Loading...
10120148 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21431 VAI AVE CONTRACTOR:DIVERSIFIED BUILDERS PERMIT NO: 10120148 OWNER'S NAME: LINDA&JERRY NISHITA PO BOX 320308 DATE ISSUED: 12/21/2010 OWNER'S PHONE: 4084580693 LOS GATOS,CA 95032 PHONE NO:(408)377-3700 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class 7 Lic.# LTEMP POWER � Contractor�(Ii 51 F t O ?LCl C S Date I 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. 1 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:$125 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:36205018.00 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 18 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 DAYS F=LAS CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue 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. RE-ROOFS: Signature Date Z--Z 1"/V 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 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. 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 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 25505,25533,an 25534. �Section 3700 of the Labor Code,for the performance of the work for which this p Owner or authorized agent: / Date: 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 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36205018 . 00 DATE ISSUED. . . . . . . : 12/21/2010 RECEIPT #. . . . . . . . . BS000012322 REFERENCE ID # . . . : 10120148 SITE ADDRESS . . . . . : 21431 VAI AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LINDA & JERRY NISHITA ADDRESS 21431 VAI AVE CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4934 RECEIVED FROM IDIVERSIFIELS BUILD CONTRACTOR JONES, GREGG LIC # 21565 COMPANY DIVERSIFIED BUILDERS ADDRESS PO BOX 320308 CITY/STATE/ZIP . . . : LOS GATOS, CA 95032 TELEPHONE (408) 377-3700 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---- 1BCBSC VALUATION 125 .00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 125 . 00 0 . 50 0 .00 0 . 50 0. 00 1EPERMITFE FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0.00 1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127. 50 0 .00 127 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127.50 visa --------------- TOTAL RECEIPT 127. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------ 402 TEMPORARY POWER 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: j Y ) �/� PERMIT# 61 OWNER'S NAME: �Q `� - PHONE# GENERAL CONTRACTOR BUSINESS LICENSE# ©N r- t- ADDRESS: p TAX 1030 CITY/ZIPCODE: Los �,4 s *Our municipal code requires all businesses working in the city to have a City ofCupertmo 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: Signature Date Please check applicable subcontractors and complete the foll ing 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 Owner Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21431 vai ave. DATE: 12/21/2010 REVIEWED BY: bob s. APN: BP#: *VALUATION: $125 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY f1 PENTAMATION 1REAP14 USE: SFD or Duplex ,t)r r, �i,�,=,F , PERMIT TYPE: WORK install temp power SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $42 TOTALS: $42.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT 1 ;,_ Other Elec.Insp. 0.0 hrs $42.00 lic f it I`, 1';fird t �,fF'C_IF"?.St. /-cc. NOTE: Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resohition 09-051 Eff. 7%7:10j FEE QTY/FEE MISC ITEMS 1,/(m Ch' (-k f r t PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 C`ol;�i�'t�t'xic}tr I'rl.i Work Without Permit? 0 Yes E) No $0.00 1'tit171t1! <' i''c'i 5. Travel Documentation Fee: ITRA VDOC $42.00 Strong,Motion Fee: IBSE1sMICR $0.50 Select an Administrative Item Bldp-Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50 Revised: 12/07/2010 CITY OF CUPERTINO TEMP POWER CUPEkTINO PERMIT APPLICATION FORM APN # Date: V 2— Building Address: -2-7/ 431 Z9 t' 414c ��7 Owner's Name: Phone#: Contractor: Phone #: 7 - 70 n � rf Fax #: X08 ' 3 77- 390 Contact: !Zhone#: ff' Contractor License #: Cupertino Business License#: Job Description: Residential Commercial ❑ Valuation (cost of project): Type of Constructio . N/ Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Power>lK E 1REAP14 Amps 1 ERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps 1 EPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E 1BCBSC Cal Bldg Standards B ALL PERMIT _ Commission Fee TYPES 1BSEISMICR Seismic Residential B 1TRAVDOC Travel & Documentation B Fee Revised 01/07/09 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20605 VALLEY GREEN DR CONTRACTOR:SOUTH BAY PERMIT NO: 10120004 CONSTRUCTION CO INC O' R'S NAME: APPLE INC. 170 KNOWLES DR DATE ISSUED:12/01/2010 OWNER'S PHONE: 4088620902 LOS GATOS,CA 95032 PHONE NO:(408)379-5500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT IN FO: BLDG ELECT r PLUMB License Class C_ Lie.# i3(„ 4 MECH RESIDENTIAL COMMERCIAL // Contractor `76• Date ] hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:VALLEY GREEN 5(VG5)-COMM'TI-TENANT (commencing with Section 7000)of Division 3 of the Business&Professions IMPROVEMENTSTO ONE EXISTING OFFICE INSIDE EXISTING OFFICE Code and that my license is in full force and effect. BUILDINGS.IMPROVEMENTS CONSIST OF WALL RELOCATION, 1 hereby affirm under penalty of perjury one of the following two declarations: 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. 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 whi is permit is issued. Sq.Ft Floor Area: Valuation:$18000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:32610046.20405 Occupancy Type: correct.1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PENT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Si- '-ire &AIL _ —Date (2- l-j t� Issued(yj Date: ❑ ER-B ILDER DECLARATION 1 hereby affirm tha exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the 1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,1 shall contaminants as defined by,the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. O r or tL riz agent's Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 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 1 hereby affirm that there is a cons .30977,,Civ C.) lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.30 ur--the above mentioned property for inspection purposes.(We)agree to save Lender's Name tify and keep harmless the City of Cupertino against liabilities,judgments, cu. ,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18, I 1 understand my plans shall be used as public records. Signature Date Licensed Professional I