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B-2017-1662 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1662 10144 VISTA DR CUPERTINO,CA 95014-2223(316 24 036) ANTHONY LEWIS INCORPORATED SAN JOSE,CA 95126 OWNER'S NAME: CHU JOHN W AND CHRISTINE T TRUSTEE DATE ISSUED:09/26/2017 OWNER'S PHONE:312-402-3870 PHONE NO:(408)217-8621 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#851107 Contractor:, .0k i ► •;.0;1 a Date 08/31/2019 X BLDG X 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: (N)EV CHARGING STATION-(50 AMP)REPLACE ELECTRICAL- I hereby affirm under penalty of perjury one of the following two declarations: GARAGE;SUB-PANEL(125 AMP)-SAME LOCATION 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. 1,\,r,(40, 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. Sq.Ft Floor Area: Valuation:$2750.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 316 24 036 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 regulation.,erth. - •ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signatu � ���rly` a-te 09-26-2017 Issued by:SEAN HATCH Date:09/26/2017 I hereby affir empt from the Contractor's License Law for one of the RE-ROOFS; following two re, . s: 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) 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:09-26-2017 I hereby affirm under penalty of perjury one of the following three declarations: 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 2. 1 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. 1 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 Cod', ections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: '��,_T APPLICANT CERTIFICATION Date:09-26-2017 __ I certify that I have read this application and state that the above information is •I t . t k correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a ciinstruction I: ding agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is'. u-• ;ec.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 09-26-2017 Professional \\I-k/ ALTERNATIVE ENERGY PERMIT APPLICATION *9 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION e.,..4., 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 AE (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq CUPERTINO 1/0/ I/ _ I PROJECT ADDRESS ' O ! q 1 \ I 1 s 0...)e APN#343 _ /•z,34 OWNER NAME jr\(\eIR ,,,,Lana i 0 E-MAIL ADDRESS i,t J 15CITY,STATE,ZIP FAX CONTACT NAME (_ k,( �, r `�^, PHONE( A S Q �f 7 6�j E-MAIL ,{�_ ,,,�}./�� f\lV! \` l l.[ o l I Aniv ib ^' l irc.�leM1 t s t 1(e'^ J •cdn STREET ADDRESS ` , G`S pee_ CITY,STATE,ZIPSot VI7FAX ❑OWNER 0 OWNER-BUILDERI., Cl OWNER AGENT 0 CONTRACTOR- Q 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAMtpos)Fit\iiMkki c \ LICENSE NUMBER?S!107 LICENS�E J a BUS.LIC# COMPANY NAME 04. 1 E-MAIL XU �(_J FAX 1 ''' � l�( S �C �eiU.)1s©'Q /L 0(l(.f oC •((N•_, STREET ADDRESS h l ( / CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 'fpSFD or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes t1 No FLOOD ZONE 0 Yes 7.No 0 SOLAR PANELS y ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING ` 0 OTHER: !! FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATI ,+ or. <4, F0 ./ DESCRIPTION OF WORK k (I C( ) Sb 2y0VC,><u„f ' (iS tO2N14.-1 ILI --CO 40 (pe f(,ed iq 7ricE..'- '(?Qalac.2 � (4Iy 5 .)A0W1 coyv � ( "-)t-4-7 L/? RECEIVED BY: .7 n By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner'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 buil ' g c ction. authorize reprrveseetaf o ino to enter the above-i entified/ -prperty for inspection purposes. "(�`i to Signature of Applicant/Agent: Date: (( 7 SUP L MENT INFORMATION REQUIRED OFFICE USE ONLY W lig OVER-THE-COUNTER 0.4 E" EXPRESS U U x 0 STANDARD U j 0 LARGE 5- ❑ MAJOR PVApp_2011.doc revised 03/16/11 \ri.)/ SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE e.�nss COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building aC�.cupertino.orq { PERMIT CANNOT BE F INALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED,SIGNED,AND RET '° D TO i s t i ,E;UIN G,,DIVI PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds $1000.00,CRC Section R314,R315,and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply,alarm(s)may be solely battery operated. In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational,as of the date signed below Address: vi 4 S:telt- c s\Pt Permit No. 1-1"` LO 14 2- Specify Number of Alarms #Smoke Alarms. MN #Carbon Monoxide Detectors. ( — I have read and agree to c p/'y with he terms- • onditions of this statement Owner(or Owner Agent's)Name: i ttif e_hfs+eve Cint,0Signature . .. .. /. ... Date: .. Contractor Name: 67.-konyYJf S Signatur: Lic.# ... Date:r °./t?.t Smoke and CO form.doc revised 01/10/2017