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15090105I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 7910 OCTOBER WAY OWNER'S NAME: LIN HELEN J AND ERNEST KWAN OWNER'S PHONE: 4087713887 6' LICENSED CONTRACTOR'S DECLARATION License Class Lic. # (] �-6 Contractor h dc, C Date I hereby affirm that I am licensed under the provisions f Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. affirm under penalty of perjury one of the following two declarations: and will maintain a certificate of consent to self -insure for Worker's .nation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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 permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmI s the City of Cupertino against liabilities, judgments, costs, and expenses which ay accrue against said City in consequence of the granting of this permit.itionally, the applicant understands and will comply with all non -point source regul ions per the Cupertino Municipal Code, ection 9.18. Signature A Date I ❑ �OWNE4-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: i. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. 2. 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 permit is issued. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature. Date CONTRACTOR: NT ELECTRIC PERMIT NO: 15090105 3584 KIRKWOOD DR DATE ISSUED: 09/16/2015 SAN JOSE, CA 95117 PHONE NO: (408) 835-5879 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL TEMPORARY POWER Sq. Ft Floor Area: I Valuation: $700 APN Number: 36213036.00 1 Occupancy Typc: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DIT ISSUANCE OR 180 + OM L D INSPEC 17, ied b • Date: � RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants ase b the Bay Area Air Quality Management District I will maintain compliance wit he Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, S tions 25505, 25533, and 25534. Owner or authoriz a frit: % Date / I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional U4 CUPERTI[-10 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 hl 0% &=ilnA (408) 777-3228 - FAX (408) 777-3333 • building a1cuoertino.orcl �O ❑ P=,oiNC. ❑ MECHANICAL ❑ ELECTRICAL ❑ )vRSCELLAATEOUS APN k ^, /3 ,_, O PROJECT ADDRESS / O © C-, I ' J ,A , a` I 31./, ((,' G / NOWERNAMb /�/ PHONE 40r -77J �i QE-M.AIL STREET ADDRESS A 10 0dob '/1/ CITY, STATE, ZIP I FAX CONTACT NAM C7 / 1 PHONE (l % v E MAIL, r( UU / �J T Dp STREETADIESS CITY, STATE, ZIP FAX 13OwR IIt 11M`NER-BUILDER ❑ OWNER AGENT 0011,101,IRACTOR 13EI CON7RACTOR AG.'T ❑ ARCHITECT IJ E14GINTEER ❑ DEVELOPER ElTENA1'T CONTRACT! !# 9- /J / + C-f� yew / LICENSE NUMBER lo , �G 2- LICENSE TYPE BUS.BUS. LIC COMPANY NAIL „) rl.QChit c E-MAIL �( �. a re Vr y 0 �l J D • FAX STREET ADDRESS 2 Com(,I i JK;V t 1. W ,00 ( v1 CITY, STATE, ZIP 1 � a �f, ( f PHOI\t�vio f 3 —e Q j ARCHITECT/ENGINTZR MOM I LICENSE NUMBER BUS. LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE Y USE OF ❑ SFD. DUPLEX ❑ MULTI-FAKILY PROJECT IN Wn.DLAND ❑ YES PROJECT IN ❑ YTS BtJ 1240: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO IS THE BLDG AN ❑YTS EICHLER HOME? ❑ ':0 DESCRIPTION OF WORK TOTAL VALUATION: —7 V Q ` 0(j By my signature below, I certify to each the following: I am the property owner or authorized agent to act on o ner's behalf. I have read this application and the information I have p ided is correct I have read the Description of Work and veri accurate. I agree to comply with all applicable local ordinances and state laws relating to bu' in- construction. I authorize representatives of Cupertino to enter the above 'dentified rope inspection purposes. Signature of ApplicantlAgent: Date: �— S"PlyEMEWTAL INFORMATION REQUIRED MEPAliscApp_1011.doc remised 06121/11 rl CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 7910 OCTOBER WAY DATE: 09/16/2015 REVIEWED BY: MELISSA UNLLs APN: 362-13-036 BP#: 'VALUATION: $200 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p $48 PENTAMATION 1REAP14 PERMIT TYPE: i WORK INSTALL TEMPORARY POWER SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb, flan (:'heck QTY UNLLs BP FEES Elec. Permit Fee: IEPERMIT Temporary Power 1ERT<200 Other Elea Insp. 0.0 hrs $48.00 100 Amps $48 Permit .Fee: :Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes Q No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n;viri, et,- ► Thou foot aro havod an tho nreliminary information available and are only an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711/13) Meeh. Plan Check Plumb, flan (:'heck Elec. Plan Check 0.0 1 hrs $0.00 17 1 Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT Other A C!"it. hi.t;rte Plumb Ineh, Other Elea Insp. 0.0 hrs $48.00 1lech. InsP. Fee: Plumb. hisj). Fee: Ekx. lnsp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n;viri, et,- ► Thou foot aro havod an tho nreliminary information available and are only an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check h ee: Suppl. PC Fee PME Plan Check: $0.00 Permit .Fee: :Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning 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 SUBTOTALS: 1 $190.501 $0.00 TOTAL FEE. $190.50 Revised: 07/02/2015