15120122CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 830 STENDHAL LN
CONTRACTOR: DAN FULGA DBA PERMIT NO: 15120122
-
AXISCON LLC
OWNER'S NAME: LIOU DEREK AND CATHERINE AMY
P 0 BOX 471 DATE ISSUED: 12/14/2015
OWNER'S PHONE: 4085977546
REDWOOD ESTATES, CA 95044 PHONE NO: (408) 507-2733
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
INSTALL TEMPORARY POWER (100 AMP)
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License Class 1� Lie. 4 93 �3 '7
Contractor L;R n %y/9k Date
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
erformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2500
II 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: 37541020.00
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 INSPE TI N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
�Uk*� I
Issued by:TAJW Date:
granting of this permit. Additionally, the applicant understands and will comply
with all point a regulations per the Cupertino Municipal Code, Section
9.18. i
RE -ROOFS:
Signature Date #2-/y -/r
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 (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_upertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sect' s 5, 25533, and 25534.
Section 3700 of the Labor Code, for theerformance of the work for which this
p
Owner or authorized agent: Date:
permit is issued.
1 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 (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.
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
M
WA
CUPERTINO
GENERAL PERIMI i APPLICATION 15
COMMUNITY DEVELOPMiENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (=:08) 777-3333 • buildinO(0)CUDer' ing.org
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USE OF 9SFD, or DUPLEX ❑ IJ:ULTI-FA.I,0.Y . PRO�=CT IN WILDLF? D ❑ YFS PROTECT LN
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By my signature below, I certify to each of the following: lam the property owner or authorized anent to act on the
prop- owner's behalf. I have read this
application and `Lhe information I have P&edisnett. I have read the Description of'Work and verify it is accurate. I agree to complywith all applicable Iocal
crdioances and s ate laws relating to b ctioa. I authorize representatives of Cupertino to enter the above
-identified property for inspection purposes.
Signature of Applicpt/Agent: Date: l2 — /Y — 15
S PLEAT ICTAL LNFORv_rATION REQUIRED
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A,I'EP1lflsc,4,vp_2011.doc revised 06121/11
CITY OF CUPERTINO 1' j laolaa
W%,-7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS. 830 Stendhal Lane
1 9
FEE ID
DATE: 12114/2015 '
7
REVIEWED BY: PAUL
.Plan ("heek 17ee,,
1 APN: 375 41 020
BP#:
*VALUATION: 1$2,500
*PERMIT TYPE: Minor Building Permit
I ERT<200
PLAN CHECK TYPE: Temporary Power
PRI.4,L-Iff
SFD or Duplex
PENTAMATION
IREAP14
PERMIT TYPE:
WORK
INSTALL TEMPORARY POWER
(100 AMP)
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
AMPS
VOLTS
.Plan ("heek 17ee,,
BP FEES
SulyiL PC. : ce
Temporary Power
I ERT<200
100
<--600
$48
PNM Unit Fee:
$48.00
PME Permit Fee:
$48.00
("Onstruction Krv:
flee:
Work Without Permit? 0 Yes) No
$0.00
Adv(.mcel 111anning.1','yees:
Travel Documentation Fee: I TRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.001
SUBTOTAILS
$145.501
$0.00 TOTAL PEE:,
111fuli"I'. i'1(01 Check. 11o,
': CO: Elec. Permit Fee: ]EPERMIT
-L )Yh $48.00
'her
er.,Weeh..bisp� 011 Ot
lavJ. Fee:
VOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. (-'ontact the Dept jor aaan -i info
FEE ITEMS (Fee Resolution 11-053 Eff. 711113
FEE
QTY/FEE
MISC ITEMS
.Plan ("heek 17ee,,
SulyiL PC. : ce
.Perwif T'ee:
PNM Unit Fee:
$48.00
PME Permit Fee:
$48.00
("Onstruction Krv:
flee:
Work Without Permit? 0 Yes) No
$0.00
Adv(.mcel 111anning.1','yees:
Travel Documentation Fee: I TRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.001
SUBTOTAILS
$145.501
$0.00 TOTAL PEE:,
$145.501
Revised: 10/01/2015