The URL can be used to link to this page

11110007 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22080 SAN FERNANDO CT CONTRACTOR:MORE LAND PERMIT NO: 11110007 CONSTRUCTION OWNER'S NAME: RONSDALE MANAGEMNET&AZ CHEMICAL 5514 AMBY DR DATE ISSUED:11/01/2011 :R'S PHONE: 4088366070 SAN JOSE,CA 95124 PHONE NO:(408)221-0892 ❑ LICENSED CONTRACTOR'S DECLARATION Iv ' 11 `�, BUILDING PERMIT INFO: BLDG ELECT �'" PLUMB License Class Lie.# R g V\ w , MECH r. RESIDENTIAL r COMMERCIAL ri 1 � I /� Contractor )i'CC P s�A. 156x1 It Date L\ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEMPORARY POWER POLE (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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1500 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 is issued. APN Number:35712011.00 Occupancy Type: 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 ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued byI L�7,==:::;) Date://—/—// 9.18. tt �I— Signature (09 Dale RE-ROOFS: MW OWNER-BUILDER DECLARATION 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 I hereby affirm that I em exempt from the Contractor's License Lew for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25.534. I will maintain Compensation,m provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25.532(s)should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or author] Compensation laws of California. If,after making this certificate of exemption,I Date: 1 become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save iiftitify and keep harmless the City of Cupertino against liabilities,judgments, urand expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 •CUPERTINO (408)777-3228• FAX(408)777-3333- building a�cuoertino.orD MISr V PLUMBING N ECRANICAL ELECTRICAL MLSCEI r ANEOUS PROIECTADDRESS a . e OWNERNAME 5 PHONE �)�IL�� / L. E-MAIL STREETADDRESS q C!g,SiA ffir/J6 J C y 0 FAX li* CONTACT NAME PH E-MAIL STAEETAODREss CRY,STATE, ZIP FAX ❑OWNFA ❑ OWNER-aUBDER ❑ OWNERAGENT ❑ WMRACro0. ❑CONTRACTOR AGENT ❑ Asc m'ELT ❑ENGMEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME n LICENSE q_ 1 LICENSETYPB A BUS.GCM COMPANY NAME I E-MAIL iFAX IL (q(311Z MARE ,STATE a PHO 2,1 — 10 ARcHrrEcriENO1NEERNAME LICENSE NUMBER BUS.LIC 0 COMTANYNAME' E-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE OF RGM.DUPLEX ❑ MULTI-FAMLY PROIECTINWIDWVD ❑ YES PROJECTOR ❑YES 13 THE BLDG AN ❑YES 7DESING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE E ❑NO EICHLER HOME? ❑NO CRIPTION OF WORK 1. TOTAL VALUATION: �\ SOO RECEIVED BY: By my signature below,I certify to each of the following: I son the property owner or authorized agent to act on the property awner's behalf. I have Lead this application and the information I have provided is correct have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating m building constrytcgpR�ygtrthonze representatives of Cupertino to enter the above•id_engtied property for inspection pui5oses. Signature of ApplicantfAgertr � Y�'(O Data: SUPPLEMENTAL INFORMATION REQUULED OFFICE USE ONLY r la-oVER-THX-COUNTER o. ❑ EXPRESS Y U _ ❑ STANDARD U ❑ LUKE 6 ❑ NAIOR MEPMrrcApp 1011.docrevi.red06/21/11 • CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35712011. 00 DATE ISSUED. . . . . . . : 11/01/2011 RECEIPT #. . . . . . . . . : BS000015213 REFERENCE ID # . . . : 11110007 SITE ADDRESS . . . . . : 22080 SAN FERNANDO CT - SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RONSDALE MANAGEMNET & AZ CHEMI ADDRESS . . . . . . . . . . : 15159 MONTALVO RD CITY/STATE/ZIP . . . : SARATOGA, CA 95070 RECEIVED FROM . . . . : MORE LAND CONSTRUCT CONTRACTOR . . . . . . . : VICTOR RIVERA LIC # 28320 COMPANY . . . . . . . . . . : MORE LAND CONSTRUCTION ADDRESS . . . . . . . . . . : 5514 AMBY DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE . . . . . . . . : (408) 221-0892 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41.00 0.00 41 .00 0. 00 1BCBSC VALUATION 1, 500 .00 1.00 0. 00 1.00 0 . 00 1BSEISMICR VALUATION 1,500 .00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1. 00 44.00 0.00 44 .00 0 . 00 1ERT<200 UNITS 1. 00 44.00 0.00 44 .00 0 .00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0.00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 174 .50 0.00 174 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 174 .50 --------------- TOTAL RECEIPT 174 .50 VOICE, ID - DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER • CITY OF CUPERTINO FEE ESTIMATOR.- BUILDING DIVISION • Q tADD.RESS: 22060 san fernando ct. DATE: 11/0112011 REVIEWED BV: bob s. BP#: "VALUATION: $1,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP14 USE: PERMIT TYPE: WORK temp power pole SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $44 TOTALS: $44.00 ;tferh. Pian Che,,lc Plumb. Pian Check Elec. Plan Check 0.0 rhrs $0.00 h&girth, Per;uit hive: Plumh.,L'ea'sh t ae: Elec. Permit Fee: IEPERMIT Other.V;�eh.hesp. Other 0.0 Plunrh Insp. Other Elec.Insp. hrs $44.00 • Li I ;1'le.h.Inc). Peer, PluurG. harp.Fee: Eler.Inco. Fee NOTE: 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 prellfadna Information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS REee Resolution /1-053 E£X 71Lill FEE QTY/FEE MISC ITEMS Plan Chea*Fes: Suppl. PCFee PME Plan Check: $0.00 Pcrnjit Fs,a: Supp/. £resp Fee PME Unit Fee: $44.00 PME Permit Fee: $44.00 Construction Tax Administrative Fee: IADMIN $41.00 Work Without Permit? O Yes 0 No $0.00 Adrorm¢W Planning Fces: Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 I� y SUBTOTALS: $174.50 $0.00 TOTAL FEE: $174.50 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 OU P E RT I N O Telephone: 408-777-3228 C Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: p D S PERMIT# k 0- C7 OWNER'S NAME: PHONE# Q00 936 ^ GENERAL CONTRACTOR: BUSINESS LICENSE# O ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. —` �� I am not using any subcontractors: � L Signature Date Please check applicable subcontractors and complete the following information: &/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum /Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date