The URL can be used to link to this page

09040088 CITY OF CUPERTINO BE ILDING DIVISION PERMIT �+� � INFO`.: :* PERMIT NO. BUILDING ADDRESS: 22811 STONEBRIDGE ST WESTEC ELECTRI PERMIT ISSUE DATE VNER'S NAME: B QX SA CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: REPLACE EXISTING 100 A SUB BLDG ELECT PLO MO cd o LICENSED CONTRACTOR'S DECLARATION PANEL AT GARAGE 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 y in full force and effect ? License Class Lie.8 n t- Date t--k'Uca Contractork" ST:e_ ARCHITECTS DECLARATION I understand my plans shall be used as public records X96 CE4 Licensed Professional y g OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the Zp O following reason.(Section 7031.5,Business and Professions Code:Any city or county P which requires a permit to construct.alter,improve,demolish,or repair any structure In prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation G that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 Sq.Ft.Floor Area yF $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure isnot intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law docs 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- builder will have Ute burden of proving that he did not build or improve for purpose of sale.). ❑1,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 contractors)licensed pursuant to the Contractors License Law. ❑1 am exempt under Sec. B&P C for this reason vner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 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. 0 1 have and will maintain Workers 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: r.'rtAll—E 1= t carrie UND Policy I (05'30�^�� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY Fr rA 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.) W A Lenders Name 0 z Lenders Address U 0 1 certify that 1 have read this application and state that the above information is VL 1� correct.l agree to comply with all city and county ordinances and state laws relating to O Vbuilding construction.and hereby authorize representatives of this city to enter upon the U 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 in any way accrue against said City U Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�: SOJ3R� ,G2LAT(ONS. y�1�l—a`1 Re-roof: Signatu of pp scan ontractor Dare T of EZoof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety 'ode,Section 25532(a)? All roof:;shall be inspected prior to any roofing material being installed. ❑Yes � No ll�� 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new I naterials for inspection. District? ❑Yes RNo 1 have read the hazardous materials requirements undcrChapier6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be meet° °issuance of a Ccnifmcau:of Occupancy. SIgnatur of Applicant Date ' 5�/ �"`1' v All roof coverings to be Class'A!'or better Owner or authorzrd agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildi.n De artment JOB ADDRESS: PERMIT# 1 v NQ g - OWNER'S NAME: 1 IV S t M,�/� `' PHONE# (yoq (o GENERAL CONTRACTOR: fit_�c TPS C- FAX# I am not usingsubcontractors: 1�' any - - —� — S�.gnature Date Please check applicable subcontractors and corn plete the following ' o tion: SUBCONTRACTOR BUSINESS 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 Owner/Contractor Signature Date tt- CITY OF CUPERTINO OF CUPEkT1NO GENERAI. BUILDING PERMIT APPLICATION FORM d 9-- APN # 3q 2 13 0z 2.v V Date: Oct Building Address: Mailing Address (if different from building address): Owner's Name: A,_�-.J i N Phone#: ��-t 0 m - - C� )o HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Vj E S-F C e L �c-T R 1G Phone: Fax: Contractor License#: c;6(OC�%I Cupertino Business License#: Contact: Phone: Fax: Residential �. Commercial Job Description: '�,ePLAC-e i ©OA SUS Pf�s-AjeL AN- L, Ac7C' Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, I-B ❑ II/III/V-A ❑ IUIII B, IV-HT,V.-B Valuation: Square Footage: ' �O Project Size: Express Et Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicab le, include in plan set& the sheet index. Points Achieved: �'— For help, contact Build it Green at www.buflditgj-een.org Revised 02/05/09 CITY OF CUPERTINO CITY or GENERAL BUILD ING APPLICATION CUPEt�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM I STUCOAP Stucco Al plications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea :; windows) IWINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P l ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M IPLMBLNCK Stand Al,)ne Plumbing Pln Ck (hrly) P I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-si and alone IB ',BSC Cal Bldg Standards Commission Fee B ALL PERMIT r TYPES I BSEISMICR Seismic Residential B / B IBSEISMICO Seismic Commercial ITRAVDOC Travel Lc Documentation B IBUSLIC Busines3 License B 5 of 5