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14050086CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18832 TUGGLE AVE CONTRACTOR: CHEN'S CONSTRUCTION PERMIT NO: 14050086 COMPANY OWNER'S NAME: GRAND SUCCESS LLC 10349 LEOLA CT APT 1 DATE ISSUED: 05/13/2014 OWNER'S PHONE: 4083911329 CUPERTINO, CA 95014 PHONE NO: (408) 726-2956 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION INSTALL TEMPPOWER (j � � / License Class Lic. # / Contractor L&4A O� 6) Date l J 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. Sq. Ft Floor Area: Valuation: $500 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37532028.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA ROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Da Issued by: te 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 Datd9(— *1 RE-ROOFS: 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by for this the Health & Safety Code, Sectio 5, 25533 and 25534. / /3 Section 3700 of the Labor Code, for the performance of the work which Owner or authorized gge>'i Date:os 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 918. Signature Date trc'';.i4ss s GENERAL PERMIT APPLICATION SU � EP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(cDcunertino.OrgI� 111 MISC 71 UT TrT. AD7-.Tr-- I—II„slrr PTA-rrrnT- IJ�RT.Fr7P1CAL FIMISCELLANEOUS PROJECT ADDRESS I (tij \ b L_ V I APN # OWNERNAME ' PHONE/ (Z2 t� E-MAIL 7• ` STREET ADDRESS CITY, STATE, ZIP I FAX CONTACT NAME PHONE EMAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OR74ER-BUILDER ❑ OWIZERAMgr ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCrIITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME & / ) LICENSENUMBERf�b3v'� LICENSETYPE BUS. LIC# COMPANY NAME /%% Ef ✓.S Ohs i (� C 0i1V ( -V Yl E MAII CGVV t� 3 `F �i O1i C�lj+/1 FAX STREET ADDRESS` �r I CITY, STATE, ZIP n r y cA Dl Y/ L PHOI\TBj 0 Q r 2) —1 '� �# f� Ti /� ARCHITECT/ENGWEERNAMEE LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MUI T!-FAMII Y BUILDINCr.. ❑ COWIERCIAL - PROJECT IN7IIAND ❑ YES URBAN INTERFACE AREA ® NO PROJECT IN ❑ YES FLOOD ZONE ® NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK /7 1,5 K k on to to TOTAL VALUATION: �1.� W�� FED Byrk By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property ovtimer s behalf. I have read this application and the information I have provided incorrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relati g to buil ' nstruction. I authorize resentatives of Cupertino to enter thecab�ove-identified property for inspection purposes. Signature of Applicant/Agent: Date: S E NAL II\TFORATA REQUIRED .g �TWA =Kra OFFICE USE Ol�LYs=Wa" OR- THirCO.LAT�R e ..,- ��STr1�-DARDS - - 01 MEPMisc,4pp_2011.doc revised 06121111 �� CITY OF CUPERTINO TUU Ucmrna A 9rnu _ 1TTTTT .TIINC IIIVICION L rc:h. Plan Che(k A&'ch. z�t'YF7tti 1'L'B: I'himb. Permit Fee: Other Plumb Irasp. Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 0.0 1 hrs I $47.00 I l,�ec.lniiz ft�e NOTE: This estimate does not include fees due to other Departments ye. rianning, r"MIG rr urna, r, �u•..cw•y ��.. �• -�.�.• �•-��- __ !..,tort tho Dont for addn'l info. Ulstrict, et(:. . I nese eea urc ow. — woc P, �•.......», FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) 18832 tuggle ave DATE: REVIEWED BY: Mendez liaADDRESS: BP#: `VALUATION: $500 $0.00 APN: Suppl. PC Fee: Reg. Q OT PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PME Plan Check: PENTAMATION 1 REAP14 PERMIT TYPE: USE: Permit Fee: WORK temp power 0.0 1 hrs SCOPE L rc:h. Plan Che(k A&'ch. z�t'YF7tti 1'L'B: I'himb. Permit Fee: Other Plumb Irasp. Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 0.0 1 hrs I $47.00 I l,�ec.lniiz ft�e NOTE: This estimate does not include fees due to other Departments ye. rianning, r"MIG rr urna, r, �u•..cw•y ��.. �• -�.�.• �•-��- __ !..,tort tho Dont for addn'l info. Ulstrict, et(:. . I nese eea urc ow. — woc P, �•.......», FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) •.• .....-.--_..._ ... __-_--- FEE ----- --- - QTY/FEE - MISC ITEMS Plan Check Fee: $0.00 = amps Electrical $47.00 IERT<200 Temporary Power Suppl. PC Fee: Reg. Q OT 0.0 hr's $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 :G'?iSl}"ik'iZ(1r TCL?': Administrative Fee: IADMIN $44.00 0 G Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldy, Stds Commission .Fee: 1BCBSC $1.00 7777 s kF7777 $139.50 $47.00 TOTAL FEE: $186.50 Revised: 04/01/2014