The URL can be used to link to this page

13120003 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20832 GREENLEAF DR CONTRACTOR:ATLANTA CONSTRUCTION PERMIT NO:13120003 INC OWNER'S NAME: HUANG LAI-CHING AND MEEI HWA ET AL 2625 MIDDLEFIELD RD#164 DATE ISSUED: 12/02/2013 OWNER'S PHONE: 6504920120 PALO ALTO,CA 94306-2516 PHONE NO:(408)518-0132 ❑ LICENSED CONTRACTOR'S DECLARRATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class 1� Lic.# � 3 7 /� ,, MECH r RESIDENTIAL r COMMERCIAL &Contractor ",^ ,; Date r I hereby affi�n that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions JOB DESCRIPTION: Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: INSTALL TEMP POWER t. 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. 2. I have and will maintain Worker's Compensation Insurance,as provided for by r FI Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:32630172.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED ;ranting of this permit. Additionally,the applicant understands and will comply with WITHIN 180 DAYS OF PERMIT ISSUANCE OR all non-point source regulations per the Cupertino Municipal Code,Section 9.18. S 180 DAY F M LAST CALLED INSPECTION. Signature Date Z 2 2013 Issued by: Date:A4 h.? ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is installed a. I,as owner of the property,or my employees with wages as their sole without first obtaining an inspection,I agree to remove all new materials for inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: Date: 2. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: t. I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the California performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain compliance with 2. I have and will maintain Worker's Compensation Insurance,as provided for by the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section Section 3700 of the Labor Code,for the performance.of the work for which this 25532(a)should I store or handle hazardous material. Additionally,should I use permit is issued. equipment or devices which emit hazardous air contaminants as defined by the Bay Area 3. I certify that in the performance of the work for which this permit is issued,I shall Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and not employ any person in any manner so as to become subject to the Worker's 25534. 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 Owner or authorized agent: Date: Z I must forthwith comply with such provisions or this permitshall be deemed revoked. CONSTRCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for APPLICANT CERTIFICATION which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with I understand my plans shall be used as public records. all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 `� MISC CUpERTIN4 (408)777-3228•FAX(408)777-3333•building a.cupertino.org \�\ ❑PLUMBING ❑MECHANICAL Q ELECTRICAL ❑MISCELLANEOUS PROJECTADDRESS �i)��`� /_/��lJ ; / / `A�PN# Ce )'7�.0U' /� OWNER NAME 1 V/JV��UQ Li� PHO Ij5 G 2--017U E (��1 �hli 4 i mql/_(0 STREET ADDRESS 2526 ' Pa r'�I'r�(� Ce �,(� CITY,Q j AT s L O]/ FAX CONTACT NAME Chir) Uan PHO / Y�Z`V IZq E-MAILChyj5 U0nj fi*/'/ 1-0 STREET ADDRESS I �i rU„[t f .I a CLST P !SZ � ��`' V' FAX �326&OWNER ❑ OWNER-BUILDER W❑I-10 (WNIIt� AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ VARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR ,(Aver- LICENSE NUMBER LICENSE TYPE BUS.LIC# 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 ❑SID or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK Yh u rG r� .12o we r f rm j TOTAL VALUATION: SX)GRCE Y • `€� ��^.,`. � ;. 2o- By my signature below,I certify to each of the following: I am the property owner or authorized agent to act opWjoperty 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 ac ate. 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 prrojperty/for inspection purposes. Signature of Applicant/Agent: Date: �✓'%/ j7 `( ' ( � SUPPLEMENTAL INFORMATION REQUIRED �Ao icT7o�E,00 11OR0 i! p ua� 11 , T� ,l R W `rV , Q�c g S W LARD .A MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20832 greenleaf dr DATE: 12/02/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: $500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARYSFD or PENTAMATION 1 REAP1 USE: Duplex PERMIT TYPE: WORK I install temp power SCOPE r Mech.Plan Deck Phmtb.Plan Check Elec.Plan Check 0.0 1 hrs $0.00 F'vle-ch.Perini[Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT Other Afech.Insp. Other Plumb Imp. Other Elec.Insp. Loi hrs $47.00 Afech.Insp.I,ee: Plumb. Inst.Fee: Elec.Insp.Tee: NOTE:This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the preffinWdna information available and are only an estimate Contact the Dept-for addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 amps Electrical Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $47.00 IERT<200 Temporary Power PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Con 1ruction Torr: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: . $0.00 Select a Non-Residential E) Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure i Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 xy: Sm $139.50 $47.00 TOTAL FEES. $186.50 Revised: 10/01/2013