B-2016-1274C
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1274
10320 MORETTI DR CUPERTINO, CA 95014-3639 (375 15 009)
(CHEN'S
CONSTRUCTION
COMPANY)
SAN JOSE, CA 95130
OWNER'S NAME: LAI LEE JEE-JEAN TRUSTEE
DATE ISSUED: 01/28/2016
OWNER'S PHONE: 408-507-2442
PHONE NO: 408-726-2956
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #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
performance of the work for which this permit is issued.
C/z 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
375 15 009
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 WORK 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 DAYS FROM LAST C SPECTION.
Code, Section, 9.18.
Issued by: MELI - -
Signatufe 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 (Sce.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
r. 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
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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
s. 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 became 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 25505,2 , 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
I� I GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildin cu ertino.or MIS -C
1 ( Z� I
❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS O 7AA
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APN # 3+5 I Cr 00
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
VONTRACTOR ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTO NAME
LICENSE Wj or?
LICETO TYPE
BUS. LIC #
COMPAN NAMFI
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FAX
STREET ADORE
CITY, STATE, ZIP ��� r f4 S
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PHONE ^ ��
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD.,DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
V
`rr
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's have 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 ply with all applicable local
ordinances and state laws relating to buil ng constructio_n_.OI authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Q per, o`JV�: Date: 'r2:24 { 6
T
SUPPLEMENTAL INFORMATION REQUIRED OFMCF, rlsF ON
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
NO � M:7 FF.F. ESTIMATOR — BUILDING DIVISION
I&ADDRESS: 10320 MORETTI DR
FEE ID
DATE: 01/28/2016
REVIEWED BY: MELISSA
N APN: 375 15 009
BP#:
*VALUATION: F$475
*PERMIT TYPE: Electrical Permit
1 ERT<200
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
7PERMIT
PENTAMATION
TYPE: 1REAP14
WORK
INSTALL TEMPORARY POWER
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
'A
Temporary Power
1 ERT<200
100
Amps
$48
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. Contact the Deptjor addn'l info
FEE ITEMS (Fee. Resolution .1.1-053 Lff L/1/13)
FEE
QTY/FEE
MISC ITEMS
'A
PME Plan Check:
$0.00
1,�,rnlil
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
TaV:
F
Administrative Fee: JADMIN
$45.00
Work Without Permit? 0 Yes (E) No
$0.00
Aldv�mce, !.P1aT;7df?? 1"ees"
'A
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bld,—, Stds Commission Fee: IBCBSC
$1.001
SUBTOTALS$190.501
$0.00 TOTAL FEE
$190.50
Revised: 01/01/2016