11120031CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10350 STERN AVE
CONTRACTOR: BESTBUILD
PERMIT NO: 11120031
CONSTRUCTION INC
OWNER'SNAME: HUCARL
1732143RD AVE
DATE ISSUED: 12/05/2011
ER'S PHONE: 408346740
SAN LEANDRO, CA 94578
PHONE NO: (510) 389-5099
97 LICENSED CONTRACTOR'S DECLARATION
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lie. q o & �
r r r
MECH RESIDENTIAL COMMERCIAL
_
Contmet Date 7- .
I hereby affirm that I am ccl d under the provisions of Chapter 9
JOB DESCRIPTION: TEMP POWER POLE
(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 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.
Sq. Ft Floor Area:
Valuation: $500
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work far which this
permit is issued.
APN Number: 37514029.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAYS FROM LAST CALLED INSPECTION.
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
/y
Issued by: Date:
9.18.
Signmu n Date ��- ' `� �� f
RE-ROOFS:
OWNER-BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
thereby affirm that 1 am exempt from the Contractor's License Lew for one of
inspection.
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(n) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should 1 use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
contaminants as defined by the Bay Area Air Quality Management District 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
I certify that in the performance of the work for which this permit is issued, l shall
not employ any person in any manner so as to become subject to the Worker's
Ownr-opApthorized agent:
Compensation laws of California. If, after making this certificate of exemption, I
Date:1� &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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
1 certify that 1 have read this application and stale that the above information is
Lender's Name
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
Lender's Address
upon the above mentioned property for inspection purposes. (We) agree to save
mfy and keep harmless the City of Cupertino against liabilities, judgments,
expenses which may accrue against said City in consequence of the
ARCHITECT'S DECLARATION
Wiand
ng of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature Date
• 6 ITEMS OF 6
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37514029.00
DATE ISSUED.......: 12/05/2011
RECEIPT #.........: BS000015493
REFERENCE ID # ...: 11120031
SITE ADDRESS .....: 10350 STERN AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: HU CARL
ADDRESS ..........: 10350 STERN AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: ZHONG M MA
CONTRACTOR .......: ZHONG MING MA LIC # 31451'
COMPANY ..........: BESTBUILD CONSTRUCTION INC
ADDRESS ..........: 1732 143RD AVE
CITY/STATE/ZIP ...: SAN LEANDRO, CA 94578
TELEPHONE ........: (510) 388-5099
FEE ID
UNIT
' QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-ADMIN
-------------
HOURS
----------
1.00
----------
41.00
----------
0.00
----------
41.00
----------
0.00
1BCBSC
VALUATION
500.00
1.00
0.00
1.00
0.00
1BSEISMICR
VALUATION
500.00
0.50
0.00
0.50
0.00
1EPERMITFE
FLAT RATE
1.00
44.00
0.00
44.00
0.00
1ERT<200
UNITS
1.00
44.00
0.00
44.00
0.00
1TRAVDOC
FLAT RATE
1.00
44.00
0.00
44.00
0.00
TOTAL PERMIT
----------
174.50
----------
0.00
----------
174.50
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
174.50
---------------
174.50
VOICE ID DESCRIPTION
-------- ----------------------------
402 TEMPORARY POWER
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
------------------------------------
•
•
WPM
CITY OF CUPERTINO
1d11"Y//LI FF.F. F.RTIMATOR — BUILDING DIVISION
APPLIANCE/EQUIP TYPE
ADDRESS: 10350 stern ave. -- - - - - DATE: 12/05/2011
REVIEWED BY: bobs.
QTY
APN: I BP#:
`VALUATION: $500
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
Other Elec. Insp. 0.0 hrs $44.00
PENTAMATION 1REAP14
USE:
$44
PERMIT TYPE:
WORK
install tem ower pole.
SCOPE
APPLIANCE/EQUIP TYPE
FEE ID
PLu,:b. Man ChuckElec.
QTY
UNITS
BP FEES
Elec. Permit Fee: I EPERMIT
Temporary Power
1ERT<200
Other Elec. Insp. 0.0 hrs $44.00
100
Amps
$44
Perndt Fce:
Suppl, Insp Fee
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
Construction niv
Administrative Fee: IADMIN
$41.00
Work Without Permit? 0 Yes (j) No
$0.00
TOTALS:
Travel Documentation Fee: ITRA VDOC
$44.00
Strone Motion Fee: IBSEISMICR
NOTE: This esNmale does not include fees due to other Departments (Le. Planning, Public worsts, Plre, sanitary sewer, utsrricr, .moor
District etc These fees are based on the prefindina in ormatlon available and are oniv an estimate. Contact the Dept for addn7Info.
