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B-2016-1824 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1824 22250 VARIAN WAY CUPERTINO,CA 95014-1065(326 17 042) ANTHONY LEWIS INCORPORATED SAN JOSE,CA 95125- 1618 OWNER'S NAME: ONG KENNETH C AND CHEN JOAN J DATE ISSUED:04/25/2016 OWNER'S PHONE:408-219-3966 PHONE NO:(408)217-8621 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ELECTRICAL Lic.#85110-7 Contractor ANTHONY LEWIS INCORPORATED Date 08/31/2017 X BLDG _ELECT _PLUMB MECH X RESIDENTIAL_COMMERCIAL 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. JOB DESCRIPTION: INSTALL NEMA EV CHARGING OUTLET IN GARAGE(50 AMPS) I hereby affirm under penalty of perjury one of the following two declarations: 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. f z.if I have and will maintain Worker's Compensation Insurance,as provided for by W Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3600.00 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 ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 17 042 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 Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertin Municipal Code,Section 9.18. 180 DAYS FRO ECTION. Signature Date 04/25/2016 Issued by:MELIS Date:04/25/2016 OWNER-BUI DER DECLARATION I hereby affirm 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 of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:04/25/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. 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 pen-nit 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 maturer 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 the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505, 53 , nd 25534. Labor Code,I must forthwith comply with such provisions or this permit shall p be deemed revolted. Owner or authorized agent: APPLICANT CERTIFICATION Date:04/25/2016 I certify that I have read this application and state that the above information is CONSTRUCT ON LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(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 04/25/2016 Professional ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMiENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3258 (408)777-3228• FAX(408)777-3333 • building(( cunerlino.org CUPi=RTIhlO PROJECT ADDRESS (j APN m 3 Z-6 r r �v� OWicRN. -TOari C I P 0 � - 396E-MAIL U � -I Zln10 1 STREET ADDRESS -► CITY, STATE,ZIP FAX 22-2-50 yariort V�Ja u er 1',o C gS41►k CONTACTNAM PHOT E.MIAIL " Paut e,,� a� q30-�bq+} �8$ 217-B6L1 STREET ADDRESS CITY,STATE, ZIP I FAX ❑ OlR-ER ❑ O NER-BUZT-DER ❑ OWNERAGENT ❑ CONTRACTOR ❑coinFACTORAGEh-1' ❑ ARC1=.CT ❑ENGDTTS.R ❑ DE\ALO?ER ❑ i_�FNr CONTRACTOR NAME Oh LIC-cSE XW ER LInE1\\SE TYPE I BUS.LIC h R� 1 4(iS J ^ lI CO},4PANY NAAQE I Wit &C. AICW 15 0 J(Tvt I IR-YLUL FAX 0 1„Q, o,�, twi5 enc-coY►�► STREET ADDRES TY, ATE,ZI P ON" 34 Avwcis Ave. � CSA g512b ARMTECTrNGINEER NP14E I LICENSE NUMBER I BUS.LIC' COMPANY NAME E-MAIL FAX STREET ADDRESS I CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN VdILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO ❑SOLAR PANELS ELECTRIC VEHICLE Cu ARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS: NUMBER OF PANTLS/L'NITS: KILOWATTS( TOTAL VALUATION: DESCRIPTION Or WORK 1,44 L NWt A40 oYk By my signature below,I certiffy to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this r application and the information I have pro ed is correct, ve read the Description of'Work and verity it is accurate. I PEree to comply with all applicable local ordinances and state laws relating to bu' i const n. authorize representatives of Cupertino to enter the ab e-/11 entified Propertyfor inspection purposes. Si_natureofApplicant/Agant: ---G Date: S 7PLPLEMENTTAL IINTFORMATIOINT REQUIRED - 'c — ❑ �PRESS za L� - �� - STANDARD x y Iv7A70R �:� a sti. PT!4pp_2011.doc revised 03/16111 1 CIL) L! MF TA E6C XGm VV �� F M F—GC, G COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO ppAPPROVED =y C r�a This scat of pians and specifications MUST be kept at the ' I rn job site during construction. It is unlawful to make any chances or alterations on same,or to deviate C o fll therefrom,without approval from the Building Official. de f � .0 Tho stamping of this plan and specifications SHALL NOT I I I � � z be held toper co e a pproval of the violation I � �� C- ��N of a , ovislons of a i Ordinance or State Law. _ �{��l� It III m "31y Eh F - Z �'d j� �(�T f' PERMIT NO. �� Z 7 vJ 1-11-) ( 32C AOL) • C� PL fJ`il�l�7.�i ECC .E., �ffrrA t Lf l DX " e—mg d�((—s� C,��u a. c� gsol�} PI ANfvING DEP;'..._ CUPERTINO Cke,r ;,�� - L - aD �`�, ` ��P -►-UPE—R-T-I N - ,l."� I — Bu ldin� Dena end _ R VIEVVE F R CODE C O PLIAN E Revi we8 By ti�— J �� ► r— �L.AN.�CI- - K-D - - -- - SCO 7) h W rel--da o (�,� [al4 ® TE _ _ P' NN N D P PLA NIIUG ►�;.i r-� _ PRfINO CI�P�RRT �—I