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B-2016-1876 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1876 22573 WOODRIDGE CT CUPERTINO,CA 95014-2674(342 15 065) MAIN STREAM ELECTRIC FOLSOM,CA 95630 OWNER'S NAME: LIAO SHEE-JEN AND CLARICE LIAO LIN I DATE ISSUED:05/03/2016 OWNER'S PHONE:408-316-0689 PHONE NO:(916)439-5253 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC10 Lic.#912100 Contractor MAIN STREAM ELECTRIC Date 03/31/2018 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(N)50 AMP CIRCUIT IN GARAGE FOR EV CHARGING I hereby affirm under penalty of perjury one of the following two declarations: STATION 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. 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:$1800.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type: 342 and state laws relating to building construction,and hereby authorize 342 15 065 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 Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Si�gnatur Date 5/3/2016 Issued by:Alex Vallelunea Date:05/03/2016 OWNER-BUILDER 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 t. 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 stricture 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:5/3/2016 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 z. 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 Health&Safety Code,Section 25532(a)should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued,I 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 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 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. .0 ;Her or au o ' ed 9_6* APPLICANT CERTIFICATION Date:5312D 1 I certify that I have read this application and state that the above information is CONSTRUCTION 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. I understand my plans shall be used as public records. Licensed Signature Date 5/3/2016 Professional ALTERNATIVE ENERGY PERMIT APPLICATION RUM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING D VISIO� I I 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228 • FP-X(408)777-3333 • buildina an.cupertino.org CUPERTINO PROJECT ADDRESS �p &OD u� �T APN R ie OWNER NAME Y y - _ g I PHONE STATE,ZIP A FAX CONTACT NAME PHONE E-M�iAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑ OVNE.R ❑ 01VNcR-BUILDER ❑ OV,'h`RAGBN-r ❑ COT-IR-IC-,OR 11CONTR0.Cp.T�.ORRAGEh-I ❑ ARC?uTtCT ❑ENG11\7EER ❑ DEQELOPER ❑ iFNA1�T CONTRACTORNATbB i ic> T-U)W�D LICBNSENLT4gl �(C/V LIC��SEi1!El I BUS.LIC COI, i?�¢1"E� l v FAX SJPy RrSS j s'1 a CITY,STATE,ZIP �- P6QNF ARCMTECTitNGINEER NP.ME I LICENSE NUMBER I BUS.LIC R COMPANY NAME E-M.kIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF �ZSFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO ❑SOLAR PANELS LO-ELECTFIC VEHICLE CY 4RGrNG STATION ❑ SOLAR WATER HEATING ❑ OTHER: FOR SOUR P11YELS: NUMBER OF PANELS/U\ITS: KILOWATTS(COMMERCI.AL ONLY): I TOTAL VALUATION:(I a©D DNESCRIPTIOOF WORK Q By my signature below,I certify to each of the following: lam the property owner or authorized agent to act on the property owner's behalf^I have,read thisk . application and the information I have provided is correct. I have read the Description of Work and ve.rit,it is accurate. I acrcc to comply With all applicable local ordinances and state laws relating to chi ion. I authorize representatives of Cupertino to enter the abov nti ed property for inspection purposes. SignatureofApplicant/Agent: Date: SUPPLED4ENTAL RNrFORA�ATION REQUIRED = -- Q = �„_= OFFTCETi�ED'�ZY ` �a I"L 0:1 ,❑.O�-E12.THF COITI�TER; - - _ S 3-L �kPRESS t u.. Et 4�T43tDARD "� y Pi!4pp_2011.doc revised 03/16/11