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15100043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18600 BARNHART AVE CONTRACTOR:WINGON PERMIT NO: 15100043 CONSTRUCTION CO OWNER'S NAME: GOLDSILVERISLAND HOME LLC P O BOX 31983 DATE ISSUED: 10/06/2015 OWNER'S PHONE: 4088963369 OAKLAND,CA 94604 PHONE NO:(510)228-6665 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL TEMPORARY POWER License Class _ Lic.# 2 m Contractor Date 0 p/s 1 hereby affir at 1 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. Sq.Ft Floor Area: Valuation:y;l?uu 1 hereby affirm under penalty of perjury one of the following two declarations: t. 1 have and will maintain a certificate of consent to self-insure for Worker's APN Number:37523014.00 Occupancy Type: Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. yI 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 EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 DAYS FRO ED INSPECTION. I certify that 1 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 0 IS- to building construction,and hereby authorize representatives of this city to enter Date: 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 RE-ROOFS: all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 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 tiignature�/ /`� /�� Date m l0 2fift' inspection. Signature of Applicant: Date: ❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: t. 1,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation,will do the work,and the structure is not intended or offered for 1 have read the hazardous materials requirements under Chapter 6.95 of the sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 2. 1,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should 1 use equipment or devices which emit hazardous air 1 hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District 1 will t. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation,as provided for by Section 3700 of the Labor Code,for the I lealth&Safety Code,Sections 25505,25533,and 25534. performance of the work for which this permit is issued. Owner r authorize rt: 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by Date: C, Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. CONSTRUCTION LENDING AGENCY s. 1 certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If,after making this certificate of exemption,I for which this permit is issued(Sec.3097,Civ C.) become subject to the Worker's Compensation provisions of the Labor Code,1 Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I understand my plans shall be used as public records. I certify that 1 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 Licensed Professional 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 GENERAL PERMIT APPLICATION M E P 4 COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333-build!nana cuDertino.oro Is ❑PL sm' ❑NbCHANIC4L ELECTRIC?? ❑MISCELLA'\ECUS PROJECT ADD FSS n I p?N# 375 75 'L 3 / l O V.111 < 42I PROM E•1✓`1Z S e,D� G-334 STREETP DRE) cCCL �l Sl.�' CJTY, STP S 0 3&' I FAX CO'�°T.4CT NAME ` � � fHO:� E•]�SII. , �� // � STREET ADDRESS QQ - CITY,SST. TE, FAX ❑ Ow-M ❑ OWI,'t�ft-B=ER ❑ OM^-�MAu'_T CO.N7XA.CTOR ❑C0ITRACTORAGENT ❑ ARC-=,.CT ❑ =NGL\'R ❑ Dc.LOFT ❑ i_ yRT CON KACTOR N.Av LIC NSE VMSFR L I LICENSE ME t BUS.LIC 4 COMPANY NAME E-MAIL I FAX uC-�, 1 pyl STREET RESS� tit CITY,STATE,ZIP PH NE ¢ 0 p ARCHITECT/ENGrNTXR NAME LICENSE N%S Bills.LIC LAW" 64r1lij COMPANYMWE -- E-MAIL, I FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD o,mPLEX ❑ ].41.'LTI-FA m y PRCIECT IN a'aDLA_N 7 ❑ 1:s I PROMCT IN ❑Y'rS IS THE BLDG.AN ❑ 'm BUTLDLNG: ❑COMNMCIAL ITRBANR7ERF.4CEARi4 ❑ 110 FLOODZ011E ❑ No EICHLERHOME? ❑ N0 DESCRIPTION'OF WORK �er'1�i�,eIp off— — — T0TA.L%1a.L1JATI0N:By my signature below,I certify to each of the following: Ian the property oo atb_ this application and the information I have provided is correct I have read the Description of Work and verify it is ac , ee to comply with all app 1c c2 ordinances and state laws relating to b 'din;construction. I authorize rrprntatives of Cupertino to enter the above-idea ified property fore purposes Signature of Applicant/.Agent: Date: 20 PLEb4ENTAL INFORMATION PLEQUIRED o 1Ic r F oaiY - 1 t_ AIEPA1iscAPP_2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 18600 BARNHART AVE DATE: 10/06/2015 REVIEWED BY: MELISSA APN: 375 23 014 BP#: `VALUATION: 1$1,200 ,:.PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY SFD or Duplex PENTAMATION 1REAP14 USE: PERMIT TYPE: WORK INSTALL TEMPORARY POWER SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $48 TOTALS: $48.00 Phunh. Plan Chet-A Elec.Plan Check 0.0 1 hrs $0.00 Elec.Permit Fee: IEPERMIT LiOther Elec.Insp. 0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public {forks, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the preliniinarj information available and are onlr an estimate. Contact the De t or addn'l info. FEE ITEMS (I'Lr Resolution 11-053 U/ 113) FEE QTY/FEE MISC ITEMS _i Ch! PME Plan Check: $0.00 ,'reit Pck PME Unit Fee: $48.00 PME Permit Fee: $48.00 ,»astructiuu I., Administrative Fee: IADMiN $45.00 Work Without Permit? Yes (E) No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 131dg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $190.50 $0.00 TOTAL FEE: 1 $190.50 Revised: 07/02/2015