The URL can be used to link to this page

13040048 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18920 TILSON AVE CONTRACTOR:BLESS ELECTRIC INC PERMIT NO:13040048 OWNER'S NAME: AKBARPOUR MAHIN 10355 STERN AVE DATE ISSUED:04/04/2013 OWNER'S PHONE: 4084996595 CUPERTINO,CA 95014 PHONE NO:(408)499-6595 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License Class Q Lic.# 6 4TEMPORARY POWER POLE Contractor I hereby affirm tha I im licensed under the provisio f Chapter 9 (commencing with coon 7000)of Division 3 of the' siness&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:$300 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 APN Number:37509017 Occupancy Type: 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 1 6 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 S EAST CALLED INSPEC ION. 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 Issue Date: with all non-point source re latio s pJer the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date_t I _Qc1 r �� 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. ❑ O -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 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 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. !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 the Health&Safety Code,Sections 550 22533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date:(>Ll—0 WL1 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 CONSTRU ION LENDING AGENCY 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 ARCHI ECT'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 9.18. Signature Date �V GENERAL PERMIT APPLICATION C) MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 11 CEfFERT IF[© (408)777-3228•FAX(408)777-3333• buildinQ41CUDertino.ora misc ❑PLUMBING ❑MECHANICAL FV(ELECTRICAL ❑MISCBLLANEOU S PROJECTADDRESS `g A �O �{1 1\SCn AVP APN: '3 75- — " /y r / OWNERNAME MOQecN J A`, 1 I PHONE qC C,,qq` _ 66q;7 �Ims elec®y41,oe . cc STREET ADDRESS \Q G }pry vp CITY, STATEzip c�pPr�; 'C,_ f5e CONTACT NAME FAX T ��^� l PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX 0'O1AINER ❑ OWNER-BUILDER ❑OVdNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGE14T ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS I CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LJC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK 0 TOTAL VALUATION: 00 �� RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner'Obehalf. I have read this application and the information I have roF a is otrect I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b Idi coon. I authorize representatives of Cupertino to enter the above-identified propet`iy for inspection purposes. Signature of Applicant/Agent: Date: f7 H C Ll— I I 0 SUIVLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY OVER-THE-COUNTER I^ ❑ ExTRESS •J U =] ❑ STANDARD U ❑ LARGE ❑ MAJOR A�PA1iscApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 18920 tilson DATE: 04/04/2013 REVIEWED BY: larry s APN: BP#: *VALUATION: $300 OkPERMITTYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION SFD or Duplex 1REAP14 USE: PERMIT TYPE: � WORK temp power elec ole SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Temporary Power 1 ERT<200 200 Amps $45 N ME TOTALS: ``, $45.00 - ' - R ur y, _ ,. �� s Mech.Plan Check Plumb.Plan Check Elec.Plan Check0.0 hrs $0.00 LIech.Permil Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT Other Alech.Imp, Other Plumb Insp. LL] Other Elec.Insp. hrs $45.00 0.0 AIech.Insp, Fee: Plumb. h7sp.Fee: flee.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the mina information available and are onlyan estimate. Contact the De t or addn7 info, FEE ITEMS(Fee Resolution 11-053 Eff 711/12) FEE QTY/FEE MISC ITEMS Plan Check Tee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suhpl. .Inst)Fee PME Unit Fee: $45.00 PME Permit Fee: $45.00 Construction :Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? ®Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion.Fee: IBSEISMICR $0.50 Select an Administrative Item.,. Bldg Stds Commission Fee: IBCBSC $1.00 $178.50 $0.00 51 $178.50 Revised: 04/01/2013 Building Department City Of Cupertino ELI 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LISTVIC ° r JOB ADDRESS: ! Q Q O -TZ S0 V! AVC, PERMIT# . OWNER'S NAME: M 0-\A% 9,n l PHONE#4 d G A'q. — 6 C GENERAL CONTRACTOR: BUSINES§jICENSE iL e6 Iq146C ADDRESS: VC CITY/ZIPCODE• 'QI *Our municipal code requires all businesses working in the city to have a C6 of Cupertn o.business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) FILL AE-N UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONT C -ORS HAVE OBTAINED �GITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Si gature Date Please check applicable subcontractors and co ete the following_inforaton G/ SUBCONTRACTOR BUSINESS NAME ' BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood k Glass/Glazing AW Heating Insulation 'x Landscaping E_ Lathing Masonry Painting/Wallpaper y Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 7777 Own e / ontractor Signatures ;, Date