The URL can be used to link to this page

14030174 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7373 FALLENLEAF LN CONTRACTOR:FALLEN LEAF SS LLC PERMIT NO: 14030174 OWNER'S NAME: FALLEN LEAF SS LLC 66 E SANTA CLARA ST DATE ISSUED:03/31/2014 OWNER'S PHONE: 4083093519 SAN JOSE,CA 95113 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] APT#28-INSTALL(N)20 AMP CIRCUIT FOR License Class Lic.# MICROWAVE/HOOD.ADD 1(N)CAN LIGHT IN KITCHEN. UPDATE ALL OUTLET RECEPTACLES FOR Contractor Date GFCl/GROUNDING 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:$800 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:35927025 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 18 AYS 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 DA:M LAST CALLED INSP TION. 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date. with all non-point source regulations per the Cupertino Municipal Code,Section 7111 9 18. RE-ROOFS: Signature Date 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 Signature of Applicant: Date: here affirm that I am exempt from the Contractor's License Law for one of he foll wing 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) I, own of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE c s c 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 affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the eclar tions: Health&Safety Code,Section 25532(a)should I store or handle hazardous I hav d 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 t CupertiV25 ,nicid I Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti s 25 5, 5534. Section 3700 of the Labor Code,for the performance of the work for which thisDater Owner or authorized agen . permit is issued. V IV . � Nrti that in the performance of the work for which this permit is issued,I shall any person in any manner so as to become subject to the Worker's o nsation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY beco a 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. grantingof thispermit.Additionally,the applicant understands and will comply with all non-po source regu tion er the Cupertino Municipal Code,Section Licensed Professional 9 18. Signatur Date_SS .� GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 � misc CUPERTINO (408)777-3228•FAX(408)777-3333•building(a-)cupertino.org \O ❑PLUMBING ❑MECHANICAL LECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS (C4 APN# OWNER NAME I PHONE E-MAIL STREET ADDRESS/ / CITY ATEnP FAX (0 y CONTACT NAMPHONE r ^ E-MAIL 3 STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER WNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAME.Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUII.DING: ❑COMMERCIAL TURBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK YeQ TOTAL VALUATION: By my signature below,I 'certify to eac the following: I am the property owner or authorized agent to act on the prope wner's behalf. I have read this application and the information I=r ided is rrect. I ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to i ng con ction. authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Date: S PLEMENTAL TRMATION REQUIRED T MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO � FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7373 fallenleaf In unit#28 DATE: 11/13/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: $800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 REAP1 i WORK APT#28-INSTALL N 20 AMP CIRCUIT FOR MICROWAVE/HOOD.ADD 1 N CAN LIGHT IN SCOPE KITCHEN. UPDATE ALL OUTLET RECEPTACLES FOR GFCI/GROUNDING IN SERIES OMNI �I Mech.Plan Check Phrrnh.Plan Check Elec.Plan Check 0.0 1 hrs $0.00 ;"tech. Permit Fee: Plumfi. Permit Fee: Elec.Permit Fee: IEPERMIT Other-Meeh.Insp. Qtlrer Plumb Imp. Li Other Elec.Insp. 0.0 hrs $47.00 _Lech.Irasp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prefimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Electrical Suppl.PC Fee: 0 Reg. .0 OT 0.0 hrs $0.00 $47.00 1BREMRECEP I Recep/Switch/Outlets PME Plan Check: $0.00 1 Electrical Permit Fee: $0.00 $70.00 IBREMFIXT Fixtures,Lighting Suppl. Insp.Fee:Q Reg. :0 OT 0 0 hrs $0.00 PME Unit Fee: $0.0.0 PME Permit Fee: $47.00 Construction:Tele-: Administrative Fee: IADMIN $44.00 0 Work Without Permit? 0 Yes (E) No $0.00 E) Advanced Planning Fee. $0,00 Select a Non-Residential G Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item BldgStds Commission Fee: IBCBSC $1.00 .. o $139.501 $117.00 :.; 'X $256.50 - Revised: 10/01/2013 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 OUPEFtTINf3 (408)777-3228•FAX(408)777-3333•buildina cr.cugertino.ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS QWJ APN 3�4' BP# OWNER,M14 OWNER DDRES5, `( LLC n DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Buil er'building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. I understand building permits are not required to be signed by property owners unless they are responsible for e onstruction and are not hiring a licensed Contractor to assume this responsibility. I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may pr tect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her me inof my own. /; understand Contractors are required by law to be licensed and bonded in California and to list their license nbers on permits and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the lue of my construction is at least five hundred dollars($500), including labor and materials, I may be ered an "employer"under state and federal law. #edrail I understand if I am considered an "employer" under state and federal law, I must register with the state and government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to loyment compensation for each "employee." I also understand my failure to abide by these laws may subject Vyrr�edsen(t'ial srious financial risk. . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family structures cannot legally build them with the intent to offer them for sale, unless all work is performed by esubcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for 6eancts anfincial or personal injuries sustained by any subsequent owner(s)that result from any latent construction in the workmanship or materials. OwnerBuilde7Fonn 2010.doc revised 04114/10 AI understand 1 may obtain more information regarding my obligations as an°employer"from the internal Re enue Service.the United States Small Business Administration,the California Department of Benefit Payments, a the California Dndslon of Industrial Accidents.I also understand i may contact the California Contractors'State License Beard(CSLB)at 1-800-321-CSLB(2752)or www eslb.ca_gov for more information about licensed ors_ I am aware of and bonsent to an Owner-Builder building permit applied for in my name,and understand that I party legally and financially responsible for proposed construction ad'h*at the site address listed above. agree that,as the party legally and financially responsible for this proposed construction activity, I will abide Y I applicable laws and requirements that govern Owner-Builders as well as employers. agree to nol fy the issuer of this form immediately of any additions,deletions,or changes to any of the. n a0oil.1 have provided on this1brm.Licensed contractors are regulated by laws designed to protect the public If yo contract with someone who ddes not have a license,the Contractors'State License Board May be unable to assist you with-any fmaric"raf loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court.It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages.if you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not those Contractors are property licensed and the status of their workers'compensation insurance coverage- CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the hollowing construction lending agency information) 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be Issued,this form roust be completed and signed by the property owner and returned to the agency responsible for Issuing the permit. Note:A copy of the property owner's driver's license, form notarization,or other velcation acceptable to the city may be required to be presented when the permit is issued to yerffy the PTprowner`s si ature. Property Owner's Signature: Date: --------------------------------------------------------------------- ------------------------------------------------------------------ (NOTE: The following Authorization Form is required to be completed by the property owneronly when designating an agent of the property owner to apply fora construction permit forthe Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility,I hereby_ authorize the following person(s)to act as my agent(s)to apply for,sign,and file a documents necessary to obtain an Owner-Builder Permit for my project. , Scope of Construction Project(or Description of Work): "t Project Location or Address: Name of Authorized Agent:Is,v T'� .rE+P Tel No Address of Authorized Agent: —f�� y� C�• I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled,out the, above information and certify its accuracy.Note:A copy of the property owners dnvei's license,fora notarization, or other venrication acceptable to time city rna be required to be presented when the permit is issued to verify the property owner's signature. Property Owners Signature: Date: Own&BuildvFoim ?010 doc reused 04114110 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-325.5 `Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR°LIST JOB ADDRESS: PERMIT# OWNER'S NAME- 5 PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE##: ADDRESS: tic, CIMQ afCITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino•business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A-CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork ,Pement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile V, Owner/Co trac ture Date