13060037 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21743 CASTLETON ST CONTRACTOR:TONY ALVARADO PERMIT NO: 13060037
CONSTRUCTION
OWNER'S NAME: RICHARD LIM 3459 MARTEN AVE DATE ISSUED:06/05/2013
OWNER'S PHONE: 4082452456 SAN JOSE,CA 95148 PHONE NO:(408)832-0206
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License Class_ ((Lic.# PANEL UPGRADE 125 AMP
Contractor Al n1 tjfll{7!! 1 Date =��
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:$800
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:35618070.00 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 A0 DAYS OF 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 DAY LAST CALLED INSPECT N.
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 Cup rtino Municipal Code,Section
9.18.
RE-ROOFS:
Signature244W-4111Date ^�'�' 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(x)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,Sectio 5 5,2553�2534 ,(
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ate:
permit is issued.
I certify that in the performance of the work for wWch this permit is issued,I shall
not employ any person in any manner so as to becpme 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 pepmit 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 rl� MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION V
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O�IVVVJ
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinp(cDcupertino.org misc
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❑PLUMBING ❑MECHANICAL []ELECTRICAL ❑MISCELLANEOUS
PROJECT-ADDRESS. co
APN# O�
OWNERN III • PHONE E-MAIL
IY� 1\ �
STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR N .� LICENau a&Q&ISE NUMBER LICENSE TYPE BUS.LIC#
Vi,
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WH.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK �^
Cal) 6 0,417j:�! f?39Vn
P
P<.
TOTAL VALUATION: �� RECEIVED BY:
By"my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the rope owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I ee to comply with all applicable local
ordinances and state laws relating to b ding traction. I auth e r resentative o Cupertino to enter the above-ide Ifi d property f pection purposes.
Signature of Applicant/Agent: Date:
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SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
W ❑ OVER-THE-COUNTER
❑ EXPRESS
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❑ STANDARD
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MEPMiscApp_201 Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21743 Castleton St DATE: 06/05/2013 REVIEWED BY: Mendez
101APN: BP#: "VALUATION: $800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
SFD or Duplex 1 REAP2
USE: PERMIT TYPE:
WORK PANEL UPGRADE 125 AMP
SCOPE
RUM
0,10Xfech.Plan Check Plumb,Plan Cheek Elec.Plan Check 0.0 hrs $0.00
L1e11h.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT
Other;k(A Insp. Other Plumb Imp. Other Elec.Insp. 0.0 hrs $45.00
11ecYr.Insp.Fere: Plumb. Insp.Fee: Elee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onlyan estimate- Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = amps Electrical
Suppl. PC Fee: Q Reg. 0 OT 0,0 hrs $0.00 $45.00 IBELEC2007 Services
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. ®OT 1 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: _r_T $45.00
Construction lax:
Administrative.Fee: IADMIN $42.00
Work Without Permit? ®Yes (E) No $0.00
Advanced Planning Feer $0.00 Select a Non-Residential
Travel Documentation Fee: ITP,AVD0C $45.00 Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldiz Stds Commission Fee: 1BCBSC $1.00
$133.50 $45.00 Q $1.78.50
Revised: 04/29/2013