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11060068 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10611 CULBERTSON DR CONTRACTOR:CHETAUD PRO BUILDERS PERMIT NO: 11060068 OWNER'S NAME: TUNG DA-YUAN AND KENG HSM-NING 63 KENNEDY AVE DATE ISSUED:06/09/2011 "'NER'S PHONE: CAMPBELL,CA 95008 PHONE NO:(408)313-4030 lu LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB License Class Lic.# Po 7Z� r.,ti MECH RESIDENTIAL COMMERCIAL Contractor RDate // I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL TEMP 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:$1900 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 this permit is issued. APN Number:37536025.00 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 DAYSJEROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. A4,ditbnally,;he-appjicent understands and will comply c1 with all non-point sourco r lati s pep no Municipal Code,Section Issued by: \I Date:(I ` r I 9.18. r Signature Date I RE-ROOFS: /7/7, OW -- R-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 am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,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 25534. 1 will maintain Compensation,as 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 25532(a)should I store or handle hazardous material. I 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 corglianc ithjhe Cupertino Municipal Code,Chapter 9.12 and the Health& ty odjt, rEti s 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Owner a I a t: Compensation laws of California. If,after making this certificate of exemption,I Date: A become subject to the Worker's Compensation provisions of the Labor Code,I must p 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 indemnify 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 ,ing 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 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# /(a K o 06 OWNER'S NAME: PHONE#-/08--S( 5 a 4CG SC) GENERAL CONTRACTOR: 1 ^ BUSINESS LICENSE# ADDRESS: G �Vt ,-�5 CA� 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 OCCUPAN INSP CTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 6 �� Signature Date Please check applicable subcont ctors and complete the following information: V 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 CITY OF CUPERTINO 6 ITEMS OF 12 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37536025 .00 DATE ISSUED. . . . . . . : 06/09/2011 RECEIPT #. . . . . . . . . BS000013704 REFERENCE ID # . . . : 11060068 SITE ADDRESS . . . . . : 10611 CULBERTSON DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TUNG DA-YUAN AND KENG HSIN-NIN ADDRESS 10611 CULBERTSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CHATAUD PRO BUILDER CONTRACTOR . . . . . . . : LIC # 32681 COMPANY CHETAUD PRO BUILDERS ADDRESS . . . . . . . . . . : 63 KENNEDY AVE CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 313-4030 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 0 .50 39 . 00 0 .00 39. 00 0 .00 1BCBSC VALUATION 1, 900 . 00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 1, 900 . 00 0 .50 0 . 00 0 .50 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 166 .50 0 . 00 166 .50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER 1 CITY OF CUPERTINO \V" FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10611 culbertson ave. DATE: 06/09/2011 REVIEWED BY: bobs. APN: I BP#: "VALUATION: 1$1,900 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex lex PENTAMATION 1 REAP14 USE: PERMIT TYPE: WORK install temp power pole. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1ERT<200 100 Amps $42 -T- TOTALS: $42.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: 1EPERMIT Other Elea Insp. 0.0 hrs 1 $42.00 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Pee.Resolution 09-05.1 Fs_ff 1.-10) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $42.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: 1 TRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg;Stds Commission Fee: IBCBSC $1.00 $39.00 IADMIN SUBTOTALS: $127.50 $39.00 TOTAL FEE: $166.50 Revised: 04/29/2011 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �� 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 \V MIS CvPERt>INo (408)777-3228 • FAX(408)777-3333 •building(Dcupertino.ora •�` C ❑PLUMBING ❑bIECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS OWNER NAME / l/ / l/`YKN I 3'7�;-M3 0 01' PHONE 7`;:AII t / STREET ADDRESS ^ ,( �J\ CITY. STATE ZI�n , FAX A-4 CONTACT NAME Id PHONEI%` •� STREET ADDRESS (^� , w 1�� (. /� "� CITY.STATE, ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 2 ✓( LICENSE NUMBEn5736.4 LICENSE TYPE BUS,LII# CQ COMPANY N ° E j QV--;.V 1 pl FAX STREET ADDRESS ^ kuc CITY.STATE ZIPr�� /A �`� PHONE ARCHTTECTIENGINEER N NM LICENSE NUMBER ((�J (/j k BUS.LIC N COMPANY NAME E-MAII. FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN 67RUCTUgE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORKS _ �r .Clnl /o �vy o� TOTAL VALUATION: By my signature below,I certify to each of the llowi I ^rop owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provi is ct V ad escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi a cti l o ' epreserltatives of Cupertino to enter the above-id tifie roperty for inspection purposes. o" r Signature ofApplicant/Agent - % Date: LETET5Z INFORMATION REQUaED MINES NEPMucA4pp_2011.doc revised 03/16/11