14020144CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10312 E ESTATES DR
CONTRACTOR: HBDT CONSTRUCTION,
PERMIT NO: 14020144
INC.
OWNER'S NAME: CHOU CHIEN-SHENG AND YEH SHU-CHEN
500 LAURELWOOD RD STE 2
DATE ISSUED: 02/24/2014
OWNER'S PHONE: 4155055329
SANTA CLARA, CA 95054
PHONE NO: (408) 803-8863
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
License Class_ Lie. # 23
INSTALL TEMPORARY POWER
01
Contractor d&ckuate 2
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: $1000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36907021 00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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
WITfIIN 180 DAYS OF IT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 D ECTION.
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
Issued by: Z Z
granting of this permit. Additionally, the applicant understands and will comply
with all non-point sourc egulations per the Cupertino Municipal Code, Section
9 18.
RE-ROOFS:
Signature Date Z
All roofs shall be inspected prior to any roofing material being installed. If a roof is
for
installed without first obtaining an inspection, I agree to remove all new materials
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 Cup mo Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Secti s 2 05, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dater
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
f�SY.fsJs..
L •
GENERAL PERMIT APPLICATION � /p MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION V
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O
ISC
(408) 777-3228 • FAX (408) 777-3333 • building Dcuper ino.org \� M
❑ ❑MECHANICAL
ELECTRICAL ❑MISCELLANEOUS
PLUMBING
PROJECT ADDRESS
n
APN q �O
ZZ
O 3 �se �Y
OW NTER NAME PHONFy/ S J v J Zr Fr&La O -t 2 Wnj.,
16r Lr d—j6j'o 44
STREET ADDRESSD3 Z
` CITY, STATE, ZIP.6,',r n I FAX
/� E-MAIL
CONTACT NAME ' p
O
Y' C-+
STREET ADDRESSCITY,
STATE, ZIP
IS C
FAX
1i-xq-1
❑ OWNER ❑ OA1?,7ER-BUILDER ❑ OWNER AGENT eCOTTIRACTOR ❑CONTRACTORAGENT ❑ ARCHrMCr ❑ ENGNEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME ,jj^ LICENSENUMBE) (p7� /�
�// /`�
LICENSE TYPE
BUS. LIC#
COMP NAME L
E
C,
FAX
O n
STREET ADDRESS J
u
_v—
CITY, STA ZIP �� y C
��03 ^r JQ 6 j7
v
ARCHTTECT/ENGINEERNAME
LICENSE NUMBER.
BUS. LIC 9
COMPANY NAME
B -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: 13 COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK <--
ale
Aen,
Elm -
TOTAL VALUATION: O s � � _, OR
- - .,,_., ..
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prope owner' £ I have read this
application and the information I have provided I*s correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
'fled
ordinances and state laws relating tobuil in nstruction. I authoriz atives of Cupertino to enter the above-ide prope , for inspection purposes.
Signature of Applicant/Agent: Date: 0
SUPPLE TALINTFORMATI REQUIRED–GFFICEus overs
� m.
` 1=010
MEP111isa4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
V I 1V1V 1 CT7M A'Tl1R _ RTTTT .'n1NC D1V1g10N
LAADDRESS:
10312 E ESTATE DR
DATE: 02/24/2014
REVIEWED BY: MELISSA
UNITS
APN: 369 07 021
BP#:
*VALUATION: 1$1,000
'PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY lex
SFD or Duplex p
Amps
PENTAMATION 1 REAP14
PERMIT TYPE:
WORK
INSTALL TEMPORARY POWER
SCOPE
PME Unit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
QTYIFEE
QTY
UNITS
BP FEES
Temporary Power
1ERT<200
100
Amps
$47
PME Unit Fee:
$47.00
PME Permit Fee:
$47.00
(.on,%owction Tax:
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$47.00
.
;t "JI. F'L.. rt C.'d'te:c'kc
L1r�rl1. Pertuii 1�'t>e:
{?rli -r Mc<h. krt
I'kc h, fast . Pce
11halrb. Plan Crack
Plumb. Permit Fee:
Other Plumb Insp.
1'lunib. Insp. Fee:
Elec. Plan Check 1 0.0 1 hrs $0.001
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 hrs $47.00
t>iec. Imp, Pce:
NOTE: This estimate does not include fees due to other Departments (/.e manning, ruouc rrurns, -rzre, vure "'y — yLJL,.I.,
..d -- n..h, nn octirnate_ rnntact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13)
FEE
QTYIFEE
MISC ITEMS
f'iLlrt ('deck Fe c:
PME Plan Check:
$0.00
PME Unit Fee:
$47.00
PME Permit Fee:
$47.00
(.on,%owction Tax:
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
ffd!'(,QFC.'E.'C/ %'it7f73777i Fees:
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bidp, Stds Commission Fee: IBCBSC
$1.00
�m
tea,
$186.50
$0.00 TOTAL FEE:
$186.50
Revised: 01/15/2014