13020065 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:..10311 GREENWOOD CT. - CONTRACTOR:AIR CONDITIONING PERMIT NO: 13020065
• INNOVATIONS INC
OWNER'S NAME: CUPERTINQ COMMUNITY SERVICES P O BOX 270075 DATE ISSUED:02/13/2013
OWNER'S PHONE: 4082558033 SAN JOSE,CA 95127 PHONE NO:(408)297-6209
13LIrCENSED CONTRACTOpR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C Lie.N !SDECLARATION
nna y S INSTALL PROPERTY LIJE CLEAN OUT
ContractorA �
l'r ji 1&7�1InIOAQSDate ,.4'13--13
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 it I tion
I have and will maintain a certificate of consent to self-insure for W er's
Compensation,as provided for by Section 3700 of the Labor Cod o e
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3575
1 have and will maintain Worker's Compensation Insurance,as prov'
Section 3700 of the Labor Code,for the performance of the work for tch this APN Number:36914025.00 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 PERMIT 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 DAY ' OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertinoagainst liabilities,judgments,
costs,and expenses which may acome against said City in consequence of the
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. � � -13-13
RE-ROOFS:
Signature Date All roofs shall be inspected poor 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property;or my employees with wages as their sole compensation,
will do'the work,andthe stricture is not intended_ur 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. I will
I hereby affirm under penalty of perjuryone of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: - Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate 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 this 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 25505,2553 , it 25534. I
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
permit is issued.
1 certify that in the performance of the work for which this permit is issued,l 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 par the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ��0
10300 TORRE AVENUE•CUPERTINO,CA 95014.3255 �7 M '
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CUPERTFNO (408)777.3228• FAX(408)777-3333• buildingQCUDertino.org 1(j b I
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CONTACT NAME PHONE `N E-MAIL
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❑OWNER ❑ OWNER-BUBDER ❑ OWNERAGENT .13 CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVEIAPER ❑ TENANT
CONTRACTOR NAME M LICENSENUMB 7I LICE�SETYPE13 BUS.LIC# n -
COMPANY NAME /-l ICG EMAIL (� F0�1d9 y6-/300
STREET ADDRESS / /(] CITY,STATE, e-•II I CA Q..I PHO qo 9N6- o0
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SM w DUPLEX 11 MULTI-FAMRY I PROIECTIN wnDLAND ❑ YEs PROJECT W [3 YES Is THE BLDG AN E3 YES
BUILDOJG: []COMMERCIAL URBAN INTERFACE AREA 19 NO FLOOD]ANE %NO EICHLERHOMET ❑NO
DESCRIPTION OF WORK
Kelm-- e deCf opewes 1J�,
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TOTAL VALUATION3 3 5 7$' RECEIVED BY:
By my signature below,I certify to each of the following: I=the property owner or authorized agent to act on the operty o er's behalf I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I a e o comyly with all applicable local
ordinances and state laws relating to buildt'r`Cconstme. . I thorim representatives of Cupertino to enter the above-idem ed petty for inspection purposes.
Signature of Appli=t/Agen. V Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
❑ EXPRESS
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❑ STANDARD
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MEPMucApp_1011.doc revised 06/11/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10311 greenwood ct DATE: 02/13/2013 REVIEWED BY: mendez
APN: BP#: *VALUATION: $3,575
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: PERMIT TYPE:
WORK install roe line clean out
SCOPE
z.n a
Ilech. plan Crzck Plumb.Plan Check 0.0 hrs $0.00 Elec. Nor..i N l
;LGrti�. /'ermi!Fee: Plumb.Permit Fee: IPPERMIT Liff. flo nin
Other l feeh. hrsp Other Plumb Insp. 0.0 hrs $45.00 Ocher Eke./nsp.
Vech. Insp../4.r.: - Plumb.Insp.Fee: Elec, pnsp. Fee:
NOTE:This estimate does not Includejees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). Thesefees are based on the Prelimina information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 Efi' 711/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 # Plumbing
Suppl.PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $23.00 IPRSEWER I Sewer,Sanitary
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
C'ons/ruelion Tar:
Administrative Fee: IADMIN $42.00 0
Work Without Permit? ® Yes IS No $0.00 0
Advanced Planning Fee:. $0.00 Select a Non-Residential
Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure
Strong.Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
" $133.50 $23.00 .F � T&ALFEE: $156.50
Revised: 01/01/2013