13020084 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19060 MEIGGS LN CONTRACTOR:D&D CONSTRUCTION PERMIT NO: 13020084
AND DEVELOPMENT
OWNER'S NAME: LI'S CAPITAL LLC PO BOX 3565 DATE ISSUED:02/142013
��OWNER'S PHONE: 4087253692 FREMONT,CA 94539 PHONE NO:(510)579-2353
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LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 13 COMMERCIALE]
License Class_ Liic.# 326.7- S TEMPORARY POWER POLE
Contractor JUIN) X lel-' Date -10L
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate 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. Sq.Ft Floor Area: Valuation:$500
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37535052.00 Occupancy Type:
permit is issued. -
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF ERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F CALLED INSPECTION.
indemnify and keep harmless the CityofCupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 3
granting of this permit. Additionally,the applicant understands and will comply Issued by Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18,
Z�(� -2u13 RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the.Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain aCertificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which fhis.permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255059 25533,and 25534.
Section 3700ofthe Labor Code,for the performance of the work for which this �Q,�p 2{
permit is issued
- Owner or authorized agent: 'P Darr.
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 to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is -
correct.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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 M I
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CUPERTINO (408)777-3228•FAX(408)777-3333•building(Gpcuoertino.org \(�^
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❑PLUMBAIG MECHANICAL ELECTRICAL OMISCELLANEOUS
PROJECT ADDRESS D/ O ' ADN# 3 2 _ O S'L
OWNERNAME r `J 5b C" I{,�(�I 1 t—( O— PHONE AOS
7„4Jr- E- MAIL
STREETADDRESS ✓• � CITY, STATE,ZIP 7J t .( FAX
CONTACT NAME Jolty V� PHONE $lo-s7R-z3r E-MAIL J X L, 10 (�/
O''Ij" C 04,A
STREETADDRESS 5o( 3 ns—
CATV,STATE,ZT-Frmw-(. QLLS'3� F.4X
❑ OWNER 13OYNER-BUDDER 13OWNERAGENT CONTRACTOR E3 CONTRACTOR AGBNT 13ARCHITECT` ❑ENGINEER ❑ DEVEWPER ❑ TENANT
CONTRACTOR NAME �Ot' , t' LICENSE LICENSE TYPE BUS.LIC#
COMPANY NAMEt—1 &MAIL FAX
STREET ADDRESS CITY,STATE, PHONE
ARCHITECLENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME' - E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHO
USE OF ❑SFDOr DUPLEX [I MULTI-FAMILY PROJECT IN WIDLAND ❑ YES PROIECTW [I YES 1S THE BLDG AN ❑YES
BNLDP`G: ❑COMN.ERCW- URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO flCHLER HOMED ❑NO
DESCRJPTION OF WORK rY 0 I\rN
TOTALVALUATIONt RECEIVED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's Fehff I have read this
application and the infortnation I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildings�tructiionn..�I aaTuuttthonze representatives of Cupertino to enter the above-identified p>rope6 for inspection putposes.
Signature of ApplicantJAgent �e�' Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
OYER-THE-COUNTER
❑ EXPRESS
Y
V
❑ STANDARD
U
❑ LARGE
c ❑ MAJOR
MEPM7scApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19060 meiggs DATE: 02/14/2013 REVIEWED BY: larrys
APN: BP#: *VALUATION: $500
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or DU leX PENTAMATION 1REAP14
USE: p PERMIT TYPE:
WORK mp power
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Temporary Power 1ERT<200 100 Amps $45
TOTALS $45.00 y
,��'11
vllech. Plan Check Plumb.Plan Check Elec.Plan Check 0.0 hrs $0.00
Me&Permil Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT
ntlrer beech: Insp. Other Plume Insp. Other Elec.Insp. 0.0 Ins $45.00
A4ech.Insp. Fee: Plumb. tulip.Fee: Elec. Insp.Fee.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). These fees are based on the prelimin ht ormadon available and are only an estimate. Contact the De t for addn'1 in o.
FEE ITEMS Fee Resolution 11-053 E . 711/12 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suppe. Insp Fee
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: IADMIN $42.00
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC $45.00
Strong Motion'Fee. IBSEISA17CR $0.50 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
;.u. .> $178.50 $0.00 �1�,�; �� TOTALFE $178.50
Revised: 01/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: Q O(o O 4l S PERMIT# ( 200
OWNER'SNAME: UVj4:Cu .%.{4a( PHONE# u k-71-236
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL,-OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL.SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: Date
- Signature
Please check applicable subcontractors and complete the following information:
&/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood'
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
Owne /Contractor Signature