The URL can be used to link to this page

14010154 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10425 JOHNSON AVE CONTRACTOR:DWK CONSTRUCTION PERMIT NO:14010154 OWNER'S NAME: CUPERTINO,CA 95014 PHONE NO:(408)996-1186 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL❑ License Class Lic.# Z40a TEMP POWER Contractor �DWk 60)15h � Date_f 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:$500 1 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:37518046.00 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 DA70 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 FR MLA T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, // nn� costs,and expenses which may accrue against said City in consequence of the Date: . 'gig granting of this permit. Additionally,the applicant understands and will comply Issued by: / with all non-point source regulations per the Cupertino Municipal Code,Section 918. l� / ROOFS: Signature � Datey�� -- any r All roofs shall be inspected prior to y 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 1,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 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 25505,25533,and 25534. j4m .� """� Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: !/ Date: permit is issued. I certify that in the p4liformance 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 orshall 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 ab information is correct.I agree to comply with all city and county ordinancid state laws relating to building construction,and hereby authorize representative 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 918. Signature Date IT APPLICATION GENERAL PERM MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \b 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408) 777-3228•FAX(408)777-3333•building(ftupertino.org MISC C(OtATINO ❑PLUMBING ❑MECHANICAL ELECTRICAL []MISCELLANEOUS PROJECT ADDRESS APN# 5 �j 44 / lllJJl�� OVTNERNAME A q �//r I FAX CONTACT NAME �. PHONE ' E-MAM STREET ADDRESS (1/ ( / �,rra/I �/ CTTY.STATE,ZIP _ . L� ( FAX �i pq4�—t ❑ OW ❑ OWNER-BUILDER 3 OOIAWMAiGATT 0 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER l❑ DEVELO(PER( ❑ TENANT CONTRACTOR NAME �,/_ LICENSE ER LICENSEE BUS.LIC# dLLQ L�(/J ? t7� COMPANY NAME ), / �� s E'MAII'_/J, STREET ADDRESS /K (�/ .'/yew � e CITY.STjATE ARCHITECT/ENGNEER NQAME ` " LICENSE NUMBER (� BUS.LIC# R? COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WIIALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL 'URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK o We'f 0 TOTAL VALUATION: �(�O` " RECEII+EDBX 4 ;xak By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pro erty owner' al£ I have read this application and the information I have provided is.correct. I have read the Description of Work and verify it is accura I agr comply with all applicable local ordinances and state laws relating to bui ding construction. I au orize representatives of Cupertino to enter the abov� �jIfi d property for inspection purposes. Signature of Applicant/Agent: Date: /� SUPP: TAL INFORMATI RE UIRED Q � OEI'TCETJSF�1�'IsY� =4 FgLL9 DIMmg HIM �h t'I � ST+A'Li�DI2I3_ MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10425 johnson ave DATE: 01/28/2014 REVIEWED BY: Sean APN: BP#: "VALUATION: $500 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: p PERMIT TYPE: i WORK tem ower SCOPE s Meeh. flan Check Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00. iLlech. Permit Fee: I Plumb.Permit Fee Elec.Permit Fee: IEPERMIT t)thc� A.h.Insp. Other Plumh Insp. Other Elec.Insp. 0.0 hrs $47.00 A�r:ch.Insp. Fee: Plumb. lisp. Feta: Elec.Insp.fee: NOTE.This estimate does not include fees due to other Departments(L e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Theseees are based on the prelindna information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = 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: Hourly Only? 0 Yes (E)No $0.00 Suppl. Insp.Fee-.0 Reg. ®OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: IADMIN $44.00 0 Work Without Permit? .0 Yes E) No $0.00 1 0 Advanced Planning Feer $0.00 L_O_j hours Inspections E) Travel Documentation Fee: 1TRAVDOC $47.00 $0.00 Inspection,Hourly ®A Strong Motion Fee: IBSEISMICR $0.50 0 # Revisions Bldg Stds Commission Fee: 1BCBSC $1.001 $0.00 1REVSFDWL SFDWL - - $186.50 $139.50 $47.00 i FEES Revised: 01/1512014