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B-2017-0353CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0353 7874 ROBINDELL WAY CUPERTINO, CA 95014-5015 (362 19 028) RADAR CONSTRUCTION INC MILPITAS, CA 95035 OWNER'S NAME: CHEUNG PO KAM ET AL DATE ISSUED: 03/02/2017 OWNER'S PHONE: 408-691-7696 PHONE NO: (408) 828-1902 LICENSED CONTRACTOR'S DECLARATION BUILDING PERNUT INFO: License Class 88 C10 Lic. #754897 Contractor RADAR CONSTRUCTION INCDate 11/30/2017 X BLDG X ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: UPGRADE 100 AMP PANEL TO 200 AMP (SAME LOCATION) I hereby affirm under penalty of perjury one of the following two declarations: m. 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. z 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 - _L permit is issued. Sq. Ft Floor Area: Valuation: $1000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 19 028 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 source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM _��SPE�CTION. Signatureii� Date03/02/2017 / Issued by: MELI AN U O R -B ELDER DECLARATION Date: 03/02/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS - following following two reasons: All roofs shall be.inspected prior to any roofing material being installed. If a roof is m. 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 (Scc.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: 03/02/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER m. 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 3. 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 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 hazardous 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 ,/ e be deemed revoked. Owner or authorized agent: 6 A4, APPLICANT CERTIFICATION Date: 03/02/2017 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. 1 understand my plans shall be used as public records. Licensed Signature Date 03/02/2017 Professional COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 1030.0 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 • building&cupertino.org ❑ PLUMBING F I MECHANICAT y3. 2-0/ F- a F] F7 T,/tTS(RT.T DASRnT TC MEP mi5-3sc PROJECT ADDRESS , �n h' h W APN # Z o ,� f OWNER NAME � �-� " � � GC PHONE � /'� p�.ryfi � E-MAILG�' STREET ADDRESS (� t� `Z i /.4j� f i f Q,YiQ C(O CITY, STATE, ZIP ( c �' Fi T G Lt C9 FAx CONTACT NAME C PHONE t� fj�(JZ��f�oZ EMAII. �_. „J�� ' `��fi,//.t• STREET ADDRESSc G CITY, STATE, ZIP J C�) ❑ OWNER OWNER -BUILDER OWNERAGENT CONTRACTOR 1:1 CONTRACTORAGENT 11 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 1> ♦ a ` LICENSE NUMBER D7 � j �f LICENSE TYPE BUS. LIC # COMPANY NAME {' ' E-MAIL / o(h RA f +,y4�t o FAX STREET ADDRESS CITY, STATE, ZIPo' �. /i �S G� PHONE (� 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 BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES HOME? El No t'�EI�C.ELER DESCRIPTION OF WORK Nr % r3 -/9 TOTAL VALUATION: %t 7 l s EIVED By my signature below, I certify't'o each of the following: I am the property owner or authorized agent to act on the prop ner's behalf. 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 build cons ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. s Signature of Applicant/Agent: Date:. [% , 2-v(77 SUPPLEMENT AT INFORMATION REQUIRED OFFICE u E ONLY ❑ OVER -TIE -COUNTER ❑ EXPRESS U ❑ STANDARD GJ ❑ LARGE a, ❑ MAJOR MEPMiscApp_2011.doc revised 06/21111