14080066 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10660 CULBERTSON DR CONTRACTOR:DWK CONSTRUCTION PERMIT NO: 14080066
OWNER'S NAME: WEI-XIONG LIAO&WEI HONG SIAO 18665 LOREE AVE DATE ISSUED:08/11/2014
OWNER'S PHONE: 4089306892 CUPERTINO,CA 95014 PHONE NO:(408)996-1186
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
INSTALL TEMPORARY POWER
License Class i>, Lic.#
Contractor Date <V1
1 ltq-
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:$300
AI 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:37534027 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 DAY , SUANCE 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 DAY L l INSPECTION.
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 comply Date:
ued by
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
r C� 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:
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(See.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. �i/4—
`/
Section 3700 of the Labor Code,for the performance of the work for which this d9 wt
Owner or authorized agent: Date:
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(See.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
Y - GENERAL PERMIT APPLICATION �UMEP
4 COtJNUNITY DEVELOPIJENT DEPARTIJiENT• BUILDING DIVISION
10300 TORRE AVENUE- CUPERTiNO, CA 95014-3255 v
(408) t?�-3228•1=AX(403)i t�-3333�buildinge-cuDe 6no.ora \�
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USE OF ❑-srD or D-JP= ❑ MaTI•FAMII Y I PROJEC7 Dq WILDLA>`'D ❑ 1 FS I PROTECT INT ❑YPS IS=BLDG AN ❑YES
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TOTALV%erUATION:
$V I7}'S1�Ti=i�re belOW,I Cef'1:�'t0 B3C1'i Of t�'ie(0110\i�.Ilc: I am u,e propel ty o-v,°neI or authorized agent to act on t e grope.t' , r s behall. I have read this
applimion and the Ymr_ration I have prod is correct, I have read the Description of-Work-and venfy it is acc':.-ate. I a -ee to comply With all applicable local
OrClilaTl0e5 and S'3te lEli'S rel Ztli,E tO 17L c 00 .ffition. I authorize representatives Of Cllgei tin0 to enter the ctJOV�':�i12�e�piD��for LSpection pu-i pOSes.
SiiatureofApahcmtl.cent: Date:
SUFPLEI75NTAL LNFORMATION RE UEF—ED " tz
Q
1✓F�':!sct�?� 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
�JMADDRESS: 10660 CULBERTSON DR DATE: 08/11/2014 REVIEWED BY: MELISSA
APN: 375 34 027 BP#: -VALUATION: $300
xPERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP14
USE: p PERMIT TYPE:
WORK INSTALL TEMPORARY POWER
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Temporary Power 1ERT<200 100 Amps $48
TOTALS: $48.00
C'tartrh. I,l.rr£: tcet'n Elec.Plan Check 0.0 1 hrs $0.00
11t>a:7. T'errrril Fee: 1'fu»a;5. I'trrr?it Fee, Elec.Permit Fee: ]EPERMIT
�,:�,<°Y. lrrsf��- other T'/re e?r Inv), L] Other Elea 0.0 Insp. hrs $48.00
i. fa v)- 1 >.: f'n;rrtb, 1 up. Fee: jnsr,
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 prelimina information available and are onl an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef.. 711113) FEE QTY/FEE MISC ITEMS
PC A
PME Plan Check: $0.00
sul"y"d, 1775 z x"ec
PME Unit Fee: $48.00
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00
Work Without Permit? ® Yes 0 No $0.00
Travel Documentation Fee: ITRA VDOC $48.00
Stronp,Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldp,Stds Commission Fee: IBCBSC $1.00
$190.50 $0.00 fiOTALhEE: $190.50
Revised: 07/10/2014
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: V66:�, Ck�beek-anr 7�r, PERMIT#
OWNER'S NAME: � —�(� PHONE# 4193o S—
GENERAL CONTRACTOR: BUSINESS LICENSE
ADDRESS: CITY/ZIPCODE: e— - T1
*Our municipal code requires all businesses w4king 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:
Signatua Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement 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
Owner/Contractor Signature Date