B-2017-0255CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0255
10260 VICKSBURG DR CUPERTINO, CA 95014-3320 (369 14 011) NORTHERN LIGHTS
ELECTRIC INC
DANVILLE, CA 94526
OWNER'S NAME: YORK ERIC T AND SHEN LUCY YU-N TRUSTEE
OWNER'S PHONE: 408-454-8934
LICENSED CONTRACTOR'S DECLARATION
ATION
License Class CC -10 Lie. #503828
Contractor NORTHERN LIGHTS ELECTRIC INCDate 08/31/2017
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.
I hereby affirm 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
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
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations p9r the Cupertino Municipal Code, Section 9.18.
dw�Signature ate 2/13/2017
DATE ISSUED: 02/13/2017
PHONE NO: (925) 833-7662
BUILDING PERMIT INFO:
X BLDG X ELECT _ PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
PANEL UPGRADE (200 AMP); (N)SUBPANEL (100 AMP) - GARAGE
Sq. Ft Floor Area: I Valuation: $5800.00
"N Number: Occupancy Type:
369 14 Ol l
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST' CALLED INSPECTION.
by: ABBY AYENDE
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
i. 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
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three 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.
i. 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.
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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 City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature
Signature of Applicant:
Date: 2/13/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health &,Safety Code Yections 25505, 25533, and 25534.
Owner or authorized agent: l \ + ✓v
Date: 2/13/2017
CQNSTR4VCJ1QNAGENCY
I hereby affirm that there is 19 construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Date 2/13/2017 Professional
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It _412949-MR-JAW1
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 A%%L
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 • buildingCcDcupertino.org
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PROJECT ADDRESS
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USE OF PsFD.DL--M ❑ MULTI-FANITLY I PROJECT W WILDLAND El YES PROTECT IN ❑ YES
BU=ING: rl COMdERC11,1, I TiRBAI,1INTERFACE AREA NO FLOOD ZONE ❑ NO
IS IUM BLDG AIN ❑ YRS
EICHLERHOME? ❑ NO
DESCRIPTION OP WORK
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TOTAL VALUATION:
By ruy signature below, I certify to each of the following: I an the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the infonnation 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 build' nstruction. r10 ereprese tatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date- 2-13-17
SUPrT;L FORIMATION REQUIRED
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