino to enter the above-i e led, n_ Inspection purposes. Signature of Applicant/A-ent: Date: 66 SU-PPLEI 4 NTAL IFO MATION REQUIRED „�. OFFICE C SE OALl::.' Etf fll 0, M.anti .. ATEPATiscApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 1032 Westlynn Way DATE: 06/16/2015 REVIEWED BY: Paul APN: 359 27 004 BP#: *VALUATION: 1$2,100 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: I PERMIT TYPE: WORK Upgrade existing panel to new 200 Amp Panel SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 200 Amps $48 TOTALS: $48.00 "Ian Check ;rh. Plan Ch(, -lee. Plan Check 0.0 hrs $0.00 Ffeci Phmat ,07 j.' Elec. Permit Fee: IEPERMIT Other Hech. Insp. Other Phimh Imp_ Other Elec.Insp. LLO hrs $48.00 Meeh, hasp. Fee: 1,11wih h7sp. FA !0C hisp. Fee: NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Efl 7/1/13) FEE QTY/FEE MISC ITEMS Plan C t t Sunpl. PC 1•cc, PME Plan Check: $0.00 Permit Fee: Sul�pl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Constructlon TUX: Administrative Fee: (ADMIN $45.00 Work Without Permit? ® Yes (F) No $0.00 Advanced Planning j �c.,. Travel Documentation Fee: ITRA VDOC $48.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $190.50 $0.00 TOTAL FEE: $190.50 Revised: 05/07/2015