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15120021 CITY OF CUPER.TINO BUILDING PERMIT BUILDING ADDRESS: 10364 STERLING BLVD CONTRACTOR:WELKIN PERMIT NO:15120021 INTERNATIONAL IND INC OWNER'S NAME: HAPPY OCEAN LLC,ET AL 18255 CLEMSON AVE DATE ISSUED: 12/03/2015 OWNER'S PHONE: 5103645343 SARATOGA,CA 95070 PHONE NO:(408)888-9096 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL Q COMMERCIAL 0 TEMP POWER 200 AMP License Class -� _ Lic.# 1 gab-11 Contractor .&tC Xile Date=-J)_l?L-2o x 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:$600 I have and will maintain Worker's Compensation Insurance,as provided for by XSection 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37524010.00 Occupancy Type: 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 the t , f granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 1 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Si nature RE-ROOFS: Signature"--:3 Date "� ]3 ZO �,S 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 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) 1,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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this ! VSJ Owner or authorized agent: (/ Dater permit is issued. I certify Shat 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 CONSTRUCTION LENDING AGENCY 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 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 9.18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �1 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building aacupertino.org misc CUPERTINO 2-002- ' ❑PLUMBING ❑MECHANICAL RIELECTIUCAL []MISCELLANEOUS PROJECT ADDRESS givo. APN# i OWNER O NAME u / ! PHONE J— E-MAIL 4 STREET ADDRESS / / jr) J CITY,.STATE,ZIP CONTACT NAME JI 1 y PHONE. r qg E-MAIL X P1 J(.L.YIZI l Q J/,G J M ADDRESS / �� / CITY,STATE,ZIP / Ito /,4, q�)�1 F AX q4qSTREET (� J l ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR 39AME l V� LICENSE NUMBER �J' ` LICENSE TYPE BUS.LIC# � b 1. COMPANY NAME E-MAIL FAX STREET ADD SSPd � CITY,STATE,ZIP / �� PHONE/��_t_/5__ ARCHITECT/ENGINEER NAME LICENSE NUMBER ( BUS.LIC# J a COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE.BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑.NO EICHLER HOME? ❑.NO DESCRIPTION OF WORK / c � ire f�� .1p o TOTAL VALUATION:. � 60 RECEIVED B" MA 14L K 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 b al 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 comp vith all applicable local ordinances and state laws relating to build* nisstruucction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: �s( L� Date: SUPPLEMENTAL INFORMATION REQUIRED :0-FFICE CJS ON ` a OV.FRTITR>CQUNTtsR. r.. sk � CI ZrXPRESS CI sm�x�ARrz LA4U a . a gAJOR MEPMiscA.P 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION K ADDRESS: 10364 Sterling Blvd DATE: 12/0312015 REVIEWED BY: Phuong APN: 375 24 010 BP#: `EVALUATION $0 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Du lex PENTAMATION 1REAP14 USE: p PERMIT TYPE: WORK Temp power 200 am _ SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS SP FEES Temporary Power 1 ERT<200 200Amps $48 TOTALS: $48 00 eeF,. 1 .,t,Check v�.� — rtt .I',,v.�Check Elec,Plan Cheek 0.0 brs $0.00 ;. ., ,r>.=u.-..<.. h �.,.s'�ir��x��:u: Elec.Permit Fee: IEPEPMIT Other Elec.Insp. 0.0 hrs $48.00 ;{c.of z L)L,.'_ _. j s(4.P.?� f.3,; ux'•,, _. 1h r' NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These Lees are based on the prelimina information available and are onl an estimate. Contact the De t for addn'l info. FEE ITEMS(1-'ee Resolution 1.1-053 F) 7/1113) FEE QTY/FEE MISC ITEMS zq.FzjI PME Plan Check: $0.00 PME Unit Fee; $48.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? C) Yes ( No $0.00 Travel Documentation Fee: ITRAVDOC. $48.00 Strom Motion Fey:: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 USTOTAI� : $189.00 $0.00 ,1. TOTAL FEE; ' $189.00 Revised; 10/01/2015