Loading...
07050172 ITY OF CUPERTINO y� p77777777 � BUILDING DIS`S10N PERMIT V� TG L�R INEOMATION BUILD N DDRESS: PERMIT NO. i �� BETLIN AVE LEI TIAMMO 07050172 OWNER'S NAME: PERMIT ISSUE DATE LEI TIAMMO 05/17/2007 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH �7 0 0 10 p LICENSED CONTRACTOR'S DECLARATION U t= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description with Section 7000)ofDivision3ofthe Business and Professions Code.and mylicense isRE—INSULA.'E & RE—STUCCO EXISTING BEDROOM. ? y in full force and effect y? License Class Lic.# O Date Contractor "a ARCHITECTS DECLARATION a 04 UJ U 1 understand my plans shall be used as public records a o Licensed Professional w OWNER-BUILDER DECLARATION 2<� I hereby affirm that 1 am exempt from the Contractor's License Law for the -0 o following reason.(Section 7031.5,Business and Professions Code:Any city or county `u which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.1�t.Floor Area Valuation a h (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2000 r3. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 five airy applicant for a permit subjects the applicant to a civil penalty of 3 6927038 '�Number Occupancy Type not more than hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sate.It, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). [11.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt u r Sec. B&P C far this mason ' Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manrter so as to become subject io the Workers'Compensation Laws of California.Date "—V r Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY (- 1 hereby affirm that there is a construction lending agency for the performance of R: > the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name a z Lender's Address U C-) I certify that I have read this application and state that the above information is - J�"' correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding consunction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. py (We)agree to save,indemnify and keep harmless the City of Cupertino against w liabilities,judgments,costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. - APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date J—l -.0,SOURCE REGULATI�tO T� Re-roofs _ Signature of Applicant/Contracter Dare HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? [-]Yes r3+10All roofs shall b--inspected prior to any roofing material being installed. If a roof is insta'led without first obtaining an inspection,I Will the applicant or future building occupant use equipment or devices which g agree to remove P emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new material; for inspection. District? ❑Yes GKU 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant.that it is my responsibility to notify the occupant of the requirements which must be met pfiortoissuance ofaCertificate ofOccupancy. Signature of Apr licant Date r-% Owner or authorized agent Dare- _ All roof coverings to be Class "B"or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36927038. 00 DATE ISSUED. . . . . . . : 05/17/2007 RECEIPT #. . . . . . . . . : BS000001370 REFERENCE ID # 07050172 SITE ADDRESS 814 BETLIN AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER LEI T'-AMMO ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM TIANMC) LEI CONTRACTOR LIC: # *OWNER* COMPANY LEI TIAMMO ADDRESS . . . . . . . . . . CITY/STATE/ZIP TELEPHONE FEE ID UNIT----- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- __ ---------- ---------- __ ---------- ENERGY PERMIT FEE 83 .16 39. 92 0.00 39. 92 0. 00 BPERMFEE VALUATION 2, 000 .00 83 .16 BSEISMICRE VALUATION 2, 000. 00 0.50 00. 00 83 .16 0.00 .00 0.50 0. 00 ----- ----- __________ ---------- ---------- TOTAL PERMIT 123 .58 0 .00 123 .58 0. 00 METHOD-OF-PAYMENT AMOUNT :2EFERENCE NUMBER --------------- -- ------------------ CREDIT CARD 123 .58 VI:3A --------------- TOTAL RECEIPT 123 .58 ' CITY OF CUPERTINO CUCITY TYOF PERMIT APPLICATION FORM (J CPN# ? q& Date: S 7 l 41 Building Address: t� Mailing Address (if different from building address): Owner's Name: Phone#: �'An M v ��` ¢off z�-i f 3 4S Contractor: 0/� License #: Contact: ' Phone:fog � I;,,�5' Cupertino Business License#: t ,Gt►1mo L_e� Fax: Building Permit Info: (��>-��n (';� � c�� tZ2 Bldg ©' Elect ❑ Pluinb ❑ Mech ❑ Job Description: Residential Cl' Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ roject Size: Standard ❑ Large ❑ Major 1] Quantity Fee ID Fee Description Fee Group BAPPLOTHER Othor Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> (OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Oj f/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR ConstaK —Resi/Mobile BUILDING BELEC 1000 Elec 6 90V<= l OOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO CUP TYOF PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bld;,Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repi De Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn ,�prinkler/Backflo PLUMBING BPSTORM Stor-m/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt o:-Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMATRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lig1 ting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heab-,r Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/P_atform Fixture ELECTRICAL BREMPOWER Power D evice/Apparatus ELECTRICAL BREMRECEPT WWI, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CL,PERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fe( Description Fee Group BREMSIGNAD Rmdl S igns Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatr cal Lighting Fix ELECTRICAL BR.EMVENFAN Vent lean Single Duct MECHANICAL BR.EMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial _ BUILDING BSEISMICRE Sei,,,mic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIlVI Sw_mming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem or ary Bldg Permit BUILDING BTEMPSVCS Terap Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mect apical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPER.MITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Lo ig Range Residential PLANNING 3 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 _ Telephone(408)777-3228 Fax(408)777-3333 CITY Of '"UPEkTINO Buildin De artment JOB ADDRESS: PERMIT# �( o -�� �� F 1 b�� e �� PHONE # $ ?-�2 t 3 4S' OWNER'S NAME: n o GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the follow BUSINESS LICENSE # SUBCONTRACTOR BUSINESS NAM Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date