Loading...
13030118 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:.18674 LOREE AVE. CONTRACTOR:RRG CORPORATION PERMIT NO: 1303011$ OWNER'S NAME: MAHBUB BASHED` 4231 BUSINESS CENTER DR STE 12 DATE ISSUED:03/22/2013 O R'S PHONE: 4088342984 FREMONT,CA 94538 PHONE NO:(510)257-1400 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS C- t. . INSTALL PROPERTY LINE CLEAN OUT-SUNNYVALE License'Class Lica# SANITARY Contractor 1(�Ma�Ltt-i,YYr1 Date L 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:$2600 I 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:37525067.00 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 WIT 1 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 D S ROM LAST CALLED INS ECTION. indemnify and keep harmless the City.of Cupertino against liabilities,judgments, Costs,and expenses which may accrue against said City in consequence of the Issued b Date: granting of thi it. Additionally,the applicant understands and will comply Y' with all no oint o rce regulations per the Cupertino Municipal Code,Section 9.18. 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 I,as owner of the property,or my employees with wages as their sole compensation, will do he work,and the structure is not intended'or offered for sale(See.7044, Business&Professions Code) I,as owner of the property,'am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the projoct(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 perjury one 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 complianc Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety C e,Sec'0 25505,25533,and 25534. Section'3700 of the Labor Code,for the performance of the work for which this Date: 1' l Owner or authorized age permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation:laws of California. If after making this certificate of exemption,I 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 MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVIS N b 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPEEtTFN© (408)777-3228•FAX(408)777-3333• building CDCUDerino.org misc QPLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1 �® APN n -1 n 5—O o oV RQER NAME�10tA6v 6 awp, WW n Cow) �`�\` E-MAIL STREET ADDRESS Yum p� CITY, sT��tM'T ( 4 �� 4�bm FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OwNER ❑ OWNTTER-BU➢DER ❑ OIANER AGETTI' ❑ CONTRACTOR ❑CONTRAC�TpOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NANi1y,,, V00L,�L LIC ENSE`�1 (CE�'SE TYPE(1-47- COMPANY yL BUS.LIC COMPANYNTAME ��,nh Y E-1,4AIL FAX STREET ZM i(JWIa , � cITY,STATE,zIP J PION ARCHITECT/ENGLN'EER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.DUPLEX ❑ muun-FAMILY PROJECT IN1VILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK `S TOTAL VALUATION: ZiOC>V RECEIVED BY By my signature below',I certify t0 ea a (lowing: I am the property owner or authorized agent to act on t pr / rtY owner's behalf. I have read this application and the information I h provided correct. I have read the Description of Work and verify it is accura I agree to comply with all applicable local ordinances and state laws relatin building co ction. I authorize representatives of Cupertino to enter the aboe-identi ed propefty for inspection pu€poses. Signature ofApplicant/Agent: Date: �Sa, SUPPLEMENTAL INFORMATION REQUIRED OFFI E ONLY OVER-THE-COUNTER ❑ EXPRESS U u ❑ STANDARD U ❑ LARGE a ❑ ASAJOR MBPMiscApp 2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 18674 loree ave DATE: 03/22/2013 REVIEWED BY: mendez APM BP#: `VALUATION: $2,600 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY PENTAMATION 1 RPSS USE: SFD or Duplex PERMIT TYPE: i WORK instal property line clean out-sunn vale sanitarV SCOPE titch.Flan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan(.heck Jklech.Pern it Fee: Plumb.Permit Fee: IPPERJAWT Elec.Permit Fee: Other Alech.Insp. F Other Plumb Insp. 0.0 ��s $45.00 Other Elec.Insp. ET Mech.Insp,Fee: Plumb. Insp.Fee: Elee.Insp.Fee: NOTE:This estimate does not include fees due to other Departments( a Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are.based on the prelimina information available and are onl an estimate. Contact the Det fiv addn'1 info, FEE ITEMS (Fee Resolution 11-053 E . 7/1112) 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 Sewer, Sanitary PME Plan Check. $0.00 77 Permit Fee: $0.00 Suppl.Insp.Fee:Q Reg. ®OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Consit-zrction Tax. Administrative Fee. IADMIN $42.00 Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fee; $0.00. Select a Non-Residential Travel Documentation Fee: ITRAVDo.0 $45.00 Building or Structure ®A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldjz Stds Commission Fee: 1BCBSC $1.00 $133.50 $23.00 ., $156.50 Revised: 01/0112013 .