The URL can be used to link to this page

09050065 CITY OF CUPERTINO r�� C 1 F I 1I21. BUILDING pIVISION PERMIT PERMIT NO. rBUI;LDDING ADDRESS: 1504 CONRADIA CT LEON MASONRY pERMITI$SUEDATE 'S NAME: A CONTROL NO. PHONE: (4 0 8) 3 6 5 -16 6 0 BUILDING PERMITINFO -HITECTIENGiNEER: BLDG ELECT PLUMB MECH G C LICENSED CONTRACTOR'S DECLARATION Job Description U pr I hereby affirm that I am licensed under provisions of Chapter 9(commencing USection 70(X0)of Division 3 of the Business and Professions Code and my license is REPAIR C 3I MNEY ra. ll force and ef!!!t Z 6 �3 3 v�Znse Class Lam• r p Contractor L Cin NQSor u CHITECPS DECLARATION on rstand my plans shall be used as public records D,U i O y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county m P which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation ';,A prior to its issuance,also inquires the applicant for such permit to file a signed statement Ft.Floor Area _Z that he is licensed pursuant to the provisions of the Convector's License Law(Chapter 9 q' 2800 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 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars($500). 3562305E . 00 ❑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 orofteredfor sale(Sec.7044,Business Required Inspections and Professions Code: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 awn 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 the 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 Convector's Li- cense Caw does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a cone utor(s)licensed pursuant to the Contractor's License Law. ,B&P C for this mason ❑I am exempt under Sec Date-F Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of Perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the -irk for which this permit is issued. J 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 Workeres/Comp11ens�ation,.yinnsurance�pcarrier and Policy number are:^ �7�/ Cartier. ao\ t t I/)Y Policy No.: &o V /7 / 7 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 manner so as ro 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY F~.,tom. I hereby affirm that there is a construction lending agency for the performance of p,> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address l certify that 1 have read this application and state that the above information is LUL correct.l agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. >4 W (We)agree to save,indemnify and keep harmless the City of Cupertino against rE"y rA liabilities,judgments,costs and expenses which may in any way accrue against said City zzs U Z in consequence of the granting of this permit. Date �-+lam LICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued b`r: CE REGULA S. -� Re-roofs ture of VC --tor D°le T of:Zoof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material r fined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety .Section 25532(a)? All roof:,shall be inspected prior to any roofing material being installed. ❑Yes "rero 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 all new materials for inspection. emit hazardous air contaminants as de0ncd by the Bay Area Air QualityManagement District? ❑Yes ° I have read the hazardous materials requirements under Chapter 6.95 of the Califor- a__ au1ho- &Safety Code,Sections 25505,25533 and 25534.1 understand that if the building urrently have a tenant,that it is my responsibility to notify the occupant of the Signature of Applicant Date ns which must be m or w i encs of a Ccruficatc of Occupancy• -U All roof coverings to be Class';{•"or better t Datc CITY OF CUPERTINO CUPEI�TINO GENERAL. BUILDING PERMIT APPLICATION FORM APN # Date: 13 - Bu ding Address• 1 t S-D L v ra Mailing Address (if different from building address): wner's Name: Phone#: 1 i �l HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Contractor: Phone: 3 6 Leo►J Fax: V" Contractor License#: Cupertino Business License#: Contact: Phone: 3 _V< 6y- �:C. Fax: 3 y Residential Commercial ❑ Job Description: Pa��' C �� w� ►� epi Building Permit Info: Bldg 0 Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT,V-B ❑, �L ---3 Valuation: Square Footage: Project Size: rxpressndard ❑ 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.builditgi-een.org Revised 02/05/09 CITY OF CUPERTINO COPE TING GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW 1 ACOUSFDW SFDWL/'3uplex New B 1 ACOUSRESAD SFDWL/:duplex-Addition/Alteration B 1 ACOUSCOM Multi-Fainily/Commercial B CHIMNEY'S 1 CHIMNEY Chimney B 1 CHIMNEYR Chimney Repair B FENCES 1 FENCE>6FT Non-mas:)nry, over 6 ft in height B 1 FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1 FIREPLMAS Fireplace Masonry B 1FIREPLFAB Fireplace Pre-Fabricated/Metal B 1 FLAGPOL>20 Flag poll (over 20 ft in height) B 1 MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1 PILEDRIV Pile Foundation Driven (steel,pre- B stressed ,oncrete) 3 of 5 an CITY OF CUPERTINO CITY Of GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 STUCOAP Stucco Applications (up to 400 sf) B additiona' stucco application 1 WINREP Replacerr ent windows/sliding glass B door (ea 3 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 Plumbin€,Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Al ane Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-si and alone 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES I BSEISMICR Seismic residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &;Documentation B 1 BUSLIC Business License B 5 of 5 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildin De artment JOB ADDRESS: PERMIT # n (.0 9,15 6 �z 0 t-� �- CA k C', - OWNER'SNAME: ow< PHONE # Y-31 GENERAL CONTRACTOR: FAX# V9>9 - ;6 -69 I am not using any subcontractor : I 13_d Signature ate Please check applicable subcontractors and complete the followinginformation: 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