The URL can be used to link to this page

12030044CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23500 CRISTO REY DR CONTRACTOR: FANTASTIC BAY PERMIT NO: 12030044 BUILDERS INC j OWNER'S NAME: THE FORUM RANCHO SAN ANTONIO 675 E GISH RD DATE I.SSUED:03108f2012 OW'NER'S PHONE: SAN JOSE, CA 95112 PHONE NO: (ods) 61740141 ❑ LICE SED CONTRACTOR'S DECLARATION License Classes B Lic.9 9-M3 Contractor `��VVV J hereby affirm that 1 am licensed ander the provisions of Chnpter9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. hereby afRnu under penalty of perjury one of the following two declairations: I have and will maintain a cenificate of consent (o self -insure for Worker's Compensation, as provided for by Section 3700 of (fie Labor Code, for the performance of the work for which this hermit is issued. I have mid will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of Orae work for which this permit is issued. APPLICANT CERTIFICATION I certify that I hove read this application mid state flim [lie above information is correct. 1 agree M comply with all city and calmly ordinances and state laws relating to building construction, and hereby authorize representatives of this city (a 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 mid will comply with all non -point source regulations per (lie Cupertino Municipal Code, Section 9.18. Signature_ Date ❑ OWNER -BUILDER DECLARATION 1 hercbv affirm that 1 am exempt Dont the Contractor's License Law fm- one of the fallowing two reasons: 1, as owner of the property, or my employees with wages as their sole compensation. will do the unit, mid the structure is not intended or offered for sale (.Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to consuua the projec((Sec.7044, Business & Professions Code). 1 hereby affirm tinder penalty of perjury one of the following three 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. 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. (certify (fiat in the performance of die work for which this permit is issued, ) shall not employ may person in any manner so as to became subject to the Worker's Compensation Imus of California. If, after making this certificate Of exemption, I became subject to the Worker's Compensation provisions of the Labor Code, 1 must torthwith cotnply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION (certify that (have read this appliemion and state that the above information is correct. 1 agree to comply with all city anal couny ordinances and state laws relating tobuilding construction, and hereby authorize representatives ofthis city to enter upon the above mentioned property for inspection purposes. (We) agree to save Indemni fv and keep haridess the by 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, Sectio 9.13. BUILDING PERMIT INFO: BLDG r ELECT I- PLUMB r! I b1ECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: INSTALL TENIP POWER POLE AT JOB TRAILER IN COMMON AREA IN BACK OF MAIN BUILDING(FORUM) Sq. Ft Floor Area: I Valuation: $125 APN Number: 34254999.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. i Issued br--� RE -ROOFS: All roofs shall be inspected prior to any roofing material bene installed. If a roof is installed without first obmininglan inspection. I agree to remove all new materials for inspection. Signature of Applicant: Date: 0/d ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATF.RIA1-S DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code. Sections 255(15. 25533. and 25534. 1 will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health & Safety Cade. Section 25532(x) should 1 store at, handle hazardous material. Additionally, should I use equipment or devices %life[' emit hazardous air contaminants as defined by the Bay Area Air Quality hlanagentent District I will maintain compliance with Ute Cupertino hlunicipal Code. Chapter 9.12 and the Health & Safety Code, Sectioiu 25505, 25533, and 25534. Owner or authorized agent: Date:- CONSTRUCTION ate CONSTRUCTION LENDING AGENC\' I hereby affirm that there is a construction lending agency for (lie performance of work's for which this permit is issued (Sec. 3097. Civ C.) Lender's Name Lender's ARCIIITECT'S DECLARATION I understand my plansshall beusedas public records. Date I Licensed CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34254999.00 DATE ISSUED.......: 03/08/2012 RECEIPT #.........: BS000016225 REFERENCE ID # ...: 12030044 SITE ADDRESS 23500 CRISTO REY OR. SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... --------------- TOTAL RECEIPT : 174.