The URL can be used to link to this page

04040094 C11'Y OF CUPCRI'INO BUILDING Dlvl$10N PERM P�,,CONIRACTrR INTORMA ,:_ BUILDING ADDRESS: PLRMIT NO0404 0094 11215 MT CR O W NF.R'S NAME: PERMIT ISSUE DATE ERNEST ROBLES 5 2004 ONE: SANITARY NO. CONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MICH coo LICENSED CONTRACTOR'S DECLARATION U 1 ion 7 affirm that 1 am If the B under provisions of Chapter 9(Commencingsis lob De ��Qll p��r WithSectionlBAnetDivisionlof the Buxinua end Professions Cutic.andmyliccnsc is 'p`e,■ y) I� jI3� in urn rnme and credo FIRE DAMAGE REPAIR rryLIZ�]llll'1/'Ht uecnxe Clusx Lie.it O'o DateContractor FZ� ARCHITECTS DECLARATION r A7 C-s I understand my plana Shall he Used as .oil.(cords J�!1 200 amu J[ T O Licensed Pmfcsxional ®®®® S OWNER-BUILDER DECLARATION Contractor's ON ��'L[.Jove ] C 1 hereby affirm that I L. cscmpe from Nc Cortins Co e:Any taw for me HC following mason.(Section 1!131.5,Business and vac de Professions Code:Any city or county K m w which requires a e,also re construe,aSher.pplicant improve for such demolish,or e pair any structure Oir priormi¢issuance,also requires the applicam far Such permitmfilc asigneJmmemcm EYo that he is licensed ptamom m the provisions of the Contractor's License Law(Chap¢r9 Sq. PL. Floor Area Valuation yl- (commencing with Section]OW)Of Division 3 of the Business and Professions Code)or y F that he IS exempt therefrom and the bazis for the alleged Lvemption.Any violation of Section 1031.5 by any applicant for a permit subjects me applicant to a civil Penalty of 3 51WbIQi4dher00 Occupancy Type not more than five hundred dollars(5500). 0 1,as owner of the property,or my employees with wages m mch sole compcnsmion, will do dm work and the strucmm is not intended or offered for sale(Sec.1044,Business Required Inspections Said Professions Coce:The Contractor's Licenseea Law dors not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his awn employees,provided that such impronamots are not intended or offered for sale.IL however.Ne building or improvement is sold within one year of completion.She owner- builder will ban the burden of proving that he did not build or improve for purpose of vlo.). kp,..��s as owner of the property,am exclusively contracting with licensed contractors to 4onswct the project(Sce.7W,Business and Professions Code:)The Contractor's Li� come law does not apply to an owner Of property who builds or improves Neuron.and who contracts for such projects with a eommanor(s)Remand pursuant o the Contoaor'S License Law. Clam CXCMPL under Sec. �� '',, QQ .B h P C for this action(� l Data i WORKER'SC MPENSATION DECLARATION D/ I hereby anirm under penalty of perjury one of the f6fio`ving decluationic 0l have and will maintain a CWHicine of Consent to selfimama for Worker'sCompen- sation,u provided for by Section 3100 of the tabor Calc,for the performanm of the work for which this Permit is issued. 0 1 have and will maintain Worker&Compensation Insmance,as required by Section 37W of She Labor Code,for me Nifurmmce of me work for which Nis permit is issued. My Worker's Compensation Insurance Cartier and Policy number am: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the Permit is for one hundred dollars(SIaB US less.) I mNfy that in the pcort rmance of the work for which this Permit is issued.I shall not employ any Pawn in any manner so m to become subject to the WorkersCompensation Laws of California.Date Applicata NOTICE TO APPLICANT:If,after making this Certificate of Eacmption,you should become subject to the Workers Compensation provisions of the Labor Cadc.you must .J2 forthwith comply with such provisions or permit shall he deemed revoked. 'ZO CONSTRUCTION LENDING AGENCY 'r+ I hereby affirm that there is a constmninn lending agency for the performance of a> She work for which this permit is issued(Sm.3097,CiN,C.) W Q Lenders Nam. lender's Address u C)0 I ccnify Nat 1 pari(cad thisapplication and and some then me above information is burst.I vegan m comply with all miry and county conordinances and statet laws relating ut e 0 imonngconstrumli m and hereby amhon.,arescnutivesof thisCity mcater upon the yabove-memldgra propery for inspection Purposes. (We)agree to save,indemnify and keep harmless the City or Cupertino against 1 (q liabilities,judgmentseeox6and ex this permit. may in any way afCrve against said City V z APPI,Iqucncc of DERST Nof this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUMTIONS. k - [ "� Re-roofs If SitnauatmofApplicanUConoactor Date Type of Roof HAZARDOUS MATERIALS DISCLOSUR Will me applicam or fmufe building occupant Some or handle hvardous mown.] as defined by he Cupertino Munivipul,Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? Cl �Nn All roofs shall be inspected prior to any roofing material being installed. pp g uampan t p If a roof is installed without first obtainingan inspection,I agree to remove Will mea livnm of future building t Liu a ui mem or devices which P g emit hma.artlnus air contaminants m defined by the Bay Arca Air Quality Management all new materials for inspection. Disuin? CRs `f No 1 have read Ne hanNnus materials mquimments under Chapter 695 of the Califor. nia Health G Safety Code,Sttvons 25505,25533 and 25534.1 understand dot if the building does not curemly have a lenot,and it is my responsibility to and l'y the occupant of She animmmcnks 'hmust bit MCI pnonoissuoccofaCca0Bca2of occupancy, Signature of Applicant Date Gyve r or amherind agent Date All roof coverings to be Class "B" or better CITY OF CUPERTINO !em 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub: Blk: Lot : APN . . . . . . . . : 35626026 . 00 DATE ISSUED. . . . . . . : 04/15/2004 RECEIPT 4 . . . . . . . . . : 25199 REFERENCE ID # . . . : 04040094 SITE ADDRESS . . . . . : 11215 MT CREST PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ERNEST ROBLES ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4750 RECEIVED FROM . . . . : ERNEST ROBLES CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- --------- - --- ---------- ---------- - - - --- - - - - ---------- ------ ---- BENERGY PERMIT FEE 868 . 00 260 . 40 0 . 00 260 . 40 0 . 00 BPERMFEE VALUATION 120, 000 . 00 868 . 00 0 . 00 868 . 00 0 . 00 BPLANCHK PERMIT FEE 868 . 00 737 . 80 0 . 00 737 . 80 0 . 00 BPSEWAGE UNITS 1 . 00 62 . 16 0 . 00 62 . 16 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 19 . 98 0 . 00 19 . 98 0 . 00 BREMVENFAN NO UNITS 3 . 00 55 . 02 0 . 00 55 . 02 0 . 00 BELEC200 METERS 1 . 00 27 . 25 0 . 00 27 . 25 0 . 00 BREMVENSYS NO UNITS 1 . 00 9 . 50 0 . 00 9 . 50 0 . 00 PPLBG SQUARE FEET 1 , 300 . 00 91 . 00 0 . 00 91 . 00 0 . 00 BSEISMICRE VALUATION 120, 000 . 00 12 . 00 0 . 00 12 . 00 0 . 00 ELECTRIC SQUARE FEET 1 , 300 . 00 91 . 00 0 . 00 91 . 00 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 MPERMFEE SQUARE FEET 1, 300 . 00 91 . 00 0 . 00 91 . 00 0 . 00 MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 ---------- --- - - - - --- ---------- TOTAL PERMIT 2431 . 67 0 . 00 2431 . 67 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- - - -- -- ------ -------------- ---- CHECK 2431 . 67 9337 TOTAL RECEIPT 2431 . 67 0 CC�� WITY OF CUPERTINO* CUP TYOF NO PERMIT APPLICATION FORM qgFAPN# D 2Z Date: Building Addrew r Mailing Address f different from b lding address): tiz ,S 7-111-cel - Owner's 1 ce Owner's Na Phone #: �rney+ 7�'v 61es ¢o Contract License#: Contacts� Phone: ¢o g 23 Cupertino Business License#: 6I�✓lG�� B��S. Fax: Building Permit Info: /� BlO LJ Elects❑ � Plu MCC Job Description/ Residential cfi^� .0. < R aI✓' Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Gr p: �' /Aot 0 0 Type of Construction: Please chec this box if t roject is a second-storya i ion: • el Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX EIndJOfVConmmrnV/ uasi BUILDING BCONSTAXBQ r BQ Zone BUILDINGBCONSTAXH d Motel BUILDING BCONSTAXR esi/Mobile BUILDINGBELEC1000 <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1 OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING • BMITIGATC Comm. Housing Mit. Fee BUILDING I of (/ 3/. 6 2 7 CITY OF CUPERTINO "m" tti:"a - BUILDING DIVISION PERMIT CONTRACTOR INFORMATION �,: BUILDING ADDRESS: PERMIT NO04 04 0 0 94 1 215 MT CREST PTl .R'S NAME: PERMIT ISSUE DATE ERNEST ROBLES 2004 ONE: SANITARY NO. CONTROL NO. 741 AR CIIITLCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECII 0 0 0 0 X00 LICENSED CONTRACTOR'S DECLARf ION Chap Job Description C I ion 70 affirm that 1 am limned under provisions of Chapter 9(commencingsis p b with llforcn]ilM)of Division Jur the Businccs and Pmfcssians Coda.mod my license is j-?e inmofomeandermet FIRE DAMAGE REPAIR LicenseClaes Lie.M r O Date CiaTS DELL ' [pp,� ARCHITECTS LOTS DECLARATION y y U I underslanJ my plans shall W used as public records T o 1 Licensed Professional �® ,g OWNER-BUILDER DECLARATION Conti ON E a S 1 hereby affirm on am exempt from the Contractors o Licence Law su the J I, 0 o following reason.