10070187 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21555 MONROVIA ST CONTRACTOR:ALTEN PRODUCTS CO PERMIT NO: 10070187
OWNER'S NAME: CIIUAN ZHAO 2423 OLD MIDDLEFIELD WAY DATE ISSUED:07282010
OWNER'S PHONE: 5109968253 - MOUNTAIN VIEW,CA 94043 PHONE NO:(650)960-0760
•� LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License� 5._- �- �c`, Lic.N_
2-70,,,/ tout 2 � MECH r RESIDENTIAL r COMMERCIAL r
ContmctorLY�[r jh; _ Date
JOB DESCRIPTION: REINSTALL EXISTING SOLAR 4X8 GLAZED SOLAR
1 hereby affirm that t am licensed under the provisio of Che Icr 9
11(commencing with Section 7000)of Division 3 of the Business&Professions HATER
Code and that my license is in full force and effect. HEATER ON NI'-W COMP SHINGLE ROOF
I hereby affirm under penalty of perjury one of the following two declarations:
1 have and will maintain a cnfcate 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.
1 have and will maintain Worker's Compensation Insurance,as provided fat by
Section 3700 ofthc Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:51500
permit is issued, N
APPLICANT CERTIFICATION APN Number:35623035.00 Occupancy Type:
I certify that 1 have read this application and stale that the above information is
comet. 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
upontheabove keep
property
Cityo inspection against urposes
(We)agree
,judg save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep hannlcss the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit Additionally,(he applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point sot e1�ul 'ons=(hcpertinounicipal Code,Section9.18Signat a 6^ e�� Issued bY �7`-�--- Date: Zwb
❑ OWNER-BUILDER DECLARATION
I hereby affirm That 1 em exempt from the Contractor's Llcensc Law far one of RE-ROOFS:
All roofs shall be inspecnd prior to any mof ng material being installed. If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the pmpeny,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sm.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contractingwith licensed contractors to
construct the project(Sm.7044,Business&Professions Code).
ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Ccdc,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safely Code,Section 25532(a)should 1 store or handle hazardous material.
permil is issued. Additionally,should I use equipment or devices which emir hazardous air
I certify that in the performance of the work for which this permit is issued,)shall contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health G14
cdons 25505,25533,and 25534.
Compensation laws of Cali fomia. If.after making this cenifrcate of exemption,
become subject to the Worker's Compensation provisions of the Labor Code,I m w er l: ^�
forthwith comply with such provisions or this permit shall be deemed revoked. 4-Dale:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct, I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep hamdess the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may acerae 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 ARCHITECT'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: 'VALUATION: $1,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex OVER THE APPLICATION
USE: COUNTER. Q Yes (F) No TYPE:
MECHANICAL Q Yes 0 No PLUMBING Q Yes Q No I ELECTRICAL Q Yes No
Y
ce a
00
3 �
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s .fl.
TOTALS: 0 $0.00 $0.00
11-h. l9ou f.-hri k lYnmh. P6ni Cheek 0", P/....('/
1/rch /':raA Fen Plunih, Pe,"ll ice lari. l'r;>riir h.
i ldua 1�-rli- /icri Other Phonh. f hhrr tiler_ .
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact rite De r or addn7 info.
FEE ITEMS (l ce ReWhoion 09-051 Ell 711.,09) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: (E) Reg. Q OT FO.01 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
( )11,11 In:lir91 T(n
Acoustical Fee: Q Yes (E) No $0.00 Q
Work Without Permit? Q Yes (D No $0.00 E)
Planning FCC. $0.00 Select a Non-Residential Q
77rn•r l)nriun -iih ilinn Fees.:
Building or Structure Q
i
Stron"Motion I'CC: /BSEISMICR $0.50 1.0 hrs Standard Hourly Rate
Bid Skis Commission Fee: IBCBSC $1.00 $126.00
SUBTOTALS: $1.50 $126.001TOTAL FEE: 1 $127.50
Revised: 7/27/2010
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be kept on the job at all times and it is 14LbR =u_rc raZ
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on same without written permission from D Y>aD
the Building panmen a o1 Cupertino. ALl IM W Uhl 90'
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