13100047 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10649 MORENGO DR CONTRACTOR:TES COMPANY PERMIT NO:13100047
OWNER'S NAME: JOSEPH LIANG 3549 CECIL AVE DATE ISSUED:10/04/2013
OWNER'S PHONE: 4089968099 SANTA CLARA,CA 95050 PHONE NO:(408)605-2297
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIALEI
License Clas �'7 Lic.#�7 9 O 16 CREATE CONNECTION FOR METER PANEL
Contractor Date Ld
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 Valuation:$800
performance of the work for which this permit is issued. Sq.Ft Floor Area:
I have and w, a' tai�rker's Compensation Insurance,as provided for by
Section 37 f e L or Code,for the performance of the work for which this APN Number:37534012.00 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 1A0 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 M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, G
costs,and expenses which may accrue against said City in consequence of the Issued by Date: /
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source re gu ations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature AV Date C U �� 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 Date:
Signature of Applicant:
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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 Code,Sections 2 ,2553 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agent: Date:
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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION LO
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 pU
19-1 (408)777-3228•FAX(408)777-3333•building cDcupertino.or�$\
MISC
GUPERTINO❑PLUMBING ❑MECHANICAL ELECTRICAL [:]MISCELLANEOUS
PROJECT ADDRESS o 6z1 qD R Ew pie. APN# / y5 o I 2-
OWNER NAME n /1 L/Q�1 f/? PHONES j SF Q !n��Lf LJ EMAIL ••�
STREET ADDRESS 06 r_/nr/rP-r]e/7 J i V/( CITY,STATE,ZIP / C/ �// ( ^ ` FAX
CONTACT NAME �� /'(/ V CTCV !/I" PHONE 1 0 E-MAIL 6
STREET ADDRESS _ l.. }""�/ / � C- CITY,STAT IP J��`� FAX
❑OWNER ❑ OWNER BUILDER ❑ OWNER AGENT J(CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME i L LICENSE NUMBER
1 LICENSE TYPE BUS.LIC#
g7-7y 0
COMPANY NAME ` c EMAIL FAX
STREET ADDRESS s.s 11_IwE /1s CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEERNAME �l J LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE 11 NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK C/e �Q n ,i ^ �¢/�� n ///� �r 0a
RFCE Izli ' � A' '011'�
TOTAL VALUATION: 't-
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on tv p erty owner's behalf. I have read this
application and the information I have provided i ect. I have read the Description of Work and verify it is accur . I agree to comply with all applicable local
ordinances and state laws relating to building ns ction. I uthorize jr e��ntatives of Cupertino to enter the above-iden Ified property for inspection purposes.
Signature of Applicant/Agent: r `l V Date:
SUPPLEMENTAL INF TION REQUIRED JEFI�:
i K
T�
s
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10649 morengo dr DATE: 10/04/2013 REVIEWED BY:
APN: BP#: "VALUATION: $800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1 REAP?
USE: SFD or Duplex PERMIT TYPE: A
WORK create connection for meter panel
SCOPE
L4ec,lr Plan Check Phsrrrb.Plan Check Elea Plan Check 0.0 hrs $0.00
Tech. Permit Fee: Plurals.Permit Fee: Elec.Permit Fee: 1EPERMIT
Other.Mech.Insp. Other Plumb Imp. Li Other Elec.In
.1�ce
ch.ins)..Fee: Plumb.. Iris):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 therelimina information available and are on an estimate Contact the Dept or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E 7/1/13) FEE QTY/FEE MISC ITEMS
.
Plan Check Fee: $0.00E-1 # Electrical
Suppl.PC Fee: Reg. Q OT0.0 hrs $0.00 $139.00 IBREMMISC Conductors
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
C onsir action Tax:
Administrative Fee: 1ADMIN $44.00
Work Without Permit? ®Yes (E) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee: iBSEISMICR $0.50 Select an Administrative Item
Bldg,Stds Commission Fee IBCBSC $1.00
$139.50 $139.00jjj $278.50
Revised: 10/01/2013