1404011610
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10438 N STELLING RD
CONTRACTOR: JOSHUA
PERMIT NO: 14040116
CONSTRUCTION & REMODELING
OWNER'S NAME: HONGQI HU
10613 GASCOIGNE DR
DATE ISSUED: 04/18/2014
OWNER'S PHONE: 4088024052
CUPERTINO, CA 95014
PHONE NO: (408) 725-3692
36 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic�. #y 5;119((J 2'
INSTALL TEMPORARY POWER POLE
Contractor �^' ' Inrate rLS
1 hereby affirm that I am lic se un a the p sions 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
hereby affirm under penalty of perjury one of the following two declarations:
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
Sq. Ft Floor Area:
Valuation: $500
rIerformance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 32630096.00
Occupancy Type:
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 F T C LED INSPE TIO .
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will com
te: !pl Y Da
with all non -point source regulations per the Cupertino Municipal Code, Sectio
9 18.
RE-_�
Signature IiP Jr� � Date
any
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:
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)
1, 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. 1 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.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date:
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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
GENERAL PERMIT APPLICATION �MEP
ITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
COMMUNITY
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
EU051111TINO (408) 777-3228 • FAX (408) 777-3333 • buildina(a CUDertino.org misc
ft IZT TZr7P 1'r A I nMTSCELLANEOUS
MEPMiscApp_201 Ldoc revised 06/21/11
PROJECT ADDRESS �® r� j
APN #
///
OWNERNAME j /`l / PHONE /o�_ (jO
a�/�Vl,/
STREET ADDRESS
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CITY, STATE(Zin
ZZ
FAX
CONTACT NAME /n !/ �j / PHONE ,lam j11
(% (J(' v1 G
E-MAIL
STREET ADDRESS
CITY, STATE,L ZIP
FAX
E3 OWNER '❑ OWNER-BUILDER OWNER AGENT CONTRACTOR 11CONTRACTOR AGENT E3ARCHITECT ElENGINEER 13 DEVELOPER 11TENANT
CONTRACTOR NAME !ter � z� �r l ICENSE NUMBER 4gD '2� / LICENSE TYPE
fv
BUS. LIC #
FAX
COMPANY NAME f7I/i%�
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/� ,/ CITY, STATE ZIP /I� i �� I ��r J
STREET ADDRESS `B y j i. v✓v" (/v"
PHONE
p
It
ARCHITECTIENGINEERNAME
LICENSE NUMBER
BUS. LIC 4
COMPANY NAME
E-MAIL.
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMII.Y
BUII DING: ❑ COMMERCIAL -
PROJECT IN WIIALAND ❑YES
TURBAN INTERFACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK a+ - �y
J
�V YGL e I iq
-
TOTAL VALUATION:W
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property e 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 accurate. I agree to comply vrith all applicable local
ordinances and state laws relating to building construction I authorize representatives of Cupertino to enter the above -identified roperty for inspection purposes.
Signature of Applicant/Aaent: Date:
SUPPLEMEN AL INFORMATION REQUIRED
NNO
�� EXPILESS a.
."`
-_
r 3'
EMA70R
MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
Em FEE ESTIMATOR - BUILDING DIVISION
APPLIANCE / EQUIP TYPE
10438 N STELLING RD
DATE: 04/18/2014
REVIEWED BY: MELISSA
ImlADDRESS:
APN: 326 30 096
BP#: 14040087
"VALUATION: $500
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
Amps
PENTAMATION
PERMIT TYPE: 1 REAP1
WORK
INSTALL TE MPORARY POWER POLE
SCOPE
,Sulvl)/� hLyil) I cc
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Temporary Power
1 ERT<200
100
Amps
$47
,Sulvl)/� hLyil) I cc
PME Unit Fee:
$47.00
PME Permit Fee:
$47.00
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? ® Yes •; No
$0.00
TOTALS:
Travel Documentation Fee: 1TRAVDOC
$47.00
Strom Motion Fee: 1BSEISMICR
�t� �i
s. a
-01M
t i r 71
r,
ec/i. T Yar k llhot;b. Man L:'hieci; Elec. Plan Check 0.0 hrs $0.00
Lit>;711. Perm,; tFee.� 1111,mh� flermil J-er:: Elec. Permit Fee: IEPERMIT
C) T,Em ;lffrc�. I«s, 0(h r Phimb Insp.Li Other Elec. Insp. 0.0 1 hrs $47.00
11ac e: Pufrtb hr.V).11-Ile f1�c'e.Ins l
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dictrirt- etc )- These fops aro hacod an tho nroliminary information availahlo and oro only an owimato_ Contart the Dont far addn'1 infn_
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Ch"cl.
Stppl. P(:' ]-,("c
PME Plan Check:
$0.00
,Sulvl)/� hLyil) I cc
PME Unit Fee:
$47.00
PME Permit Fee:
$47.00
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? ® Yes •; No
$0.00
Prtli'i771?7is !'E.'c'.S':
Travel Documentation Fee: 1TRAVDOC
$47.00
Strom Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
1 $1.00
$186.50
$0.00[]TOTAL FEE:
$186.50
Revised: 04/01/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: /O V 3 N •
PERMIT # 1q0q011-6
OWNER'S NAME:
PHONE # ' lt&g ' 25'10 O
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS: /
CITY/ZIPCODE: B/
*Our municipal code requires all businesses working iA the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BEt 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:
Owner / Contr or Signature Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Avg
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
Owner / Contr or Signature Date