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15090020CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1102 MILKY WAY CONTRACTOR: CALWEST PERMIT NO: 15090020 CONSTRUCTION OWNER'S NAME: PARKVIEW EDGE PROPERTIES LLC 5 FAIRCHILD DR DATE ISSUED: 09/02/2015 OWNER'S PHONE: 3106403070 MOUNTAIN VIEW, CA 94043 PHONE NO: (510) 332-7699 ®- LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ INSTALL 14' OF (N) GAS LINE TO (1) GAS KITCHEN License Class C, 36 Lic. # S t STOVE Contractor ���l�CCi �6y\S�ACr7Date 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 Sq. Ft Floor Area: Valuation: $500 performance of the work for which this permit is issued. 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: 36220006.00 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 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 FROM LAST CALLED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 1�L'� t �] granting of this permit. Additionally, the applicant understands and will comply i'4�It- ' Issued by: Date: v- ' with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. <! Signature S4WQ 6 1'V Date 2 �S^ 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 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. 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, Sectio25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner `- O 61Date: 2/l permit is issued. or authorized agent: 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 he 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 CUPERTINO GENERAL PERMIT APPLICATION 145MOD90 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(Dcupertino.oro KPLU'=NG ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS /rQr PROJECT ,ADDRESS I 4-°N 360 OWNER NAME F II'��. t % (F- r V l "�-' r L-�•� ! PHONE �l ©� W 3 I a.' �I E-MAIL STREET?.DDRES"�/�`�-1� .�-,y��' Q,� �, i C S np— FAX CON"IACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ O1A1,ML ❑ ORR.'ER-BU E:R ❑ OWNERAGrhT ❑ CONTRACTOR ❑ CO?.'TRACTORAGEA'T ❑ ARCHITECT ❑ LNGWEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N.kbE �S LICENSE NUMBER � � � \ LICENSE TITS BUS. LIC COMPANY NAME PP 0 W `N\ E-MAIL FAX STREETADD F ��" c �• CITY,STATE Z v fi CA V C w C. PHOAE ARCHITECT/ENGIN'EER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF 9 SFD . DUPLEX ❑ MULTI-FAWLY I PROJECT IN wa.DLAND ❑ YES PROJECT IN ❑ YES B=N10: ❑COMMERCIAL URBANWTERFACEAREA ❑ NO FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLERHOME? ❑ NO DESCRIPTION OF WORK S v� h �o�t . ST'ov I FCcT. TOTAL VALUATION: � O � �RiC' _'.'� : � •� � �;����.�--�"�"-^� By my signature below, certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct I have read the Desctiption of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu Q construction. I authorize representatives of Cupertino to enter the aboriden 'fled property for inspection purposes. Si mature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED 7_ �, ,.�L ONLV U C1�ti II�L-CULR"ILi2 MEPMisa4pp_2011.doc remised 06121/11 —� CITY OF CUPERTINO 15tqCVX 1 I FEE ESTIMATOR — BUILDING DIVISION �r ADDRESS: 1102 Milky Way DATE: 09102/2015 REVIEWED BY: PAUL UNITS APN: 362 20 006 BP#: "VALUATION: $500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: I $72 PENTAMATION 1 RPGAS I PERMIT TYPE: WORK Install 14' of N Gas Line to N Gas Kitchen Stove SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check Fo.0 hrs $0.00 QTY UNITS BP FEES Fee C Piping, Gas <=4 Outlets 1PGASRES Other Elec. Inst' E37- 1 # $72 Permit F'ee: Suppl. Insp Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Q Yes (j) No $0.00 TOTALS: Travel Documentation Fee: ITRAvoOC $72.00 Strong Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E,fj`' 7/1!13) lfech. Plan Check Plumb. Plan Check Fo.0 hrs $0.00 Blec..Plan Check Ah,ch Pori. Plumb. Permit Fee: IPPERMIT Fee C )1/101. Alech. hl,v F-1 Other Plumb Insp. 0.0 hrs $48.00 Other Elec. Inst' E37- tIechhu/,. Fee Tlaanab. hasp. Fee lilec. Insp. !•ire: NOTE: This estimate does not include fees due to other Departments (La Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E,fj`' 7/1!13) FEE QTY/FEE T MISC ITEMS "lan Check Fee: A �uppl. P(' Fee 77 PME Plan Check: $0.00 Permit F'ee: Suppl. Insp Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? Q Yes (j) No $0.00 ldvanced Planning Fees: Travel Documentation Fee: ITRAvoOC $48.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 11 $214.50 $0.00 TOTAL FEE: $214.50 Revised: 07/02/2015