The URL can be used to link to this page

11060049 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10196 DUBON AVE CONTRACTOR:SAE CONSTRUCTION PERMIT NO: 11060049 OWNER'S NAME: MR&MRS PETE CARAVALHO 186 DALMA DR DATE ISSUED:06/06/2011 (""NER'S PHONE: 4152031356 MOUNTAIN VIEW,CA 94041 PHONE NO:(408)489-1786 L� LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# �/J MECH RESIDENTIAL COMMERCIAL Contractor�Jf/�. (�-,(�/(/�f�Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL TEMPORARY POWER AT NEW MAIN PANEL (commencing with Section 7000)of Division 3 of the Business&Professions LOCATION Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarati I have and will maintain a certificate of consent to self-insure for Worker' 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 Sq.Ft Floor Area: Valuation:$6000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34214054.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which ma accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of thisei It ally,the applicant understands and will comply with all non-poPations per the Cupertino Municipal Code,Section 9.18. 1 Issued by - - Date: . •�"��-��"� 46/ 4 � Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, 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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 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(a)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 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&Saf ections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I ne a or' d e / become subject to the Worker's Compensation provisions of the Labor Code,I must ate: forthwith comply with such provisions or this permit shall be deemed revoked. /I \/ (-/ All CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of%ork'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 enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, r • and expenses which may accrue against said City in consequence of the .1g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION %_,all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34214054 . 00 DATE ISSUED. . . . . . . : 06/06/2011 RECEIPT #. . . . . . • • • : BS000013675 REFERENCE ID # . . . : 11060049 SITE ADDRESS . . . . . : 10196 DUBON AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MR & MRS PETE CARAVALHO ADDRESS . . . . . . . . . . : 10196 DUBON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : HITOSHI ODAMA CONTRACTOR . . . . . . . : TOSH ODAMA LIC # 32135 COMPANY SAE CONSTRUCTION ADDRESS 186 DALMA DR CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94041 TELEPHONE (408) 489-1786 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 6, 000 .00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 6, 000 .00 0. 60 0. 00 0 .60 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 .60 0 . 00 166 .60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 166 .60 me --------------- TOTAL RECEIPT 166 .60 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACT R: BUSINESS LICENSE# 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 OCCUPANC NSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBC S HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ture 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 T-- Owner/Contractor Signature Date CITY OF CUPERTINO JJAPNFEE ESTIMATOR-BUILDING DIVISION : DDRESS: 10196 dubon ave. DATE: 06/06/2011 REVIEWED BY: bobs. BP#: "VALUATION: $6,000 'PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Du lex PENTAMATION 1 REAP14 USE: p PERMIT TYPE: WORK install temp power at new main panel location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 100 Amps $42 TOTALS: $42.00 Elec.Plan Check 0.0 hrs $0.00 Elec.Permit Fee: IEPERMIT Other Elea Insp. 0.0 hrs $42.00 NOTE: These fees are based on the preliminary in(ormation available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (P'ee Resolution 09-051 1.;f': 7/1,,"l 0) 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: ITRA VDOC $42.00 Strom Motion Fee: IBSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.601 $0.00 TOTAL FEE: $127.60 Revised: 04/29/2011 0 U, GENERAL PERMIT APPLICATION _ MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 408 777-3228 • FAX(408)777-3333•building4cupertino.omg misc CUPEI~RTINO ( ) ❑PLUMBING ❑NfECHAMCAL LECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS OWNER NAME PHONE E_'KAp- G� STREET ADDRESS / CITY, TE FAX r CONTACT NAME j E A FA.'C AD OWNER OWNER-BUILDER ' OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT C3 ENGINEER CIDEVELOPER ❑TENANT CO R C�/ '�/1�/1 LI E BUS.LIC M E- FAX COMP SRESSr--"� � OC �/A O ARCHITECTIENGINEER NAME LICENSE KNMER BUS.LIC A COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE TTSE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN ❑ URBAN INTERFACE AREA, ❑ Yes [I NO FLOOD ZONE C1 Yes C1 No rRUCTURE: Commercial DESCRIPTION OF WORK ` w TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act an the property owner's behalf. I have read this application and the information I have provid a I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rely' d' ns o'. I authorize represerrtatives of Cupertino to enter the above-iden' d prop for inspection purposes. Signature ofApplicant(Age - Date: S LEjv=AL INFORMATION REQUIRED &fEFMiscApp 2011.doc revised 03/16/11