15100042 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10405 MORETTI DR CONTRACTOR:WINGON PERMIT NO: 15100042
CONSTRUCTION CO
OWNER'S NAME: GOLDSILVERISLAND PRORTIES LLC P O BOX 31983 DATE ISSUED: 10/06/2015
OWNER'S PHONE: 4088963369 OAKLAND,CA 94604 PHONE NO:(510)228-6665
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL [ICOMMERCIAL El
INSTALL TEMPORARY POWER
License Class Lic.# I cpq 20
Contractor ate u O
1 hereby affirm ti�A 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.
Sq.Ft Floor Area: Valuation:$1200
1 hereby affirm under penalty of perjury one of the following two declarations:
t. I have and will maintain a certificate of consent to self-insure for Worker's APN Number:37514015.00 Occupancy Type:
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. 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 PERMIT EXPIRES IF WORK IS NOT STARTED
permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION 180 DAYS FROM ED INSPECTION.
I certify that I have read this application and state that the above information is
correct.1 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 VssieDate
d )6 : (J
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
granting of this permit. Additionally,the applicant understands and will comply with RE-ROOFS:
all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 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
Signature Date (v ,n/� inspection.
Signature of Applicant: Date:
❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t I,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE
compensation,will do the work,and the structure is not intended or offered for 1 have read the hazardous materials requirements under Chapter 6.95 of the
sale(See.7044,Business&Professions Code) California health&Safety Code,Sections 25505,25533,and 25534. I will maintain
z. 1,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
1 hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District 1"ill
t. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation,as provided for by Section 3700 of the Labor Code,for the health&Safety Code,Sections 25505,25533,and 2.5534.
performance of the work for which this permit is issued. /Q 6
Own e o authorized agen /fG�
z. I have and will maintain Worker's Compensation Insurance,as provided for by Date: G �� c•
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. CONSTRUCTION LENDING AGENCY
a. I certify that in the performance of the work for which this permit is issued,l shall
not employ any person in any manner so as to become subject to the Worker's 1 hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If,after making this certificate of exemption,1 for which this permit is issued(Sec.3097,Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code,1 Lender's Name
must forthwith comply with such provisions or this permit shall be deemed Lender's Address
revoked.
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION I understand my plans shall be used as public records.
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 Licensed Professional
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,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply with
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
Cionahirr Date
GENERAL PERMIT APPLICATIONMEt
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE- CUPERTINO, CA 950143255
(408)777-3228- FAX(408)777-3333- buildin0(a)Cuoertino.ora / /L
CUPERTINO 6 S? T Z
❑PLU\SSG ❑1'ECF_k"ICAL LECTPJCA.L ❑) ISCELLAN-EOUS
PROJECT ADDRESS
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STREETADDRESS CITY, ATE,ZIP PKONE
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ARCHIT MENGAMER KAME LICENSE NUMEFR BUS.LIC
COWANY NAVE E-MAIL
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STREET ADDRESS CITY,STATE,ZIP FOI�i
USE OF ❑S,D o,DUPLEX ❑ MULTI-FA-I.My PROJECT LN WILDLit,'D 137 tS PROTECT LN [3 IS YFS IS TBLDG AN ❑ 1 S
BLYMDD40: ❑CONASERCLAL I URBAN INTERFACE AREA (3 NO FLOOD ZONE ❑ NO EICHLER HCME7 ❑ NO
DESCRIPTION'OF WORK
TOTAL VALUATION:
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By my signature belo ,I certify to each of the following: I am the property owner or authorized agent propertyowner's behalf. I hive 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 with all applicable loc.--I
ordinances and state laws relating to b ilding construction. I authorize representatives of Cupertino to enter the above-id- e/': property for' pection purposes.
Signature of Applicant/Agent: Date: 6
S PLEMENTAL I FORMATION REQUIRED
Li
AIEPAIisCXPR_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
W�PERMIT
DDRESS: 10405 MORETTI DR DATE: 10/06/2015 REVIEWED BY: MELISSA
PN: 375 14 015 BP#: 'VALUATION: $1,200
PE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE. 1REAP1 A
WORK INSTALL TEMPORARY POWER
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Temporary Power 1ERT<200 100 Amps $48
TOTALS: $48.00
Pl nrl, Pl:nr C/"', Elec. Plan Check 0.0 1 hrs $0.00
,mil 1Elec.PermitFee: IEPERMIT
Ph�mh tier, Li
Other Elea Insp. 0.0 hrs $48.00
NOTE. This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS(Fee Resolution /1-053 a.' 7 1 13) FEE QTY/FEE MISC ITEMS
/hire ( iicc k Vc c:
PME Plan Check: $0.00
Permit Fe".
j' ? /,,.
PME Unit Fee: $48.00
PME Permit Fee: $48.00
onstruction Tux:
Administrative Fee: /ADMIN $45.00
Work Without Permit? O Yes 0 No $0.00
Travel Documentation Fee: ITRA VDOC $48.00 A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $190.50 $0.00 TOTAL FEE: $190.50
Revised: 07/02/2015