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151200203Y' CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 947 FERNGROVE DR CONTRACTOR: MAINE ELECTRIC INC PERMIT NO: 15120020 OWNER'S NAME: ZHAO MENGSHU AND WANG YI 599 LEISURE ST DATE ISSUED: 12/03/2015 OWNER'S PHONE: 4089738196 LIVERMORE, CA 94551 PHONE NO: (925) 443-3377 PZ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL l License Class GNU Lie. D UPGRADE MAIN SERVICE FROM 100 AMP TO 125 AMP. Contractor4MJ MQ -(1 C. Date® ,_�- 3 / 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 Sq. Ft Floor Area: Valuation: $5907 performance of the work for which this permit is issued. al 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: 37539060.00 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 WITHIN 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 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 theU�/ (� I granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: J with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. p RE -ROOFS: Signature' Date J i) 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 Avo 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 Section 3700 of the Labor Code, for the performance of the work for which this 533, and 25534. the Health & Safety C "505, 25d", Owner or authorized agents . Qc� 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 revolted. 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 cot COMB 10300 CUPERTINO (408) n ., M PERMIT APPLICATION DEVELOPMENT DEPARTMENT • BUILDING DIVISION AVENUE • CUPERTINO, CA 950143255 B • FAX (408) 777-3333 • buiiding0cupertino.om n AT TFRATFQ-N i TI FIREVISION /DEFERRED 146? i512OD20 ORIGINAL PERMIT # LJ lYL'W l.V1V �lit{ia.11V1`I `I r�:++aiaaava. ��+ ..-.��.�.•��• __ � _— ----_ PR=CrADDRESS "�% _ �/ N# 5 6 60 OWNERNAME J^(to �`�Z� F`' STREET ADDRESS i aff, STATE, ZIP FAX t corrrAcr NAME pgO E-MAIL . STREET ADDRESS I CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNERBUQAER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHrrECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ~ I Ole, � / LICENSE NCII�ER (�O LICENSE TYPE BUS. LIC # cowANYNA'm .l e, r WL i/�` / MAI •cffY, FAX STREET ADDRESS �[� R�+ ( J STATE, ZIP f N , n/��' (� V- PHONE ARCMI'ECr1ENG NEER AME ' I i LICENSE NUMBER BUS. LIC # COMPANY NAME i E-MAIL FAX STREEr ADDRESSPROICE I CTfY, STATE, DESCRIPTION OF RK J r !? V C)L I I • I MCNT INGUSE PROPOSED USE i coNsm TYPE # STORIES USE TYPE OCC SQ.FI. VALUATION (3) XISTG AREA NEW FLOOR AREA 1 DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECWORCH AREA i GARAGE AREA HDETACH ATTACH S DWELLING IRMS: IS A SECOND UNIT YES BEINGADDID' ❑NO SECOND STORY YES ADDMON2 ❑NO PRE -APPLICATION 13YEs IFYES.PROVIDIECOPYOF ISTBEBLDGAN 13 YES i TOTAL VALUATION: -- PLANNINOAPPLB ❑NO PLANNMAPPROVALLETTER EICRUMBOMEY ❑NO }156103 t By my signature below, I certify to each gf the following the property owner or autho ' ag on the property owner's behalf.. I have read this have the Description of verify it is accurate. I agree to comply with all applicable local application and the information I have pro co read ordinances and state laws relating to b on orize ves of cupertino to enter the above -identified property for immZon purposes. Signature of Applic ant/Agent Date: SUPPLEMENVL D F01MATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for - _ existing building(s). Aemolition per pit is required prior to issuance of btuilding >' " •- permit for new building i { Commercial Bldgs: Provide a completed Hazardous Materials Disclosure _ form if any Hazardous Materials are being used as part of this project. I Copy of Planning Approval Letter or Meeting with Planning prior to - _ submittal of BuRding Permit applic+On. B1dgApp 2011.doc revised 06/21/11 S CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE EQUIP TYPE ADDRESS: 947 Ferngrove Dr DATE: 12/03/2015 REVIEWED BY: Phuong UNITS APN: 375 39 060 BP#: 'VALUATION: 1$5,907 ,'--PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps TP—ENTAMATION I REAP 2 I PERMIT TYPE: 14 WORK Upgrade main service from 100 amp to 125 amp. SCOPE a. APPLIANCE EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Elec. Permit Fee: ]EPERMIT Services A 1 ERT<200 Other Elec. Insp. 1 0.0 hrs $48.00 125. Amps $48 Pernl,;i pee: a. PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes (@ No $0.00 TOTALS: A Travel Documentation Fee: I TRA TIDOC $48.00 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 District. etc.). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 1.1-053 L,'f_711113 FEE QTY/FEE Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: ]EPERMIT Other Elec. Insp. 1 0.0 hrs $48.00 1-'hqo1,,,5, ""v; -fe, F;e., .. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 1.1-053 L,'f_711113 FEE QTY/FEE MISC ITEMS A PME Plan Check: $0.00 Pernl,;i pee: a. PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: (ADMIN $45.00 Work Without Permit? 0 Yes (@ No $0.00 A., 'i A Travel Documentation Fee: I TRA TIDOC $48.00 Strong Motion Fee: IBSEISMICR $0.77 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: SUBTO $190.77$0.00 TOTAL. FEE: $190.77 Revised: 10/01/2015