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B-2016-1652 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1652 10163 JUDYAVE CUPERTINO,CA 95014-3522(375 07 055) GURRIES ELECTRIC INC SAN JOSE,CA 95127 OWNER`S NAME: WANG HANK CHIA-CHI AND HANK CHIA-CHI WANG I DATE ISSUED:03/30/2016 OWNER'S PHONE:408-952-6303 PHONE NO:(408)710-4251 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#912358 Contractor CURRIES ELECTRIC INC Date 04/30/2018 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under 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 full force and effect. JOB DESCRIPTION: INSTALL 50AMP EV CHARGER CIRCUIT(NEMA 14-50R)IN I hereby affirm under penalty of perjury one of the following two declarations: GARAGE 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. 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:$500.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 375 07 055 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR AdditioR, pplicant understands and will comply with all non-pointsourceer the Cupertino Municipal Code,Section 9,18. 180 DAYS FROM LAST CALLED IN TION. Date 03/30/2016 Issued by:ALEX VALLELUNGA Date:03/30/2016 DE ARATI N I hereby of rrm that I am exempt from the Contractor's License Law for one of the RE-ROOFS- following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2.. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant contractors to construct the project(Sec.7044,Business&Professions Code). Date:03/30/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER L 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain,compliance with th ertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co e S ctions 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked.. Owner orau'thotiY6-t agent: APPLICANT CERTIFICATION Date:03/30/2016 I certify that I have read this application and state that the above information is NSTR T ti NA E Y correct,I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a nstr tion lending agency for the performance' relating to building construction,and hereby authorize representatives of this city of work's for which this permit is ued(Sec,3097,Civ C.) to enter upon the above mentioned property for inspection purposes, (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9,18. 1 understand my plans shall be used as public records. Licensed Signature Date 03/30/2016 Professional ALTERNATIVE ENERGY PERMIT APPLICATION mmm COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTI NO (408)777-3228 FAX(408)777-3333-building O cupettinO.Org PROJECT ADDRESS i (0 § r ( APN R „ ' 6/V✓ OwERNAME YA i� 1 "� STREET ADDRESS CITY, STATE,ZIP FAX CA CONTACT NAME PHONE E-T/,AIL IPF '7kD3q7 STREET ADDRESS 'Q� ,y �g - CITY,`TATE, ZIP FAX ❑ OVFat ❑ O1kTzR-BUILDM ❑ MwEER AGEM ❑ COI TRACTOR E COhiRACTOR AG'cI\T El ARCI-uiaCT ❑ENGINEEP El DEVELOPER ❑ TExAI T CONTRSCTORNA14E LICENSE NT OBER q��Fs�',QU LIC��SE TYPEC'-j Q I BUS.LIC R 4 COMPANY NAME `O �) t r E-N� LFAX C�- I UfTI'e��12�cL E"11ktC. STREET ADDRESS CITY,STATE,ZIP PHONE ARCMTECTtSNGINEERNAME I LICENSE NUMBER I BUS.LICm COMIPANYNAME ! E-N..AIL FAX STREET ADDRESS II CITY,STATE,ZIP PHOT'E USE OF ❑ SFD Or Duplex ❑ MUIti-Farnily PROSECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes t# NO FLOOD ZONE ❑ Yes � No ❑SOLAR PANELS ELECTRIC VEHICLE C11ARGING STATION -7-❑ SOLAR WATER'DATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PAI ELS/ NITS: KILOWAPIS(COMI,,IERCIAL ONLY): TOTAL VALUATIO DESCRIPTION OF WORK �p` i �� � � .• �� � � � ,— ItECFIG tD BY = s By my signature below,I c -,iy to each o the following: I-, the property ol\mer or authorized agent to act on the property owner's be alf. I have read this application a.�d the inform tion I have pr c z. read the Description of Work and verify it is accurate. I a-aree to comply with Ell applicable local ordinances and state laws r xinQ to b�' nstru o . I authorize representatives of Cupertino to enter the above-identified rope, for inspection purposes. Signature ofApplicant/Agent: Date: SUPPL _ NITAL INFORMATION REQUIRED UISTER Ra— ❑.T 7A70R. _ PV4pp_2011.doc revised 03116111 Awe 'SIL o w ,N n z coMzsI .:5 o CL zr cw lb rj, 2 ° c 2 Qa { iat e> a 55 cz � � P > C5 a ta5 a'o Q ) r o ® VV as Ui C8 E3 ¢� w l> cti LU