Loading...
10020060 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21023 CHRISTENSEN DR CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10020060 DATE ISSUED:02/10/2010 OWNER'S NAME: RUBINDER R BAL PHONE NO: ER'S PHONE: 4083985566 ' ❑ LICENSED CONTRACTOR'S DECLARATION B UILDING PERMIT INFO: BLDG ELECT PLUMB License Class ( ' 10 Lic.# 15a© MECH r— RESIDENTIAL r COMMERCIAL Contractor A-�'/n�� rj&() Date JOB DESCRIPTION: SERVICE REPLACEMENT 100AMP;ASHA ELECTRIC PD I hereby affirm that I am licensed under the provisions of Chapter 9 FOR (commencing with Section 7000)of Division 3 of the Business&Professions B 3L 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Valuation:$1000 Section 3700 of the Labor Code,for the performance of the work for which this q.Ft Floor Area: permit is issued. APPLICANT CERTIFICATION ,►PN Number:32654001.00 Occupancy Type: 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 PERMIT EXPIRES IF WORD IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by:'!i Date: Signature I l /tel 1/ylt/ Date OWNER-BUILDER DECLARATION RE-ROOFS: mat I hereby affirm that I am exempt from the Contractor's License Law for one of installed without firsroofs shall be tobtain ng an iected prior to nspection,t on,roofing gree to remove all nial being lew materialsof ifor the following two reasons: p I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the intain Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will ma performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(x)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will which this permit is issue I certify that in the performance of the work for d,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I O�n- ,^r a ho &id age become subject to the Worker's Compensation provisions of the Labor Code,I must /`rY'�X Date: forthwith comply with such provisions or this permit shall be deemed revoked. — — CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I herebyaffirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to saveer upon the above mentioned property for inspection purposes.(We)agreeLender's Address i- ' -qnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION gi a.,ting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature f� Date �J Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 326E4001. 00 DATE ISSUED. . . . . . . : 02/10/2010 RECEIPT #. . . . . . . . . BSO00009731 REFERENCE ID # . . . : 100::0060 SITE ADDRESS 21023 CHRISTENSEN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RUBCNDER R BAL ADDRESS 21023 CHRISTENSEN DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1652 RECEIVED FROM RUBINDER REKHI BAL CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- - 1BCBSC VALUATION 1, 000 .00 1 . 00 0 .00 1. 00 0 . 00 1BSEISMICR VALUATION 1, 000 .00 0 .50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 .00 114 . 00 0 . 00 114 . 00 0 .00 1EPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42_00 ------0_00 ----- TOTAL PERMIT 241. 50 0 . 00 241 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 241.50 VISA --------------- TOTAL RECEIPT 241 . 50 k Y CITY OF CUPERTINO CUPEk iNO GENERAL BUILDING PERMIT APPLICATION FORM Date: 'G �0 Building Address: Diq SID 1 ST&IVS&- Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No 14, HOA: Exterior work onl Yes No ❑ If es, rovide letter from HOA Phone#: Owner's Name: / Phone: �- Contractor: �L�7�r Contractor License#: gGfrj' �0 Cu ertino Business License#: Phone: Contact: Fax: Residential) Commercial Job Description: 'me-✓v i - 100Pc� Building Permit Info: Bld ❑ Elect EJ--- Plumb ❑ Mech ❑ Type:ofCon§truction(Usage Class): Occupancy Type: 1-A, ❑ II/III/V-A ❑ II/III B, IV-HT,V-B [�--- Valuation: Square Footage: Project Size: Express tan Sdard ❑ Large E] Major ❑ Green Building: Please complete relevant portior. of the Green Ban self&the sheetindext&attach it to the application or if applicable, include in p Points Achieved: i For help,contact Build it Green at www.buildit2reen.org Revised 07/14/09 CITY OF C UPERTINO Cin OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sfl B additional stucco application W. IEPER:MITFEE Replacement windows/sliding glass B door (ea 8 windows) ./ STR New Window-structural shear B wall/masonry(includes lan ck fee) Electrical Permit FeeE TFEE Mechanic��1 PermitFee M FEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alcne Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alcne Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourl -stmd alone 1BCBSC Cal Bldg Standards Commission Fee B ALL ERMIT TYPES 1BSEISMICR Seismic]Zesidential _ B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel &:Documentation B 1BUSLIC Business, License B 5 of 5 Community Development ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF -UPERTINO Buildin Department JOB ADDRESS: PERMIT #IX alAxT/ r14 q-01 , 0d(�) OWNER'S NAME: ?p�?�`Ic� PHONE GENERAL CONTRACTOR: FAX # I am not using any subcontractors: --A--Zt 111 SignatureDate Please check armlicable subcontractors and com :.ete the followin information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile owner/Contractor Signature Date