13040127 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18655 RALYA CT CONTRACTOR:GRAND NEST PERMIT NO:13040127
CONSTRUCTION
OWNER'S NAME: YICHUNG CHOU 13428 CHRISTINE DR DATE ISSUED:04/17/2013:
OWNER'S PHONE- 40838624.65 SARATOGA,CA 95070 PHONE NO:(408)891-8059
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License ClassLic.# 641 � INSTALL TEMP POWER
Contractor -,94A/V Date
I hereby affirm that I am licensed under the provisions of Chapter
(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 Insurance;as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number 37525008.00 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 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property.for mspectionpurposes. (We)agree to save 180 DA F OM LAST 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.
VL
RE-ROOFS:
Signature` � V Date `l L I ' 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"theContractor'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 lthe 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(See.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. 1[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,and 25534.
Section 3700 of the Labor Code for the performance of the work for which this (f I
permitis'issued. Owner or authorized agent: Date:—
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
Compepsation laws4Califomia.',It after'makingthis certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to theWorker'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 withsuch 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 buildingi construction,and hereby authorize representatives of this city to enter
upon th6above 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.
grantmg o£this permit.Additionally,the applicant understands and will comply
with all non-poinCsource'regulations'per the Cupertino Municipal Code,Section Licensed Professional
9 18
Signature' Date
GENERAL PERMIT APPLICATION � MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION (ti\�
.10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0
CUPERTINO (408)777-3228• FAX(408)777-3333•buildino(,)CUDertino.org MISC
❑PLUMBING ❑MECHANIClAL ❑IErLECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS b3S Raj a / �` Y`� 0 (� 7r5•I wI APNr
OWNER NAME i(�/ ./ O/I J PHONE /r,ol p { ( [ E-MAIL
STREET ADDRESS `/ Qrl /IJ a lJ CITY, STATE,CZIP O/°u]f �„' ��I FAX
CONTACT NAME l 0 U PHONE l v/ E-MAIL
STREET ADDRESS a G�L� 'V` OIC/ SCWe ,STATE,ZIP F.
11o)NNER ElN'1D
m .'ER.BuiER ❑ OWNERAGENT ❑ CONTRACTOR ❑CON�TRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME h LICENSE NUMBER LICENSE TYPE BUS.LIC#
.AVIV\. Vljh
COWANY NAMEr E-MAIL FAX
G
STREET ADDRESS I CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF [I SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN=LAND EI PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: 'o o RECEIVE
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act th roperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Rork and verify it is acc te. I agree to comply with all applicable local
ordinances and state laws relating to bu' `ng construction. I authorize represe 'ves of Cupertino to enter the above-identified propel y for inspection purposes.
Signature of Applicant/Agent: Date: ( Zo
SUP NTAL INFORMATION REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
❑ EXPRESS
V
U
❑ STANDARD
U
❑ LARGE
❑ MAJOR
A�EPA1iscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 18655-royal- t— DATE: 04/17/2013 REVIEWED BY: Mendez
APN: A- ' BP#: *VALUATION: $300
%PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
SFD or Duplex 1REAP14
USE: PERMIT TYPE:
WORK power'. .
SCOPE
,Meeh.Flan Check- Plumb.Plan Check Elec.Plan Check 0.0 hrs $0.00
Llech.PernzitFee: Plumb.Permit Fee: Elec.Permit Fee: 1EPERMIT
Other.tlech.Insp. Other Plumb Insp. Li Other Elec.Insp. L0.0 hrs $45.00
.Aaech.Insp.,Fee: Plumb. lisp.Fee: I:lee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(be.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelinmdina information available and are only an estimate. Contact the De t or addn'I info,
FEE ITEMS(Fee .Resolution 11-053 E 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: . $0.00 200 amps. Electrical
Suppl.PC Fee: E) Reg. 0 OT 0.0 1 hrs $0.00 $45.00 IERT<200 Temporary Power
PMEPlan Check:. $0.00
Permit Feet . $0.00
Suppl.Insp.:Fee-0 Reg. ®.OT 0.0 hrs $0.00
PW Unit Fee: $0.00
PME Permit Fee: $45.00
T-T .
Construction.Ta ..
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes 0 No $0.00
Advanced Plannin Fee: $0.00 Select a Non-Residential
Travel Documentation Fee:; 1TRAVDOC $45.00 Building or Structure
i
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: - 1BCBSC $1.00
$133.50 $45.00
Revised: 04/01/2013