BLD-2020-1130 CITY OF
BUILDING PERMIT
CITY HALL
10300 TORRE AVENUE•CUPERTINO,CA 95DI4-3255
PHONE 408-777-3228
CUPERTINO WW1N,CUPERTIN0,0RG
BUILDING ADDRESS:201s7-%1SUNCA,cuparllno,CA%014-0427 qPN ssesaaii PERMIT NO:BLo-loan-nao
OWNER'S NAME:81 GUANHUA AND ZHEN ZHEN In Care Of MARY SUNG OWNER'S PHONE:
CONTRACTOR:FRYEELECTRICINC CONTRACTOR PHONE;406.0947791
DATE ISSUED: 0 ISSUED BY:neleyn VALUATION:$1.500
JOB DESCRIPTION-
(N) EV CHARGING STATION IN GARAGE — (50 AMP)
LE ENSED C NTRA OR'S DECLARAT
CONTRACTOR: FRYE ELECTRIC INC LICENSED CLASS: C1 Q - E LICENSED NO:982345 EXP DATE: 04130120'e
I hereby affirm that I am licensed under the provisions of Chapter (coWMencing,with Section &Profe Sion
Code and that my license is in full force and effect-
I hereby affirm under penalty of perjury one of the following three declarations:
D I have and will maintain a certificate of consent to self insure for Worker's Compensation,as provided for by 5gLion 370Q of the
Labor Cede 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 Section 37DO of the Labor Code,for the
performance of the work for which this permit is issued.
D I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any mariner so as to
become subject to the Worker's Compensation laws of California.l4 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.
HAIARDOUS M15TERIALS DISCMURE
I have read the hazardous materials requirements under Chapter 6.95 of the galifi2mia -iralth&S-it Zly Codt,,Sections 2550s 255.3.31 and 25534.1
will maintain compliance with theLL -rtino Nlunici al Cote Chanter 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 flay Area
Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the health&Safety Code,
Sections 25505,23533,and 25534_
PA LEAD- FE DISCLOSURE
17 An EPA Lead-Safe Certified Renovator will be responsible for this project.
Certified Firm Name: Firm Certification No:
4P No EPA Lead-Safe Certified Firm is required for this project.
CONSTRUOION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work which this permit is issued
(Section 3097,Civil Cod�y).
Cl Yes all
Lender's Name:
Lender's Address:
APPLICATION 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,judgements,costs,and expenses which may
accrue against said City m consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point
source regulations per theCupert.in 1ylunicjp:l Code,Section 9 18. � /f�}
41 Signature OCrU(j•-Date r2�0,,D
EVERY PERMIT ISSUED SHALL BECOME INVALID UNLESS THE WORK ON THE SITE AUTHORIZED BY SUCH PERMIT IS COMMENCED WITHIN 365 DAYS AFTER ITS ISSUANCE,
OR IF THE WORK AUTHORIZED ON THE SITE BY SUCH PERMIT 1S SUSPENDED OR ABANDONED FOR A PERIOD OF 365 DAYS AFTER THE TIME THE WORK IS COMMENCED,