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B-2016-1398 PERMIT, APP, FEE ESTCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1398 21101 CANYON OAK WAY CUPERTINO, CA 95014-6573 (342 60 011) ( INFINITE ELECTRIC) CAMPBELL, CA 95008 OWNER'S NAME: YU RONALD AND KATHLEEN TRUSTEE DATE ISSUED: 02/19/2016 OWNER'S PHONE: 6504501637 PRONE NO: 4085926782 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 110 Lie. #855310 Contractor( INFINITE ELECTRIC ) Date 2/19/2016 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed corder the provisions of Chapter 9 (commencing MECH X RESIDENTIAL_ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in fall force and effect. JOB DESCRIPTION: INSTALL (N) 50 AMP CIRCUIT FOR EV CHARGING NEMA 14/50A I hereby affirm under penalty of perjury one of the following two declarations: RECEPTACLE IN GARAGE 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. 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. Sq. Ft Floor Area: Valuation: $850.00 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 APN Number: Occupancy Type: ordinances and slate laws relating to building construction, and hereby 342 60 011 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations er the Cupertino 180 DAYS FROM LAST CALLED INSPE Code, Section 9.18. JGTTON. �/j�/ Issued by: PAUL O'SULLIVAN 'I Signal--�-'-- Date 2119 2016 Date: 2/19/2016 J OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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. 1, 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: r. 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. 1. 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 In 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, 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: 2/19/2016 ALLROOF 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 IIealth & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 255 and 25534. c Owner or authorized agent. Date: 211912016 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 Date 2/19/2016 Rrofessk CUPERTINO ALTERNATIVE ENERGY PERMIT APPLICATION mm COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 A mt: (408) 777.3228 • FAX (408) 777-3333 • buildinoacupertino.org PROJECT ADDRESS APN S a CMIERNAME �u HONE So SD -1b3, E-MAIL ,� _ `E1 AD�DR) SS 'ITY, ST. TE, Z1P c FAX N AC'T VANE .� ONE E-MAIL y-, D SqZ- i c�nr�5 Ivy whs� S REET ADDRE i.0- ^'i)tA �. ITY,yySTAE, 27�� O FAX OWNER ❑ OWNER -BUILDER ❑ ONNERRACEENT ❑ CONTRACTOR tTCO��NPRACTOR AGENT ❑ ARCIVTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C 7�.'TRACT I.4E Ae. LICENSE NUA4BER�S4� I-ICE];'SE TYOP� BUS. LIC9 COMPRAY IS' R9E &MA1L / FAX STREET ADDR S ITY, ST TE, ZI PHONE ARCIITECTIENCiINEER NAME- LICENSE NUMBER go55�1 1 BUS, LIC. COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE �' USE OF Irk OFD or Duplex ❑ hfulti-Family U/ PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ COmll'ICTC, I�aI// �,/' URBAN INTERFACE AREA ❑ Yes Fl N-O FLOOD ZONE ❑ Yes (�0 ❑ SOLAR PANELS r=I ELECTRIC VEHICLE CH4RGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FORSOLJRPAA'ELS- NUMBEROFPANELWUNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATION: ��"-'7�' �v DESCRIPTION OF WORK 32ECEIVED'BY z-: - � �. _�_ By my signature below, I certify to each of the following: I am thetrorty owner or authorized went to act on the property owner's behalf. I have readthis application and the information I have provided is correct, Lhave read the Desertion-af-W ork and verify it is accurate. I a eato comply with all applicable local ordinances and state laws relating to buildingccstructton. I�uthoUze—r esentatives of Cupertino to enter the abov,�lden 9fiad pr erty for inspection purposes. �'""" T Signature of ApplicanVAeent; e�-� Date: SUPPLEMENTAL ORMATION UIRE REQD 2 '-Ja2. ��_ O�SHIIrCaLr�R4`EA �t]��, 1', �❑.PRESS � � �`L,.£fi 2F zzl + PVApp_201 I. doe revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION JAFADDRESS: 21101 CANYON OAK WAY DATE: 02/19/2016 APN: 342 60 011 BP#: REVIEWED BY: PAUL "VALUATION: $850 -PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION SOLAR-RES PERMIT TYPE: 14 WORK TINSTALL N 50 AMP CIRCUIT FOR EV CHARGING NEMA 14/50A RECEPTACLE IN GARAGE SCOPE hvq,r'h=� C7re-Gi 7ir 1 a t kec;. n i x i2 Ej $/ '.h. fav" Fee' t h ni? 11YSli 1;K, fivK Imp10R NOTE: This estintnte does not inclinde fees (line to other Departments (i.e. Planning, Pahlic Works, Fire, Sanitary Sewer District, School Dislrirf atr.) The,, fan, ore hated nu 1he nreliminary iefarnmlinn availuhle and are only an eciimote. Contne7 the Devi fir addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711/i3� FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Alternative Energy System $109.00 iCARGSTA EV Charging Station Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 T hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ( (Ll:jitltl 1<JL. . tuhuh: ' 41r;.it(v, t t.'i.'. 0 E) Work Without Permit? 0 Yes (D No $0.00 Advanced Planni�Fee: $0.00 Selectallon-Residential Q Building m• Structure I 'fr nr c 1fa< itrdC+-picz <3r l`c? 5_ Shone Motion Fee: IBSEISMICR $0.50 Select an Administrative Item ) Bkl. S� 'tds Commission Fee: 1BCBSC $1.00 SUBTOTALS:' $1.50 $109.00 TOTAL FEE: $110.50 Revised: 0 ©.1