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B-2016-2304 CITY OF CUPERTINO BUILDING PERMIT BiTII.DING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2304 921 SAGE CT CUPERTINO,CA 95014-4217(359 06 00� ALECO ELECTRIC I VACAVILLE,CA 95687 OWNER'S NAME: YUEN MAN FU AND YANG ALICE DATE ISSUED:07/12/2016 OWNER'S PHONE:408-834-6839 PHONE No:(s06)573-8803 i i['ENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: I License Class WARM-AIR HEATING VENTILATING AND AIR-CONDITIONING X BLDG X ELECT _PLUMB I Lic.#�4$9�4 — Contractor ALECO ELECTRIC Date 10/31l2016 _MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 af the Business&Professions Code and that my JOB DESCRIPTION: license is in full force and effect. REPLACE PANEL(100 AMP);SAME LOCATION I hereby afSrm under penalty of perjury one of the following two declarations: i. 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. a, I have and will n}aintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$200Q.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above �N Number: Occupancy Type: information is correct.i agree to comply with all city and county ordinances 359 06 006 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 pERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities,judgments,costs,and expenses which wITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source re ulations per the Cypertino Municipal C�,Section 9.18. � Issued by:Abby Ayende .. Signature Date 7/12/2016 Date:07/12/2016 ' �� OWNER-BUII.DER DECLARATION RE-ROOFS:. I hereby affirm that I am esempt from the Contractor's License Law for one of the A11 roofs shall be inspected prior to any roofing material being installed.If a roof is following hvo reasons: � installed without first obtaining an inspecrion,I agree to remove all new materials for i. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature ofApplicant: z. I,as owner of the property,am exclusively contracting with licensed Date:7/12/2016 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: �L ROOF COVERINGS TO BE CLASS"A"OR BETTER i. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensa6on,as provided far by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE . performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the �. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will Section 3700 of the Labor Code,for the performance of the work far which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the pernrit is issued. Health&Safety Code;Section 25532(a)should I store or handle hazardons a. 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 �r contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of Califomia. If,after making this certificate of the Health&Safety Code,Sections 2551�5,25533,a 553 j exemption,I become subject to the Worker's Compensation provisions of the L�>�^� Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent: be deemed revoked. Date:7 1/ 2/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the pertormance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the apPlicant understands ARCffiTECT'S DECLARATTON and will complywith all non-point source regulations per the Cupertino Municipal, I understand my plans shall be used as public records. Code,Section 9.18. Licensed Professional Signature Date 7/12/2016 GEIVERAL PERIV��T e4PPLICA°TION � � � COMMUNITY DEVELOPMENT DEPARTMENT=BUILDING DIVISION , . � 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTiNO �408)777-3228• FAX(408)777-3333 • buildinq(c�cupertino.orq I � �-Ze�c� _2� ❑PLUMBING ❑MECEIANICAL LECTRICAL ❑MISCELLANEOUS � PROJECT ADDRESS /1 � Q APN# a�G; � � �� /_ o�. ,� ✓ ( rJ OWNERNAME ` PHONE E-MAIL �l-e.�n 1`�a� �a$) s 3 - (�g SIREET ADDRESS c CITY, STATE,ZIP FAX 02 � J Ct 2- C �e.t- CONTACT NAME PHONE E-MAII, , e �e i o� ts�'�- �t� 9 c� e ec Q r��l �� STREET ADDRESS�o� � �� C � I� CITY,STATE,ZIP `r�C C(V � ,1 C? F��J � %�� Y � ��❑OWNER ❑ OWNER-BUII.DER ❑ OWNERAGENT ❑ CONTRACTOR �ONTRACTORAGENT ❑ ARCH11'ECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CON'PRACTOR NAME • LICENSE NUMBER LICENSE TYPE BUS.LIC# o e. e r c- `� �I C-\0 ��o� COMPr1NY NAME E- FAX o e �2 c r�e. e� o t 12 e. c. Cv .c 0'} �1 - 31e8' 51REET ADDRESS CITY,STATE,ZIP PHONE Cs v - � �15 (o �- O �-3- S g a 3 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PIIONE USE OF C�'SPD or DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WII..DLAND ❑ YES PROJECT'IN ❑YES IS T7-IE BLDG AN ❑YES BUII,DIN6: �COIvA�RCIAL URBAN IN'I'ERFACE AREA Q�1Y0 FLOOD ZONE ❑NO EICHLER HOME7 ['�}3Q0 DESCRIPTION OF WORK OO ��rV\c� � 1�e 1 e � � Y.� � L ' ke � TOTAL VALUATTON: ,QZ � O O O RECENED BYi p V� V By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property o ner's ehalf. 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 comply with all applicable local ordinances and state laws relating to buil ' constru�tion. I au ori e re,presentatives of Cupertino to enter the above-' enrifi property for inspection purposes. Signature ofApplicant/Agent: � Date: 7�a"// 5� �� SUPP E NTAL INFORMATI QUIRED o�icE usE orrtY� • "w `❑ ovER-Tn�cou�v�x � w ` _ " � i0 EXPRESS ^ � , U � ` .� ❑ STANDARD ;' aUz ' _,' ' ' . a �`LARGE ' . a _ _ ❑ MAJOR ` MEPMiscApp_2011.doc revised 06/21/11