13040143 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7373 f ALLENLEAFLN CONTRACTOR.TBD-z^v-fl;i PERMIT NO:13040143
DETESB-•
OWNER'S NAME:"FALLEN LEAF SS LLC G DATE ISSUED:04/18/2013
OWNER'S HONE: 4088577309 PHONE NO:
P
LICENSED CONTRACTQOR''SS DE/C�L'ARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lie.# '! y S�/ GARAGE AREA-RELOCATE 2 LIGHT FIXTURES AND
CIRCUITS
ContractorP��(� 7 17
I hereby affirm that 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:$300
I have and will maintain Worker's Compensation,hisurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35927025.00 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'eomply with all city and county•ordinances and state laws relating WIT 180.DAYS OF PERMIT ISSUANCE OR
to building:construction,and hereby authorize representatives of this city to enter .
upon t}}e:above mentioned property for inspection purposes. (We)agree to save 180 D Y F M LAST CALLED INSPECT ON.
indemnify and keep harmless the Cityof Cupertino against liabilities,judgments,
costs,and expenses'which'may accrue against said City in of the
granting of this permit, Additionally,the applicant understands and will comply Issued by: Date:
with 4 non-point source(regulations per the Cupo Municipal Code,Section '
9.18'
Aid rri—Ir
RE-ROOFS:
Signature Date ut !! 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-R] ARATION,
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 doltho work,land.the'structur e'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(Sed7044 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 ofthe 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,5hapter 9.12 and
I have and will maintain Workers Compensation Insurance,as provided for by the Health&Safety Code,Secti 25 5,2 3 a d 255
Section.3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dat
permit is issued...
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person mi any manner so as to become subject to the Worker's
Com
pelisation,,laws of California. If aftermaking this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Workers 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;orthis permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
I I ,
Lender's Name
I PLICANT CERTIFICATION Lender's Address
I certify that I IhgY,e F ad is applieagon and state:thatthe above information is
correct.1 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,fq inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify 0nd keep�►"' ess,the City.of Cupertino against liabilities,judgments,
costs,', expenses l}bicho may accrue against said City inconsequence of the I understand my plans shall be used as public records.
granting of th'i4emutj Additionally,,the applicant understands and will comply
with all non point,source repulationsi per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signaturepate
I
GENERAL PERMIT APPLICATION
MEP
1 'I' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
Iliil 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
11. I (4Q8)777-3228 FAX(408)777-3333•buildin4Ccilcupertino.org D M
'Is,C
CUPER. J NO
PLUMBING ❑MECHANICALECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS /� rAPN# 351 2'I b2S��
OWNERNAME ` r' PHONE &MAIL
STREET ADDRESS CITY, STATE,ZIP O/l
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CONTACT NAME ��/t y PHO �) E-MAIL
STREET ADDRESS 2y (I ,^ CITY,STATE,ZIPC FAX
❑OWNER ❑ QWNER-BUILDER ❑ OWNER AGENT .❑ CONTRACTOR ❑CONTRACTOR AGENT FAX
13 ENGINEER ❑ DEVELOPER ❑TENANT
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ARC HITECT/ENGIIQEER!NAME " + LICENSE NUMBER BUS.LIC#
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ST�11REET ADDRESS I I ! CITY,STATE,ZIP PHONE
USE;of P SED.,DUPLEX 1 4 �[UL.Ti-FAME.Y PROJECT IN WI DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑:YES
BUILDING .,. Q COMMERCIAL I.': - - URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO BICHLER HOME? ❑*NO'
DESCRIPTIP OF 7RK
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By Ilmy'srgna e,below,I ce ify 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'tlie;information I.have prodded is cortect. I e read the Descr' verify it is accurate. I agree to comply with all applicable local
Ordinances and state laws relating to i g o i a r es of Cupertino to enter the abov/e�d n Ifi/e� pe r r inspection purposes.
Signature ofApplicant/Agent. Date: l� / � _
EMENTAL INFO TIO QUIRED
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MEPMiscApp_2011.doc revised 06121111
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CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7373 FALLENLEAF LN DATE: 04/18/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: $300
*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair-
PRIMARY.-,.
epair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 REAP1 0
WORK GARAGE AREA-RELOCATE 2 LIGHT FIXTURES AND CIRCUITS
SCOPE
L1ec�� Plan Check, Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00
Mach. Permit Fee:', Plumb.Permit Pee: Elec.Permit Fee: 1EPERMIT
Other A1ech.,Insp.'. Other Plumb Insp. Ll
Other Elea Insp. 0.0 hrs $45.00
t ech.In I c c Pluratb. Insp.Fee: Elec.lnsp. Pee:
NOTE_:This estimate does'not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District 'etc . These ees are based on the reli»iina in ormation available and are only an estimate. Contact the De t or addn 1 info.
FEE ITEMSi(Fee Resolution 11-053 E 7/1/122 FEE QTY/FEE MISC ITEMS
Plan Check Fee: ', $0.00 2 # Electrical
Supp 1.PC Fee: (E) Reg. Q,OT 0:0 hrs $0.00 $45.00 IBREECEP Recep/Switch/Outlets
PME Plan Check: $0.00 2 Electrical
Permit Fee: $0.00 $67.00 IBREMFIXT Fixtures,Lighting
Supp/ Insp.Fee-.0 Reg. Q OT FO.01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
t onsttzaction :Tax:
Administrative Fee: 1ADAffN $42.00
Work Without Permit? Yes ® No $157.00 (D .:
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Docum'entationfee: • ITRAVDOC $45.00 Building or Structure' O .
i
Strong Wtion Fee ;' ! 1BSEISMZCR $0.50 Select an Administrative Item
Bldg Stds'CommissionFee IBCBSC 1 $1.00
$290.50 $112.00 : ' $402 50
Revised: 04/01/2013
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3 BUILDING DiVISILON-CUPERTINO
°T7 This set of plans and specificati MUST be kept at the
job site during construction. It is unlawful to make any �\
changes or alterations on same,or to deviate ® �
therefrom,without approval from the Building Official. L _
The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
�Y
DATE
; ,3 PERMIT NO.