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15040241 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8139 HYANNISPORT DR CONTRACTOR:THOMAS ELECTRICAL PERMIT NO: 15040241 INC. OWNER'S NAME: DING CHENG-LIANG AND TING LUH-LUH 265 CALDWELL CT DATE ISSUED:04/30/2015 OWNER'S PHONE: 4084213273 MORGAN HILL,CA 95037 PHONE NO:(408)463-0883 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL _ ELECTRICAL PANEL UPGRADE(200 AMP). License Class (--to Lic.# Contraetor�' c Cj _Date' ' '4 _775779 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:$2400 "Ove and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35611018.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION ,`Ucetti- that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED ' correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 2-/ / granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. �$ RE-ROOFS: Si nat` ur ;mit 4— installed == ate�l jy^lS All roofs shall be inspected prior to any roofing material being installed.If a roof is 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 2595,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this — - 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 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 918. Signature Date .. ......................... GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255Lo MISIC (408)777-3228• FAX(408)777-3333•buildingCo?cupertino.org CUPERTINO / ❑PLUMBING ❑MECHANICA^L ®ELECTRICAL ❑MISCELLOUS PROJECT ADDRESS Q J 3 J r"4- �JC. APN# _3�/'_ , //. U/}./rA�NE� 1' OWNERNAME o 1 '�>^ _/ PHON j�D b`41 (_ E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX l�oc� pr. L✓ 1r ,no G/1 -141 CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX El 'OWNER [I OWNER-BUILDER ❑ OWNER AGENT L7 CONTRACTOR El CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC# f}le� Cvr ne" o95-1611e E-MAIL FAX COMPANY NAME 6M,, GlecM'c�,l 'LAC, �ICX_ 1�IviLt4s_1=(ec4c�ca N'S� . Yah Ile7,? STREET ADDRESS CITY,STATE,ZIP PHONE (1f2"-?3,Yck 265 yoa) ARCHITECT/ENGINEER NAME :::I UMBER BUS.LIC# COMPANY NAME MAIL FAX STREET ADDRESS TY,STATE,ZIP PHONE USE OF FD or DUPLEX ❑ MULTI.FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA 0 FLOOD ZONE ZNO EICHLER HOME? O DESCRIPTION OF WORK V carte SQ fu\2_t e,ner2tDo Aw,PS RECETYEDBY rT ss r.w TOTAL VALUATION: 2, 1(oo,o z) 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 t east authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED Y W ,' OFFICEUSEoivLY 4 # ` 33 EXPRESS ` *s . 9U t o x S©'STi11VDARDb N e Y' GA ,rQ EARGE St` fry .a MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 8139 Hyannis Port Dr. DATE: 04/30/2015 REVIEWED BY: Sean MIAPN: BP#: *VALUATION: 1$2,400 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP2 USE: PERMIT TYPE: WORK Electrical Panel Upgrade 200 amp). SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 200 Amps $48 TOTALS: $48 00 .. ,:. ..i . ...: c. 1-lech. Plan Check t'.0 b,I'%,n?("heck Elec.Plan Check 0.0 hrs $0.00 Jech,Per•rrit I"ec; I'iattr b Arnait r'ee: Elec.Permit Fee: IEPERMIT olh(',•:tec°i?. li,r,. Ofh-vr 1'hw} b lavo. Li Other Elec.Insp. 0.0 hrs $48.00 l0ech.lrtrr;.Fe, I'hvnb.Inst),P°,e: Istc c;. r,s,>..1=ee: NOTE:'This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees 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 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan(.'heLk.1"ee: s�t,)pl. .11("F"e PME Plan Check: $0.00 Permit Fee: hSyppl. .lnV1'ee PME Unit Fee: $48.00 PME Permit Fee: $48.00 ('..'onslr action Tax: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 A...c/vapce l.PlcanruIng.Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 M SUBTOTALS $190.50 $0.00 TOTAL FEE $190.50 w E Revised: 04/01/2015