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13040193 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20833 DUNBAR DR CONTRACTOR:BG CONSTRUCTION INC PERMIT NO:13040193 OWNER'S NAME: KATHURIA DEVINDER 850 W SUNSET BLVD DATE ISSUED:05/01/2013 OWNER'S PHONE: 4082421203 HAYWARD,CA 94541 PHONE NO:(510)432-6249 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMER71,0 License Class Lic.# 1 '6 2/ TEMPORARY POWER POLE Contractor (I Cc CLk--S T' T�V,C Date ��l— 2d k 3 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. 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:$500 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:32630157.00 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 WITIHN 180 F 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 18 57F,AO T 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 Ia granting of this permit. Additionally,the applicant understands and will comply Issued Date: with all ;urI ce regulations per the Cupertino Municipal Code,Section 9.18. '� RE-ROOFS: Signature 2 C Date S—("20(3 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. 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 Co 5505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this CDate ^2UI permit is issued. Owner or authorized agent: 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,aftermaking 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 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. 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION v\ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building Ca�cupertino.org \ M1S.G . CUPERTINO v PLUMBING MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT'ADDRESS r 1K rr Y/ , APN# �_ _ 3 0 - ( �►. 3 OWNER NAME t ��-1/► 'j �, /1 PHONE STREET ADDRESS �' N (�V�l.vt vrl CITY, STATE,ZIP FAX COTVIACT NAME �rC �� ! PHONE afj�(� \qp_��D EMAIL �rC�� It �/�14 �t rV U of (� o STREET ADDRESS y_ Q �� CITY,STATE,ZIP FAX I \ OWNER I OWNER-BUIIDER 'i ❑OWNERtAGEINT` ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER' ❑TENANT _ CONTRACTOR NAME t t LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME.,! EMAIL FAX STREET ADDIt�S CITY,STATE,ZIP PHONE dll I ARCHTTECTIENOIN$ER NAME 61 LICENSE NUMBER BUS.LIC# I COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE 4F ❑SFD qr DUPL,EJC p MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑WS - .BUILDINCr ,.;.❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? - ❑.No . I . DESCRIPTIONOiWORK fJUC1� I „, I L , it I I i ,_i VIII I'. , � I.I l I �,• lit TOTAL,V UATIOI�, ' QO pe By my signature beloW I certify to'each of the following: I am the property owner or authorized agent to act the property owner this application and the linformation I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ord�anceslarld'State I4ws relating to b in g construction. I authorize representatives of Cupertino to enter the abov dent!£! property for inspection purposes. Ilii'. II :IIIIIII I I Ir'' � i Signature ofAp rlirant/AAgent� I' Date: P€EMENTAL INFORMATION REQUIRED iR� i�1i U 16 I ill; 'll illy ' li 'i� II: I 1 I it I li iI I I llil � i , III i'i Ill I Ill 'I ;i . �� It I II I I, I i P I I I MEPMiscAPP_2 11oc revised 06/21/1 1 ' I CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20833 DUNBAR DR DATE: 04/29/2013 REVIEWED BY: MELISSA APN: 326 30 157 BP#: "'VALUATION: $500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION 1REAP14 USE: p PERMIT TYPE: A WORK TEMPORART POWER POLE SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $45 F' $45 00 M TOTALS: � � NOW Afech.Plan CheckPlumb. Plan Check Elec.Plan Check 0.0 hrs $0.00 Lfech. Permit lei?: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT C)zher.Tech.Insp. Other Plumb Insp. Other Elea Insp. Loi hrs $45.00 llech.Insp.Fee: Plumb. hrsh.Fee: Elec.Insp.Fee: NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelfinina information available and are onl an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E�' 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Sz11)p1. .PC Fee PME Plan Check: $0.00 Permit Fee: SuPpl. Insp Fee PME Unit Feer $45.00 PME Permit Fee: $45.00 Consiruction TiLv- Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning,,Fees.- Travel ees.Travel Documentation Fee: ITRA VDOC $45.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item �l3ldpi,Stds Commission Fee: 1BCBSC $1.00 $178.50 $178.50 $0.00 ' n . �. . Revised: 04/29/2013 Building Department City Of Cupertino LM 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: 2 a 33 r)(,vj3boj 0 fl, PERMIT# OWNER'S NAME: tJ&-v L Tt4t- ( Vv* PHONE# t-( 3 2 6Z (l°( GENERAL CONTRACTOR: 13 Cp Cc-)A BUSINESS LICENSE# ADDRESS: ASO Lg-,• Sc,t rs�� LvY)� CITY/ZIPCODE: ,�V-% C C SCS�t *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V 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