No preview available
10100205I CITY OF CUPERTINO BUILDING PERMIT I I BUILDING ADDRESS: 20875 VALLEY GREEN DR # 103 I CC NTRACTOR: KORET FOUNDATION I PERMIT NO: 10100205 I I OWNER'S NAME: KORET FOUNDATION 120f 75 VALLEY GREEN DR I DATE ISSUED: 10/28/2010 I 'NER'S PHONE: 4082530200 IN-] License Class Contractor LICENSED CONTRACTOR'S DECLARATION Lic. # I hereby affirm that I am licensed under the provisions of Chapter 9 (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. 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. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three' 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Compensation laws of California. If, after making this certificate of exemption, 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above inform tion 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 ~4emnify and keep harmless the City of Cupertino against liabilities, judgments, 3, and expenses which may accrue against said City in consequence of the b.anting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature r / ��� AA, Date ! 02 / 61) CU PERTINO, CA 95014 PHONE NO: JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL INSTALL WASHER/DRYER UNITS INSIDE COMMERCIAL APARTMENT BUILDING Sq. Ft Floor Area: Valuation: $100 APN Number: 32609064.103 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by-,, Date:, �yt o �� RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is ins ailed without first obtaining an inspection, I agree to remove all new materials for ins )ection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I h ave read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533 and 25534. Ov ner or authorized agent: 1 `^Date: I o 2,6111 CONSTRUCTION LENDING AGENCY I licreby affirm that there is a construction lending agency for the performance of wo -k's for which this permit is issued (Sec. 3097, Civ C.) Le ider's Name Le ider's Address ARCHITECT'S DECLARATION I ui iderstand my plans shall be used as public records. Licensed Professional CUPERTINO OWNER -BUILDER DISCLOc:;URE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA E5014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildir Walcupertino.orq Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE 2DRESS1 ( �10 APN � 1 O BP# OWNER NAMEOWNER �0 ,— U i a o w ADDRESS v 6 DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment end Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having t -lis permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialec your understanding of each provision, signed, and returned this form to us at our official address indicated. Ai agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) �1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Vv� 2. 1 understand building permits are not required to be Signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. I_3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensod Contractor and having the permit filed in his or her name ' ead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license num¢�rs on permits and contracts. 5. 1 understand if I employ or otherwise engage any pe sons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollarE ($500), including labor and materials, I may be consid ed an "employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers compensation disability insurance, and contribute to unemployment compensation for each "employee." I also ur derstand my failure to abide by these laws may subject Z ious financial risk. . I understand under California Contractors' State Liconse Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the inteiit to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does iot exceed four within any calendar year, or all of the work is perFgr�rhed under contract with a licensed general building Contractor. lk& I understand as an Owner -Builder if I sell the properly for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 CITY OF CL PERTINO F,M--7 FEE ESTIMATOR - BUILDING DIVISION 0ADDRESS: Mech. Plan Check 0,0 hrs $0.00 DATE: REVIEWED BY: FMech. Permit Fee: 1MPERMIT 1 APN: BP#: *VALUATION: $100 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family USE: y Dwelling Buildina is >3 Stories Q Yes Q No PENTAMATION PERMIT TYPE: 1 RPSS WORK $0.00 SCOPE Electrical 1BREMRECEP Recep/Switch/Outlets NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t tor addn7 infn FEE ITEMS (Fee Resolution 09-051 Eff. 71,10) Mech. Plan Check 0,0 hrs $0.00 Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 FMech. Permit Fee: 1MPERMIT Plumb. Pcrmit Fee: iPPERMIT Elec. Permit Fee: IEPERMIT Other Mech. Insp. 1.0 hrs'$42.00 Other Plumb Insp. [1.0 Other Elec. Insp. 1.0 hrsMech. Insp. Fee: IMECHINSP $126.00 lhrs$42.00 Plumb. Insp. Fee: 1,'LMBI126.00 Elec. Insp. Fee: IELECINSP $126.00 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t tor addn7 infn FEE ITEMS (Fee Resolution 09-051 Eff. 71,10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $0.00 Plumbing IPRSEWER I Sewer, Sanitary Suppl. PC Fee: E) Reg. 0 :07TF0,071 hrs $0.00 PME Plan Check: $0.00 =0 $0.00 Electrical 1BREMRECEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee{' Reg. 0 OT 0. 0 his $0.00 0� # Mechanical $0.00 IMFR=<100 Furnace, Forced -Air PME Unit Fee: $0.00 PME Permit Fee: $504.00 Col?_/Iv rt fwn Ttn7_1 Acoustical Fee. 0 Yes (E) No $0.00 0 0 Work Without Permit? Q Yes E) No $0.00 Plannin Fee: $0.00 Select a Non -Residential Building or Structure Q 0 i Travel Documentation Fee: I TRAVDOC $42.00 Strong? Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $547.501 $0.00 TOTAL FEE: $547.50 Revised: 10/17/2010 CITY OF CUPERTINO 8 ITEMS OF 16 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lost: APN ........: 32609064.103 DATE ISSUED.......: 10/28/2010 RECEIPT 4 ......... BS0000:_1865 REFERENCE ID # ...: 10100205 SI'Z'E ADDRESS .....: 20875 'IALLEY GREEN DR #103 SUBDIVISION ...... CITY CUPERT:CNO IMPACT AREA ....... OWNER KORET :FOUNDATION ADDRESS 20875 'IALLEY GREEN DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: VILLAG:3S AT CUPERTI CONTRACTOR .......: LIC # *OWNER* COMPANY KORET FOUNDATION ADDRESS 20875 'IALLEY GREEN DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........: FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC -------------------- NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 100.00 -------------------- 1.00 0.00 1.00 0.00 1BREMRECEP NO. OUTLETS 1.00 42.00 0.00 42.00 0.00 1BSEISMICR VALUATION 100.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1PREPPIPE FLAT RATE 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 ---------- ---------- 253.50 0.00 253.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- CASH --------------- 1.00 -------------------- cash CHECK 506.00 1028/1029 TOTAL RECEIPT --------------- 507.00 `CITY of CUPERTINO CITY OF CU:PERTINO GENERAL BUILDING PERMIT APPLIC.A.TION FORM !o /WcPOs— APN # D 9 d Date: Building Address: Mailing Address (if different from building address): 5A—M 6 -- Owner's Name:, �® j2,C� T /::-01V041-1,C)-1V Phone #: j�I1OUV _2._ --OZO0 HOA: (Exterior work only) Yes ❑ No Z.. If yes, provideletter from HOA Contractor: TB D , �DC-VO;-;' " Phone: - wlvo fYow Meecdo G Fax: Contractor License #: -T13D Cupertino Business License #: Contact: ryl iCi,+r4�L T121A)e%2. Phone: qDv 252 -?6, L13 Fax: 1406- -173 -/02--S Residential U Commercial ❑ Job Description: JJS�LC, W Iq 514672/02;72 o�f S _� e -,t c C_0 Vn m C—V_C l W .A p €3-p_TMaN, i " f3 Lt i LD t s° Building Permit Info: 6 F Bldg Elect Rf Plum b LYI Mech Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B © 2 - Valuation: �� Square Footage: Project Size: Express ❑ Standard Lam' Large ❑ Major ❑ Green Building: Please complete relevant portion of this Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Ants Achieved: Ft -.r help, contact Build it Green at www.buil- Revised 02/05/09