(Section]11]15,Business and Profession Code:Any city nr county (�/ / 1 m r which requires a Permit m construct,alter,improve,demolish,or repair any structure 6 91— �12QQQO prior to its issuance.ahumquires the applicant for such permiuo file a signed statement F o that he is licensed pursnanitothe pmvisionsOfthe CommoorsLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation ,a (commencing with Section](XX))of Division]Of the Business and Professions Code)or y that he is exempt therefrom and the baso for the alleged exemption.Any violation of Semon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mon than rive hundred dollars D500). 3 D]NIJ26cr00 ccupancy Type ❑I,as owner of the properly.or my employees with wages act their sole eampersmme, will do the work,and the awcture is not intended or offend for sale(Sec.7044,Business and Professions Code:The Contractor',Limn.Law does not apply m an owner of Required Inspections progeny who builds or improves thereom and who does such work himselfor through his own employees,provided that such improvements are not intended or offered for mile.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 Wild or improve for purpose of sale.). as Owner of the property,am exclusively contracting with licensed contractors to onguuct the project(Sec.7044,Business and Profusions Cade:)The CanOacmrs Li m.,.•Law docs not apply to an owner of property who Wilds or improves daemon,and who contracts for such projects with a contractorfs)licensed pursuant to Ne Contractor's License law. ❑ lam ex m l uddee,S-cc, a� ,. ,s ,B&P C for this reason V"DRK iL�C/Ca—a Dau WORKER'SC MPENSATIONDECLARATION I hereby affirm under penally of perjury one of the fdTlo ving declarations: 1 have and will maintain a Cenificam of Consent m elf-insum for Worker',Cumpcn- sation,as Provided for by Section 3700 of the labor Code,for the perfarmanm of the work for which this permit is issued. ❑1 ban and will maintain Worker's Compensation Insurance,as required by Section 37M of the labor Codc.for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Caprice For icy No.: _ CERTIFICATE OF EX EM MON FROM WORKERS' COMPENSATION INSURANCE (This taction need not W eumplmed if the permit is forone hundmd dollars(SI)(B or less.) 1 tali fy that in the performance or the work for which this Permit is issued,I shall not employ any person in any manner u n In become subject o the Workers Compemation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making Ibis Ccnrfea¢of Exemption,you should become subject m the Worker's Compensation provisions of the labor Codc,you muss .J z forthwith comply with such provisions or this permit shall he deemed revoked. z O CONSTRUCTION LENDING AGENCY F" I herchy affirm Nat there is a construction lending agency for the performance of IX dad work for which this permit is issued(Sol.3097.Ci,C.) 0 Lender's Namc a z lender's Address U Q I certify that l ban read this application and sum that the above information is d[ P correct.l agree to Comply with all city and county ordinances and sure laws relating to C)U Wilding Construction.and hereby authorise reprenntatives of his city to enter upon the above-mentioned Properly for inspection purposes. FG (Wc)agree he gran indemnify Per keep harmlev the City Of Cupertino against N liabilities judgments.costs and expenses which may in any way meloe against said City U z m consequence of UNDERSTANDS of this Permit, "-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGU TIONS. st, Re-roofs Srgna c of AreplicanVCanuacimDale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle harardolls material as refined by the Cupenrno Municipal Code.Chapter 9.17,and the Ifcallh and Safely Afte.Scetiex n5J2(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ya �Nu Will the applicant nr more building eccupom tete avurpmem or devices which If a roof is installed without first obtaining an inspection, I agree to remove tat hasardnus air conmminanu as defined by the Bay Arca Air Quality Management all new materials for inspection. isbin? ❑Yes �Nn 1 have read the hasardous materials requirements under Chapter 6.'95 of the Calif e- ma Health&Smcty Codc.Sccumu 15505,25537 am125334.1 undeenc nd that if do Wilding Ores not currently have a anal,Nat it is my responsibility m nod fy the oup pant of d¢ requirements -0mostSometpriortnisaummceor.CenifcaapIOcmpancy Signature of Applicant Date turaatnur;xadagent pin All roof coverings to be Class "B" or better