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ----------- I ------------------------- 402 ------------------- 402 TEMPORARY POWER OWNER ............: THE FORUM RANCHO SAN ANTONIO ADDRESS ..........: 23500 CRISTO REY DR' CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: ALBERT SALMANI CONTRACTOR .......: YOSH GAHRAMANI, CEO' LIC # 32301 COMPANY ..........: FANTASTIC BAY BUILDERS INC ADDRESS ..........: 675 E GISH RD CITY/STATE/ZIP ...: SAN JOSE, CA 95112 • TELEPHONE ........: (408) 647-4010 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- lA_DMIN ------------- ---------- HOURS 1.00 -----------------;-- 41.00 0.00 41.00 0.00 1BCBSC VALUATION 125.00 1.00 Oj.00 1.00 0.00 1BSEISMICR VALUATION 125.00 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 -------I 0,.00 --- 44.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 174.50 01.00 174.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE ---------------I----- NUMBER ----------------- CREDIT CARD --------------- 174.50 VISA --------------- TOTAL RECEIPT : 174.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ----------- I ------------------------- 402 ------------------- 402 TEMPORARY POWER E�,,�� CITY OF CUPERTINO w► l j FEE ESTIMATOR - BUILDING DIVISION 0 ADDRESS: 23500 cristo rey dr. DATE: 0 310 8/2 01 2 REVIEWED BY: bobs. UNITS APN: I BP#: "VALUATION: $125 •PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: $44 1REAP14 PERMIT PERMIT TYPE: WORK Install temp power pole at job trailer. SCOPE APPLIANCE / EQUIP TYPE FEE ID plumb. Pian Char -k I I QTY UNITS BP FEES Elea Permit Fee: IEPERAIIT Temporary Power 1ERT<200 Other Elec. Insp. El hrs $44,00 100 Amps $44 Pet nrit Fre. Supp1.lnvp Fee PME Unit Fee: $44.00 PME Permit Fee: $44.00 Cwtvirt:rnnn Tat. 17- Administrative Fee: IADAIIN $41.00 Work Without Pennit? O Yes (j) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSE1Si11CR NOTE: This estinurre dries not include fees due to other Depannreuts (i.e. Planning, Public Works. Fire, Sanitan• Sewer District, School O!* 'A'm e' 1 These loec are h—d nn au• nue//nennnr iufnrnrntinn nvnilahle and are nrr/v an estimate Contact the Dent far addo'l info. FEE ITEMS (fee Resolution 11-053 EB' 711111) W, Ir P'mr (.& A plumb. Pian Char -k I I Elec. Plan Check 0.0 1 hrs $0.00 ilrr.8 Perurir Fmr. Pltrarh. Permit Fee. Elea Permit Fee: IEPERAIIT Ulha iSsL hap. O ierPlundrImp. Other Elec. Insp. El hrs $44,00 44Jr Inn Fre Plumb. ln.xP. Fe'a Fier. Imp Fee' NOTE: This estinurre dries not include fees due to other Depannreuts (i.e. Planning, Public Works. Fire, Sanitan• Sewer District, School O!* 'A'm e' 1 These loec are h—d nn au• nue//nennnr iufnrnrntinn nvnilahle and are nrr/v an estimate Contact the Dent far addo'l info. FEE ITEMS (fee Resolution 11-053 EB' 711111) FEE QTY/FEE MISC ITEMS Pian Clerk 1-or. Shppl. X-1-ce PME Plan Check: $0.00 Pet nrit Fre. Supp1.lnvp Fee PME Unit Fee: $44.00 PME Permit Fee: $44.00 Cwtvirt:rnnn Tat. 17- Administrative Fee: IADAIIN $41.00 Work Without Pennit? O Yes (j) No $0.00 AdVun, eJ Pleinnrn- Pee .- Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSE1Si11CR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: $174.50 Revised: 1/19/2012 9 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 (408) 777-3228 • FAX (408) 777-3333 • buildina0cuoeruno.ora IPI iiT. r: AU, rai VlFicI Tr -et Hirt cDgQf MEP ' PROJECT AnoRssfiq� O� L APN a Z3So0 Cr�S� !�{r� .rf�h 0 4 I OWNERNAME F`pyr.h J� AjJo �n1r 4Sg}j�/ y,0j00 E-MAIL SfR-.`TADDRE55 Q I , STATE LIP FAX /,�. S:� CONTACT NAME GJ,1 d / ✓al/�7 O n P"°" Yo 8,)9 �J - 02-8biE B' 1� STREET ADDRESS CITY. STATF- LSP FAX ❑ OWNER ❑ OW'-BURDER ❑ OWN RAGENT ❑ CDi. LTOR ❑CON: UCTORAGENi ❑ ARCHD'ELT ❑ Eti� ❑ D'cV LER ❑ TF2lAN; CONTRACTOR LICENSE NUMBER LICENSE TYPE J� RJ(( BUS L[[ p (` J COMPANY NAME E-MAM FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHI—I.CT/ENGLNEER NAME LICENSE 1 U m BOB. ric 9 COMPANY NAME ' E-MAIL FAX STREET ADDRESS CRY, STATF- ZIP I PHONE USE OF ❑ wDUPLJt ❑ MN.7-FAMILY I PROJECT IN WERL.NU El Y=- I PROF�IN 11 YES URR BING: 9M�RCa* URBANUVtEAFACEAREI ❑ NO FLOOD ZONE ❑ NO I TS THE BLDG AN ❑ YES EICHLER HO..KE7 ❑ NO DESCRIPTION OF WOAR and B/G' mC ! upb TOTAL VALUATION: / -4n 'W / ( O• S T K Man PA- RECEIVED BY: By my signature below, I certify to each of the fallowing: I am the property owner or anchorized agent to act on the prapery awner's behalf. I have :cad this application and the infeomation I have provided is car. Ld have read the Description of Werk and verify it is accurate. I ague w cornnly with 0 applicable local ordicanera and scree laws relating mbuildying cdon. [ authariu reprrsenurtives of CeFerdno m rnter tSe above'ddm/af,�cdd pproperty@m for inspection Fucs. Signapue of ApplicanU/ Agenc � � Date: SUPPLEMENTAL 1INTFOR2VfATION REQUIRED �/y.�., -- �a '"r 1tiY JNINNY ]d o "use ONLY iy F V < OVER -THE: -COUNTER ❑ BXPRE4 ❑ STANDARD ❑ LUtCE ❑ a OR �. 3LYp aH Q3JI�9A� 6NV!d 10.1.1 MEPMisaIpp_2011.doc revised 0621111