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13070204 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19400 SORENSON AVE CONTRACTOR:LEON CONSTRUCTION PERMIT NO:13070204 OWNER'S NAME: FONTAINBLEU LLC 5514 MAPLECREST CT DATE ISSUED:07/31/2013 OWNER'S PHONE: 4084489898_ SAN JOSE,CA 95123 PHONE NO:(408)209-1272 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS License Class/ ,,, C-"l O Lic.# $G 6 2 PROVIDE POWER TO SHOP SEE PERMIT#12010054 Contractor fes'�' A!c Date 7 3/1-3 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. M F 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:$1000 ' I have and will maintain Worker's Compensation Insurance,as provided for by M` Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37503005.5 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 1-80 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless a City of Cupertino against liabilities,judgments, �' costs,and expenses which y accrue ' t.said City in consequence of the �3�/3. granting of this permit. ditio ly a li ant understands and will comply Issued by: Date: with all non-point s re tion per a upertino Municipal Code,Section 9.18. / / RE-ROOFS: Signature5"°f Date �t 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(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 equip9pent 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 ea Al al Management District I performance of the work for which this permit is issued. will maintain compliance with the C lino ie' a Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 05, 53 , 5534. �j Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date• ^J/ -I permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 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 e ImGENERAL PERMIT APPLICATION 4 MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 U CUPERTINO (408)777-3228•FAX(408)777-3333•buildingCa�cuperti 1O.Org �j0 MIS 1J ❑PLUMBING ❑MECHANICAL [—]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# OWNERNAME��NT�\�� 'LLC PHONE qB � STREET DRESS `` CITY, STA E,ZIP b FAX SoxeNSof v , CITY, t 1,11 No 00) Q CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME N N ST�VL�tQ LICENSE NUMBER 4[O n LICENSE TYPE ` BUS.LIC# COMPANY NAME �?' ^ MAIL / rt FAX A J ` c'.n cA T 11 k(Vl J C•�t Wt• STREET ADDRESS CITY,STATE,ZIP PH NE t >��c»L�ss cT• 5 AN o sr, Q a S 123 o 2Oct(2 �-f ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.r DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WHALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL - URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK oriel c.c 4& rGV�•� Nft� 5�� Sic •'�ii� /.?G/IJIJS� TOTAL VALUATION: O oD m RECEIVED 4 By my signature below,I certify to each of the r.=Z ing: I am the perty owner or authorized agent to act on the roperty owner's behalf. I have read this application and the information I have providere I have a e escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relati:ju�flo on. I auth ' ereesentatives of Cupertino to enter the above-identified/property for inspection purposes. Signature of Applicant/Agent: 0'1/ Date: J r/ SUPPLEMENTAL INFORMATION REQUIRED `"`' Q OFFICE USE ONLY w OVER-THE-COUNTER ❑ EXPRESS V x ❑ STANDARD V Z ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19400 sorenson dr DATE: 07/31/2013 REVIEWED BY: Mendez APN: BP#: 'VALUATION: 1$1,000 xPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP2 USE: p PERMIT TYPE: WORK provide power to shop see permit# 12010054 SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Services 1 ERT<200 100 Amps $47 TOTALS: $47.00 gpgg r Ltech. Plan Check Phimb.Plan Check Elec.Plan Check 0.0 hrs $0.00 ,tlech.Permit Fee.; Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT Other,llech.Insp. Clther Plumb Insp. Other Elec.Insp. 0.0 hrs $47.00 rllfech.Insp.Fee: 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). These fees are based on the preffinWha information available and are only an estimate. Contact the Dept for addn 7 info, FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Chick 1,'ee: Suppl. PC"1,ee PME Plan Check: $0.00 Permit Fee: .Suppl. Insp Fee PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction :Tear: Administrative Fee: 1ADMIN $44.00 Work Without Permit? ®Yes (j) No $0.00 Advanced Planning k7ees. Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion.Fee: IBSE1SN11CR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $186.50 $0.00nj��g $186.50 Revised: 07/0.1/2013