The URL can be used to link to this page

09040084 CITY OF CUPERTINO BUILDING DIVISION PERMITRr � PERMIT NO. BUILDING ADDRESS: 1155 ELMSFORD DR GORE HOME EXTERIOR PERMIT ISSUE DATE OWNER'S NAME: ,T-P,Nn rUANG mRrTc'I' S A CONTROL NO. )NE: (916) 652-1135 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH app LICENSED CONTRACT'OR'S DECLARATION Job Description V I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code.and my license is RP LC 5 VJNDW S IN BDRM S H in full force and effect v�Z License Class Lm•$ n t-w Dam Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records D,u i tL y Licensed Professional OWNER-BUILDER DECLARATION n ay I hereby affirm that 1 am exempt from the Contractors License Law for the Cp O following mason.(Section 7031.5,Business and Professions Code:Any city or county ,c m 9 which requires a permit to construct.alter.improve.demolish,or repair any structure o Z In prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area yt- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5459 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars(5500). 36208019 . 00 ❑1,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 Required Inspections and Professions Cade:The Contractor's License Law does not apply to an owner of 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 sale.If, however,the building or improvement is sold within one year of completion,the owner- E;;;�Tuesxicness urden of proving that he did not build or improve for purpose of roperty,amexclusively contracting withlicensed contractors to 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 erupt under Sec B&P C for this reason r Owner Dale WOR IS OM S1 DEC RATION I hem affirm u er'pe y of perjury ane of the following declarations: `J I have and will maintain a Certificate of Consent to self-insum for Worker's 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 Worker's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPnON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icsa) I certify that in the performance of the work for which this permit is issued.1 shall not employ any person in any manner cosu 'est to the workers'Compensation Laws of Applicant NOTICE TO A :1•a r te g G tion,you should become subject a Worker's mpensation provision of the Code•you must ,Z forthwith comply ith such previsions or this permit shall be deed'evoked. O CONSTRUCTION LENDING AGENCY [~-t I hereby affirm that there is a construction lending agency for the performance of �+ the work for which this permit is issued(Sec.3097,Civ.C.) Owr Q Lender's Name Lender's Address U 0 1 certify that 1 have read this application and state that the above information is V. correct.1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against " liabilities•judgments•costs and expenses which may in any way accrue against said City �J �J U Z in consequence of the granting of this permit. Date ( ""J ►'� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b,': REGUL 11 NS. - Re-roofs;jRCF_ ofcan contractor Date Type of hoof HAZARDOUS MATERIA DISCLOSURE Will thea plicant or future building occupantstom or handle hazardous material as defined by the Cupertino Munic' al Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? `c All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which At hazardous air contaminants as defined by the Bay Area Air Quality Management all new r iaterials for inspection., District? ❑Yes J too 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 whichm meet p r to issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class';`'or better � t�Owne r auth '.ed gm �q C) CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPJLICATION FORM APN # ,--, Date: ey ` 1 01. 0110 Building Add res 6 (�eA-Iko) Mailing Address (if alifferent from building ddress) Owner's Name: i n Phone#: HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA 4-�7 ) 7-2 — 6 Contractor: -0 ,(� rn p-dDue -06 Phone: n > ,tel V Fax: Contractor License#: g b 73 --1- Cupertino Cupertino Business License#: Contact: Phone: Fax: Residential Commercial ❑ Job Description: J 5f.2 Building Permit Info: Bldg [J, _ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Eg, _ .3 Valuation: 5��y Square Footage: Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.or �— Revised 02/05/09 CITY OF CUPERTINO CITY Of GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco �.pplications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Wi idow-structural shear B wall/ma:onry(includes plan ck fee) IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M I PPERMITFEE Plumbino,Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand A]one Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand A]one Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standarc Plan Check (when no E/M/P) B when not over counter) hourly-s-znd alone 1BCBSC Cal Bld€; Standards Commission Fee B ALL PERMIT TYPES / l BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &;Documentation B 1BUSLIC Business, License B 0- 5 of 5 or( LA L "�ro EAj W -IYJLO-� 11,14-f6- �- V,X-r vy�K c I/ ��— oe-e-t' C"P 9 c4a Lim- Ncr An Wir I-) A COD'vs Nr Cc't. set be hot lawful to It is fir tio, f, uPrpyei of Icatic"o -ITT. ►�/1 e-e� '� dr�S � z Z C_� e r� i� v 1 C _.. - o0 p o►M Community Development 10300 Torre Avenue If assw" Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,UPEkTINO Build-Ing Department JOB ADDRESS: PERMIT# Ck kb C r_ ;7 l 0 1pc,�) C vo �- O R'S NAME: 'e PHONE # ?7 —0,P:1 GENERAL CONTRACTOR: 0 )04,,Q-_ tEAX# 14 f�P4 .e VO I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI:4ESS NAME BUSINESS LICENSE # 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 Nvner/ Sigq6 e Date