13120053 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7558.TIPTOE LN CONTRACTOR:BESTBUILD PERMIT NO:13120053
CONSTRUCTION INC
OWNER'S NAME: YANG CHIANG-YUAN AND TE-TUAN 1732 143RD AVE DATE ISSUED: 12/05/2013
OWNER'S PHONE: 6509418608 SAN LEANDRO,CA 94578 PHONE NO:(510)388=509
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Class_ Lia# b I INSTALL TEMP POWER
Contractor=?<r � - 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 Valuation:$500
performance of the work for which this permit is issued. Sq.Ft Floor Area:
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:35932048.00 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 inspection purposes. (We) agree to save 180 DAYS FROM M�� ST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, S 13
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 regulations per_the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date LZ/. D,�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 Date:
Signature of Applicant:
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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting withlicensed 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. 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 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
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
performance of the work for which this permit is issued.
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 Owner or authorized agen Date: _Cc<
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
work's for which this permit is issued(Sec.3097,Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked. 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:
Date
Signature
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION /
72
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 O�J
(408)777-3228•FAX(408)777-3333•building
GUPERTINO acupertino.org 1?j MISC
6�
❑PLUMBING ❑MECHANICAL LECTRICAL []MISCELLANEOUS
PROJECT ADDRESS ( Lw APN L)
Q`
OWNER NAME I�> - f P ,rif l �t(/ E-MAIL
u `� , v�J A
STREET ADDRESS 4� (�,7 J II _ ., �j^ /1 CITY,STATE,ZIP
CONTACT NAME 1� PHONE E-MAIL
D� t7fl
STREET ADDRESS ve CITY,STATE,ZIP L�rFAX
`L
1:1OWNER 11OWNER-BUILDER 1:1OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT 11ARCHITECT ❑ENG R DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICINSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHTTECT/ENGWEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAH. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI FAMILY PROJECT IN WH.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: E]COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO -
DESCRIPTION OF WORK
IN
01 P-11
TOTAL VALUATION: ��,��+ �' b0 ,�bfill
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property 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 agree to comply With all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: 2 y� 1
SUPPLEMENTAL ON REQUIRED Mr ��
Q �- OkF,lCE�3E
O
tla.bw w R THIrCOTEIi�
�e�I�EXPAESS r.'
r
U
MEPMiscApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7558 tiptoe In DATE: 12/05/2013 REVIEWED BY: mendez
101APN: BP#: *VALUATION: $500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1 REAP 14
USE: SFD or Duplex PERMIT TYPE: i
WORK ternp power
SCOPE
--------------
Q1W ,
� W ,
N1ech. flan CheckI'hrrrrb.Plum Check Elect.Plan Check 10.0 hrs $0.00
L1ech.Permit Fee: Plumb.Permit t:e: Elect.Permit Fee: 1EPERMIT
Other.1Aech.Insp. Other-Plumb Insp. Other Elea Insp. 0.0 hrs . $47.00
lfech.Insp.Fee: Plumb. hrap.Fee: Iaec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District eta). These fees are based on the preffintina information available and are only an estimate. Contact the Dept for addn 11 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1 amps Electrical
Suppl.PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $47.00 IERT<200 Temporary Power
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.(E) Reg. ®OT 0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction ?air:
Administrative Fee: IADMIN $44.00
Work Without Permit? ®Yes (E) No $0.00
Advanced.Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion Fee:. 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
_ ,; . $186.50
$139.50 $47.00 �p
Revised: 10/01/2013