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11100175 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10365 CALVERT DR CONTRACTOR:CW BUILDERS PERMIT NO: 11100175 OWNER'S NAME: FAI DANIEL JOHN ET AL PO BOX 3206 DATE ISSUED: 10/24/2011 OWNER'S PHONE: 4088889669 SARATOGA,CA 95070 PHONE NO:(408)378-4323 L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r- License Class Lic.# rZ L T Z MECH RESIDENTIAL COMMERCIAL Ur Contractor�� 3 �!ae;j Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEMPORARY POWER POLE (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:$325 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 permit is issued. APN Number:37517025.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point re ons per the Cupertino Municipal Code,Section Issued b Date: 9.18. . Signatur � Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the p Health&Safe Code ctions 25505,25533,and 25534. 1 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 Ow r n ent• df— Compensation laws of California. If,after making this certificate of exemption,I Date: become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this pennit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, cam^*s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ing of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. �.,,. all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37517025 . 00 DATE ISSUED. . . . . . . : 10/24/2011 RECEIPT #. . . . . . . . . : BS000015139 REFERENCE ID # . . . : 11100175 SITE ADDRESS . . . . . : 10365 CALVERT DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER FAI DANIEL JOHN ET AL ADDRESS . . . . . . . . . . : 10365 CALVERT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CHARLIE WU CONTRACTOR . . . . . . . : CHARLIE WU LIC # 25285 COMPANY . . . . . . . . . . : CW BUILDERS ADDRESS PO BOX 3206 CITY/STATE/ZIP . . . : SARATOGA, CA 95070 TELEPHONE . . . . . . . . : (408) 378-4323 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1. 00 41. 00 0 . 00 41 .00 0. 00 1BCBSC VALUATION 325. 00 1. 00 0 . 00 1.00 0. 00 1BSEISMICR VALUATION 325 .00 0.50 0 . 00 0 .50 0. 00 1EPERMITFE FLAT RATE 1 .00 44 . 00 0. 00 44 . 00 0. 00 1ERT<200 UNITS 1. 00 44 . 00 0. 00 44 .00 0 .00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0 . 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 174 .50 0. 00 174 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 174 .50 VISA --------------- TOTAL RECEIPT 174 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10365 calvert dr. DATE: 10/24/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: $325 RIPERMITTYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: p PERMIT TYPE: WORK install temp power pole SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $44 TOTALS: $44.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT Other Elec.Insp. 0.0 hrs $44.00 NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelinina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS Resolution 11-053 E FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Administrative Fee: IADMIN $41.00 Work Without Permit? Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 i Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $174.50 $0.00 TOTAL FEE: $174.50 Revised: 10/01/2011 GENERAL PERMIT APPLICATION MEP La COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• buildincupertingorgMISC CUPERTINO ❑PLUMBING ❑MECHANICAL CIELZCTRICAL ❑MISCELLANEOUS PROJECT ADDRESS /V,3 / C�,, 1 �e 1 Lr vc- APN , ' t O 2—s OWNER NAME ]� �I/�r t PHONE (/�\ I ` E-MAIL f/ e1 �6 1 STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME ' i , � PHONE j r, '—�{ ^) ) E-MAIL 7 STREET ADDRESS D go y �� 0 CITY.STATE ZIPsei i �L,l W FAX ❑ 0� ❑ OWNER-BUILDER ❑^OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME G LICENSE NUMBER Z/ LICENSE TYPE BUS.LIC# COMPANY NAME ; ` f( ( „ E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS �� CITY,STATE,ZIP PHONE USE OF jffSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK L TOTAL VALUATION: L� 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 behalf. I have read this application and the information I have p is c j 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 di ction I uthonz epresentatives of Cupertino to enter the abo e``-llid tified property for inspection pu{poses. Signature of Applicant/Agent, � �--- Date: V SUPPLEMENTAL INFORMATION REQ=D ��OFFIICE USE ONLY L�7 OVER-THE-COUNTER ❑ EXPRESS X U W ❑ STANDARD T U ❑ LARCE a ❑ MAJOR MEPMucApp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1 PERMIT# OWNER'S NAME: �O' v1e ',�� PHONE# V GENERAL CONTRACTOR: 'I C�{- 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 S ONT CTORS HAVE OBTAINED A CITY OF CUPERTINO 54, BUSINESS LICENSE. I am not using any subcontractors: Signature Date 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 lv 2� l Owner/Contractor Signature Date