B-2016-2488CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-201,'6-2488
10798 JUNIPER CT CUPERTINO, CA 95014-6556 (342 57 006)
ANTHONY LEWIS
INCORPORATED
SAN JOSE, CA 95125-
1618
OWNER'S NAME; Cheung Roland F And Jenny Trustee
DATE ISSUED: 08/0.1/2016 '
OWNER'S PHONE: 650-730-0057
PHONE NO: (408) 217 ,8621
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: i
I
License Class ELECTRICAL Lic. #851107
Contractor ANTHONY LEWIS INCORPORATED Date 08/31/2017
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_ MECH X RESIDENTIAL— COMMERCIAL
I
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
NEW; 2 - EV CHARGING STATION; (50 AMPS); 1 INSIDE GARAGE 1
I hereby affirm under penalty of perjury one of the following two declarations:
EXTERIOR OF GARAGE r
1. I have and will maintain a certificate of consent to sclf-insure for Worker's
j.
Compensation, as provided for by Section 3700 of the Labor Code, for the
of the work for which this permit is issued.
AI
f zhave 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: $1950.00 #
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
342 57 006
i
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.
Additionally, the applicant understands and will comply with all non-point
WITHIN 180 DAYS' OF PERMIT ISSUANCE OR
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source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST C D INSPECTION.
Signatures/ l---' - Date 08/11/201.6
Date: 08/11/2016
2WNER-BUILDER DECLARATION
RE-ROOFS!
I hereby affirm that I am exempt from the Contractor's License Law for one of the
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)
z. 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: 08/11/2016
i
I hereby affirm under penalty of perjury one of the following three declarations:
i
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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
s. 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
hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit
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, 25 33, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
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be deemed revoked.
Owner or authorized agent:/�j
APPLICANT CERTIFICATION
Date: 08/11/2016 l`
I certify that Ihave 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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 08/11/2016
Professional
CUP ` INO
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • bu'rlding(@cupertino.org
PROJECT ADDRESSr
101q 14 tr- Ct. Cu �), CA q' l �t APN# 2 O
OWNER NAME
Pogo 730-9057 E-MAIL
e 3b aail.com
STREET ADDRESS CITY, STATE, ZIP FAX
soaW o,.%Poi eco 06ftss
CONTACT NAME. E-MAIL
No i Cvt�n PH NE 6130-9661A ppmeyl(;)a
STREET ADDRESSCITY, STATE, ZIP FAX
3�b Auzet�,.s AxSam Sncc. 7-A , 61 slz�
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR �% CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC #
,AW L.e,.Ir M1 10 736110
COMPANY NAME E_I�lAIL FAX
hon Ivowls -c, A18vrIS 91Yt�lnaP1 Il•ulslriC.Carin `
STREET ADDRESS,, , IP PH NE
ali1 4vwoos Avc, jY'S=ZCA O -$1
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME - E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF SFD or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE:. ❑ Commercial URBAN INTERFACE AREA ❑ Yes -,a' No FLOOD�ZONE ❑ Yes No
❑ SOLAR PANELS ELECTRIC VEHICLE CHARGING STATION ❑ SOLAR WATER HEATING ❑ OTHER:
FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (I.BAHI4I;RE�NLL ): TOTAL �VALbUATION:
DESCRIPTION OF WORK / Y .
atio.H J 2 AMP MP 140 \101,7 •e eC46Q 11CCJ4 �-r W6MX 144'0 oviIz c
By Iny signature below, I certify to each of the following: I am t e property owner or onzed agent to act on the pro
application and the information I have provi ed is correc I read the Descriptio of Work and verify itis accurate.
ordinances and state laws relating to bui con thorize representatives of Cupertino to enter the above -i(
Signature of Applicant/Agent: Date: -6411
S PPLNTAL INFORMATION REQUIRED
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local
PVApp 2011.doc revised 03116111