FEE ITEMS (Fee Resolnlion 11-053 Eff 7/l/l i)
afer4. F'iu,r Ghrzk
PLu,:b. Man ChuckElec.
Plan Check 0.0 hrs $0.00
wech, Yerurit Fee:
Plumh, Pep mir Pce;
Elec. Permit Fee: I EPERMIT
O:h,%r.n4.�•p. Jr<si>.
Udie, PhunB lu.:p.
Other Elec. Insp. 0.0 hrs $44.00
Ilech. lnep. Fee
Numb low", 1't•r;
Elea. Imp. Fee:
NOTE: This esNmale does not include fees due to other Departments (Le. Planning, Public worsts, Plre, sanitary sewer, utsrricr, .moor
District etc These fees are based on the prefindina in ormatlon available and are oniv an estimate. Contact the Dept for addn7Info.
FEE ITEMS (Fee Resolnlion 11-053 Eff 7/l/l i)
FEE
QTY/FEE
MISC ITEMS
Plan Check, Fere:
Suppl, PC fire
PME Plan Check:
$0.00
Perndt Fce:
Suppl, Insp Fee
PME Unit Fee:
$44.00
PME Permit Fee:
$44.00
Construction niv
Administrative Fee: IADMIN
$41.00
Work Without Permit? 0 Yes (j) No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC
$44.00
Strone Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bide Stds Commission Fee: IBCBSC
$1.00
, • h SUBTOTALS:
$174.50
$0.001 TOTAL FEE:
$174.50
Revised: 10/01/2011
• f®1
CUPERTINO
X003
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M'
(408) 777-3228 • FAX (408) 777-3333 • building(ZDcuoertino.orD
—IPLiIMHMO F7 MECHANICAL I—(ELECTRICAL I— IMISCELLANEOLIS
PROJECT ADDRESS O 3 S V / tt 1 G�
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OWNERNAMEPHONE
/ JI �In PI.
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E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
LT.
PHONE ^i�Q rJ E-MAM
J D
STREEr ADDRESS
CITY, STATE, ZIP
FAX
❑ OwNER ❑ OwNER-auu.DER ❑ OWNERAGENT
CONTRACTOR ❑CONTRACTORAGENT ❑ ARCJm'ECT
❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACrORNAME
LICENSE NUMBER nq
V TJ
LICENSETYPE
BUS. LIC#
6J
COMPANY NAME i
1
I
w
E-MAIL
FAX
STREET ADDRESS .�s� \
)
CITY. STATE, ZD'
P O
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY. STATE, ZIP
PHONE
USE OF ❑ SFO o DUPLEX ❑ MULTI -FAMILY
BUIDDIO: ❑COMMERCIAL
PROJECT IN WRDI-VNO ❑YES
URBAN INTERFACE AREA C3 NO
PROJECT IN ❑ yes
FLOOD ZONE 0 N
IS THE BLDG AN ❑ YES
EICHLER HOME? NO
DESCRIPTION OF WORK
TOTAL VALUATION: P (�
RECEIVED BY:
r
By my signature below, I c4tify to each of the following: Iran the property owner or authorized agent In act on the pmperty owner's behalf. I have read this
application and the information I have provided is correct. J have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating m building construction 1 authorize representatives of Cupertino to enter the above-identificd property for inspection pufy oses.
Signature of Applicant/Agent: Date: O t
SUPPLEMENTALTION
REQUIRED
OFFICE USE ONLY
N
LT OVER-THE-COUNTER
6
Y
❑ EXPRESS
u
°1
u
❑ STANDARD
❑ LARGE
a
❑ MAJOR
MEPAfucApp_101 Ldoc revised 06121111
4
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: ,o 3 7
PERMIT #
OWNER'S NAME:
PHONE # v v
GENERAL CONTRACTOR:
Cabinets & Millwork
-. BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. j
I am not using any subcontractors:
SignatDate
Please check applicable subcontractors and comi aplete the fo i information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date