Loading...
09070186CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 819 HOOSHANG CT OWNER'S NAME: ALEX CHEN '?.R'S PHONE: 4082355954 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date I hereby affirm that 1 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. 1 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 L OWNER- BUILDER DECLARATION 1 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). 1 hereby affirm under penalty of perjury one of the following three declarations: 1 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, I 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 1 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 it ' -mify and keep harmless the City of Cupertino against liabilities, judgments, k and expenses which may accrue against said City in consequence of the git,�uig of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signatur Date CONTRACTOR: ALEX CHEN PERMIT NO: 09070186 f 19 HOOSHANG CT DATE ISSUED: 07/28/2009 CUPERTINO CA, 95014 -4218 PHONE NO: Iv PLUMB BUILDING PERMIT INFO: MECH BLDG ELECT RESIDENTIAL COMMERCIAL OB DESCRIPTION:REPLACE I WINDOW LIKE FOR LIKE NON - `;TRUCTURAL q. Ft Floor Area: Valuation: $120 ;LPN Number: 35902002.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by i Date: RE- ROOFS: ,kil 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. :signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain 4 ompliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air i ontaminants 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 Iealth & Safety Code, Sections 25505, 25533, and 25534. )wn�e%�jr authorjagent: Date:�4 CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's or which this permit is issued (Sec. 3097, Civ C.) ,ender's Name .ender's ARCHITECT'S DECLARATION understand my plans shall be used as public records. Acensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMI" RECEIPT Sec: Twp: Rng: Sub: Blh: Lot: APN ........: 35902002.00 DATE ISSUED.......: 07/28/2009 RECEIPT #.........: BS000008291 REFERENCE ID # ...: 09070186 SITE ADDRESS .....: 819 HOOSHANG CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. ALEX CHEN ADDRESS ..........: 819 HOOSHANG CT CITY /STATE /ZIP ...: CUPERTINO CA, RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS CITY /STATE /ZIP TELEPHONE .... OPERATOR: patg COPY # : 1 95014 -4218 ALEX CHEN LIC # *OWNER* ALEX CHEN 819 HOOSHANG CT CUPERTINO CA, 95014 -4218 FEE ID UNIT QUANTITY ;1OUNT PD -TO -DT THIS REC - -- NEW BAL ---- - - - - -- ---- - - - - -- ------- - - - - 1BCBSC VALUATION -- ---- - - - - -- 120.00 - --- - - - - -- ---- 1.00 - - - - -- 0.00 ---- - - - 1.00 0.00 1BSEISMICR VALUATION 120.00 0.50 0.00 0.50 0.00 1WINREP EACH 8 1.00 380.00 0.00 380.00 - - - - -- 0.00 ---- - - - - -- TOTAL PERMIT - --- - - - - -- ---- 381.50 - - - - -- 0.00 ---- 381.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER - - - -- ----------- - - - - -- --------- CREDIT CARD - - - - -- 381.50 --------------- VISA --------------- TOTAL RECEIPT 381.50 46b ��r emu- h Q-n S�`I l ` /Y�J1� 2�qk PIX-jeo, �h� -sou �J �-`� � :.� `� ra ©� .. WWRDANCE WITH THE Cl [y ;UPERT,t4o CODES ,N1) ORDO AK )r4yf 7 Ip ?" -6) - 2 , - rhis set ,)e kept Lawful to ,)n same ne, building cat.10 , The Stamp'n, be 'HALL NOI b o0roval of the OWNER- BUILDEER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. All the work authorized by this permit B. A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. All of the work B. A portion of the work (complete section below) Phone # State License # Type of work to 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' con ipensation must be on file at the City of Cupertino Building Department office. I declare under penalty of perjury that the al,ove is true and correct. I have read and understand the Owner - Builder Information (reverse side). Property Owner's Signature: G/ Date: l Z — 0 Job Address: 6M—C t C Permit # Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. � , a, CITY Of CUPEkTINO CITY OF C.UPERTINO GENERAL BUILDING PERMIT APPLICATION FORM o ct0101k� APN # � d ao ;�L _ 0 O Date: Building Address stl - c , 1P &14 Mailing Address (if different from building address): Are Hazardous Materials being used as part of thi -i project? Yes No JR HOA: Exterior work only) Yes ❑ No ® If yes, pro vide letter from HOA Owner's N e: � Phone #: gf�N Contractor: n Phone: 'J Fax: Contractor License #: Cupertino Business License #: Contact: Phone: Fax: Residential Commercial LJ Job Description: � lAU2 Gcl r 1 Building Permit Info: Bldg ❑-' Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1 -A, 1 -B ❑ II/III/V -A ❑ II/III B, IV -HT, V -:3 [9-- -� Valuation: Square Footage: Project Size: Express [g-- -Standard R Large ] Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: CO For help, contact Build it Green at www.builditgreen.org Revised 07/14/09 CITY OF CUPEI,TINO CITY OF CXPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity /Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B f I 1WINREP Replacement windows /sliding glass door (ea 3 windows) B 1 WINMEWSTR New Window- structural shear wall /masc my (includes plan ck fee) B 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alc ne Electric Pln Ck (hourly) E I MECPLNCK Stand Alc ne Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Alc ne Plumbing Pln Ck (hrly) P 1 STPLNCK -(3 Hr Min when not over counter) Standard Plan Check (when no E /M/P) hourl -stf nd alone B / I 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5