Loading...
B-2016-1275CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1275 10721 SANTA LUCIA RD CUPERTINO, CA 95014 (342 17 045) (CHEN'S CONSTRUCTION COMPANY) SAN JOSE, CA 95130 OWNER'S NAME: RUIPING WANG DATE ISSUED: 01/28/2016 OWNER'S PHONE: 408-564-1921 PHONE NO: 408-726-2956 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lie. #963071 Contractor (CHEN'S CONSTRUCTION COMPANY) Date 01/28/2016 X BLDG X ELECT —PLUMB — MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: INSTALL TEMPORARY POWER I hereby affirm under penalty of perjury one of the following two declarations: 1. 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 ,,o performance of the work for which this permit is issued. l2*" I 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 Sq. Ft Floor Area: Valuation: $475.00 this permit is issued. APPLICANT CERTIFICATION - 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 342 17 045 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 PERMIT EXPIRES IF WORD IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal 180'D O ALLED INSPECTION. Code, Section 9.18. – / Issued by: MELISS Signature`( /^ Date 01/28/2016 Date: 01/28/2016 OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 01/28/2016 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 25505, 25533, and 25534. exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall Owner or authorized agent: be deemed revoked. Date: 01/28/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city. Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 01/28/2016 CUPERTINO GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinoCa)cupertino.org misc U PLUMBING U MECHANICAL U ELECTRICAL U MISCELLANEOUS PROJECT ADDRESS w ` APN # Z 1 ? Q Ct OWNERNAME ` �/ I/ * � /04 PH(q _ 2 �- E-MAIL STREET ADDRESS ' CITY TATE, ZIZ_ o I '? CA q r� FAX CONTACT NAM 1 'f'(y V�tJU STREET ADDWSILII CITY, STATE, ZIP STA F, ZIP e �� `� FAX ❑ MULTI -FAMILY PROJECT IN WB.DLAND ❑ YES URBAN INTERFACE AREA ❑ NO ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE �MBER © LICEN YPE BUS. LIC # 3 r COMPANY ME j E -MAI FAX MEPMiscApp_2011.doc revised 06121111 STREET ADD 41"r ^ p Li/ CIT TE, C S^ 9 `QBE I JLIC ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. # COMPANY NAME E-MAIL, FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD.r DUPLEX BUILDING: ❑ COMMERCIAL ❑ MULTI -FAMILY PROJECT IN WB.DLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK T.DAn. in QQ/�,},�y /1�'�A4,4 _ _A,1 I7JLiD1� j I l/� YU':UA 4 MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10721 SANTA LUCIA RD FEE ID DATE: 01/28/2016 REVIEWED BY: MELISSA APN: 342 17 045 1 BP#: *VALUATION: $475 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps $48 PENTAMATION 1REAP14 PERMIT TYPE: WORK INSTALL TEMPORARY POWER pp SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Temporary Power I ERT<200 100 Amps $48 " 1; - pp PME Unit Fee: $48.00 PME Permit,Fee: $48.00 on 7�n': Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes G) No $0.00 TOTALS: '"1 $48.001, Strong Motion Fee: IBSEISMICR NOTE.- This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Mctrirt otr ) Thava faac aro haeod nn tho nrolimi"an; infnrinatinn availahlp and are nn1v an Pwiniate. Contact the Dent for aildnl info. FEE ITEMS (Fee Resolution .1.1-053.ff 7L'1113 FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 " 1; - pp PME Unit Fee: $48.00 PME Permit,Fee: $48.00 on 7�n': Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes G) No $0.00 A, Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.001 „SUBTOTALS$19050 .1 $0.00 TOTAL. $190.50 Revised: 01/01/2016