The URL can be used to link to this page

10040052 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10642 N PORTAL AVE CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10040052 DATE ISSUED:04/08/2010 OWNER'S NAME: RICHARD GREGERSEN PHONE NO: JER'S PHONE: 4083955599 ' ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH I- RESIDENTIAL F COMMERCIAL Contractor Date JOB DESCRIPTION:SERVC PANEL MODFCTN PG&E DISCOVRD WIRING ON I hereby affirm that I am licensed under the provisions of Chapter 9 THEIR (commencing with Section 7000)of Division 3 of the Business&Professions SIDE OF THE MAIN EXTERIOR PANEL.ELCTRCN WL CORRECT Code and that my license is in full force and effect. THIS IMPROPR WIRING DONE BY PRIOR OWNR.LOAD 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. 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 Sq.Ft Floor Area: Valuation:$1000 permit is issued. APPLICANT CERTIFICATION Occupancy Type: I certify that I have read this application and state that the above information is APN Number:31632054:::.00 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. h Date _ Issued by` Ate'--- Date: 1<%1 v Signature a� �., OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: I,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 or will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: I,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 I 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 HAZ )SURE ARDOUS MATERIALS DISCL Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this I use a pAdditionally,should use equipment or devices which emit hazardous air permit is issued. k for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality ManagemeChaptnt 9.12 aDistrict dI he will I certify that in the performance of the wor not employ any person in any manner so as to become subject to the Worker's maintaHealth'&Safety Code,Secthons 25505,25533nand 2 534ecompliance with te Cupertino Muicipal Cod � 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 Own orized agent LF iii�,._-k -= forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signat Licensed Professional r CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 5 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31632054 . 00 DATE ISSUED. . . . . . . : 04/08/2010 RECEIPT #. . . . . . . . . : BS000010131 REFERENCE ID # 10040052 SITE ADDRESS 10642 N PORTAL AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RICHARD GREGERSEN ADDRESS 10642 N PORTAL AVE CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2449 RECEIVED FROM RICHARD S GREGERSEN CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- ---------- -------- ---------- ---------- 1 . 00 0 . 0 1BCBSC VALUATION 1, 000 .00 1 . 00 0 .00 1BREMMISC FLAT RATE 1.00 126 . 00 0 . 00 126 . 00 0. 0 0 .00 0 . 50 0 . 00 1BSEISMICR VALUATION 1, 000 .00 0 .50 42 . 00 0 . 00 1EPERMITFE FLAT RATE 1 .00 42 . 00 0 .00 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 ------0_ TOTAL PERMIT 211.50 0 . 00 211.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------ -------------------- CREDIT CARD 211. 50 VISA --------------- TOTAL RECEIPT 211. 50 " ✓ < �� CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM \ Date: APN # r � L+ . c) v ( l Building Address: t 0 4 4-z 1J . Po x<^,- A J s. Mailing Address (if different from building address): 5 4::;k So 3 2 00 � ��«+�l�1 G�� -•j c.� --�"c�� t 03 L.o s c Are Hazardous Materials being used as part of this project? Yes ElNo HOA: Exterior work only) Yes ❑ No ❑ If es, rovide letter from HOA Phone#: Owner's Name: �{.og-3�S-SSGt4 W e=_ Phone: is 6we's Contractor:�G-v �� '`�r.,-t�cc. Fax: -- Contractor License#: Cu ertino Business License#: � �'�'`�� Phone: Contact: Fax: Residential Commercial Job Description: �.►� �.o'v` f,moo► �` -C�.eE: e�p►c e1p;; A4t£ -Vcr.�CoJ4itGO w.�cs'1�l \ C ��aS Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech 11 Occupancy Type: Type of Construction(Usage Class): IV-HT V-B 1-A, 1-B ❑ 11/III/V-A F1II/III B, Square Footage: V aluatiork;,2- �aoo Project Size: Ex ressStandard ❑ Lar e❑ Major ❑ g GBuildin Green : Please complete relevant portion of the Green Buildin&EED sheet indent& attach it to the application or if applicable, include in plan set Points Achieved: For hel , contact Build it Green at www.buildit reen.or Revised 07/14/09 CITY OF CUPERTINO CITY of GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Fee Description Fee Permit Type Quantity/Sf Fee ID Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1WINREP Replacement windows/sliding glass B door (ea 8 windows) B 1WINMEWSTR New Window-structural shear wall masonry (includes lan ck fee) Electrical Permit Fee E 1 EPERMITFEE 1 MPERNIITFEE Mechanical Permit Fee M Plumbing g Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-stand alone L PERMIT 1BCBSC Cal Bldg Standards Commission Fee B LL 1BSEISMICR Seismic Residential B I 1BSEISMIC0 Seismic Commercial B 1TRAVDOC Travel &Documentation B rB 1BUSLIC Business License 5of5 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Of JOB ADDRESS: W(*A—;- •�� - p ```' �` PERMIT# OWNER'S NA • �� .ceE�SE.-� PHONE# /E ate-s4S-�S44 GENERAL CONTRACTOR'VrEQ"W%- BUSINESS LICENSE# ADDRESS: t"4 W��S�,1Gr �� CITY/ZIPCODE: aso35 *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)HAVE OBTAINED A CITY OF CUPERTINO UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: t/ 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 Owner/Contractor Signature