The URL can be used to link to this page

09030160 CITY OF CUPERTINO BUILDING DIVISION PERMIT Cfil' T1 �CTC1R��1 ?�TI� , BUILDING ADDRESS: PERMIT NO. 20990 VALLEY GREEN DR #680 TBD - TO BE 11ETERM1UBZ_ 09030160 OWNER'S NAME: PERMrf ISSUE DATE xng-p.7r -PQ1jNnArrTQ ..-ZONE: S A CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1300 LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing za. with Section 7000)of Division 3 of the Business and Professions Code,and my license is INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES a-CH in full force and effect D_z LicenseClassLk.N E/M/P' .c.-SEE PERMIT #09030198 FOR PLAN CK 3 M� Date ITm Contractor ARCHECI'SDECLARATION COMMENTS. I understand my plans shall be used as public records �po,U L o WLicensed Professional y W OWNER-BUILDER DECLARATION I hereby aITxm that I am exempt from the Contractor's License Law for the `t p O following reason.(Section 7031.5,Business and Professions Code:Any city or county $Pi which requires a permit to construct.alter,improve,demolish,or repair any structure prior tr)its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area z<t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $100 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 32609053 . 680 ❑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 Required Inspections and Professions Code:The Contractor's License Law dots not apply to an owner of 9 property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sa as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this�n Owner lf'-' r Dae 62 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Cork:,for the performance of the work for which this permit is issued. My Workees Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less) I certify that in the performance of the vlork for w 'ch this permit is issued.I shall not employ any person in any manncrsoas bcttQmc s jest W orkers'Compensation Laws of California.Date 7 C7 V Applicant NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY F~t rte. I hereby affirm that there is a construction lending agency for the performance of Q4 5 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name z Lender's Address ;,,)C) I certify that I have read this application and state that the above information is LL" correct I agree to comply with all city and county ordinances and state laws relating to 0U building conswction,and hereby authorim representatives of this city to enter upon the W above-mentioned property for inspection purposes LL (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way scenic against said City U z in consequence of the granting of this permit. Date �--n APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P INT Issued by: v SOU CE REGULATIONS. ,/�-.�-,.. S 6 d Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Muntci al Code.Chapter 9.12,and the Health and Safety Cole,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Ya Will a roof is installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as cfrned by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No I have read the hazardous materials requirements under Chapter 6.95 of dtc Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility o notify the occupant of the requi cntsnwhich m st bemet or to issuanceof a Certifica c of Occu icy. Signature of Applicant Date r 1�1-t �•• �� -51 i,by All roof coverings to be Class'W'or better Owner or authorized agent Date OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform A All the work authorized by this permit B.portion of the work C. None of the work If B or C is checked, complete 2 or 3below. 2. A state licensed contractor will be hired to do: A. _/All of the work B. V A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to L.. �.._C.._....7 Cil Jiii:C:i 2� 41,— 3c(- ZSR o CA _U ZD IV -11, Uv/�� ✓ S L • V Lv `� CG ✓� // / 3. 'IV/, will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Oil Type of work to be erf ed 2� 41,— 3c(- ZSR o CA _U ZD IV -11, I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: Date: ZI Job Address: � o ly # � 0 �� Permit # b 9 0 3016 0 Anv chanzes to the, inf ormation provided on this form shall be submitted to the Citv of Cuvertino Build Department. City of Cupertino Building Department CITY OF 10300 Torre Avenue CUP ERT I RIO Phone: (408) 777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work If your work is being performed by someone other than yourself, you may protect vourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building per are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. very truly yours, Building Department, City of Cupertino Printed on Racyc%d Paper �. CITY OF CUPEf�TINO CITY OF CUPERTINO GENERAL: BUILDING PERMIT APPLICATION FORM cqa�)01 �0o APN # 32-6 - 6 4�:(- - CEZ Date: 0�GL 20. 2� Building Address: `d'--/ Zd D ,6✓e,.06RCi Mailing Address (if different from building addr ss): Owner's N e: o'e-� �v J, Phone #: HOA: (Exterior work only) Yes ❑ No 5Z If yes, provide letter from HOA Contractor: Phone: Fax: Contractor License #: Cupertino Business License #: Contact: f Gia G ✓(.u� Phone: Lf 09_ .2 Jr. 2_�6g3 Fax: 900 '273 - (O Z S - Residential . Commercial Job Description: Building Permit Info: / —/ BldgElect PI Plumb lid' Mech Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A 0 I1/III B, IV -HT, V -B V A r t Square Footage: Valuation: /00, Project Size: Express ❑ Standard P"" Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application 11 if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditp-reen.org Revised 02/05/09 �':_ CITY OF CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5