08010058 (2) CITY OF CUPERTINO v anag, . gwa
BUILDING DIV?SION PERMITCONTRA °TOR INFO A'IIi
".,;! < .
BulLT �6gDRFsFIG TREE CT TBD — TO BE DETERMINED PER 08010058
OWNER'S NAME: - PERMIT ISSUE DATE
PAT SHEFFER 01/10/2008
NE: SANITARY NO. CONTROL NO.
ARCHTECUENGINEER: BUILDING PERMIT INFO
200 AMP PANEL UPGRADE, BLDOO 8
PLUMB MECH O
3ci; LICENSED CONTRACTOR'S DECLARATION
!fiIlmrebyafnmdWlwll¢nsedunderprovidonsafCnepwr9(mmmcncing ^-^' ^^ ^-"^^^^^^-^ - SobiDescnption
with Session TOM)of Division 3 of the Busincu and Professions Code,and my licesse is
e❑ in full fare.end effen.
P3 Z Lmenm Class Lk.N
9 yt Dam Courtesan ARCHITECTS DECLARATION
g I underhand my pons"I W used a public rvorda
5 U
k G Licensed Professional
5 OWNER-BUILDER DECLARATION
COO
9 1 hereby aRrm that 1 1. attempt from the Contras Cas License Law for the
i 0 o following moon.(Sadao construct.
Busiest and Professions Code:My city m county
S$ wined requires•e.ohm no codes dw river.impmw,demWit t w e a sig emy d svunum
_Z y Pnw m be issuance.r man,to to tM applicant for such Permit m filenuum Law(Chapter
FF<
that neianamedpa�ction7 epmaaiomarthe oftheBrutoral�ma�onsCapar9 Sq.Ft. Floor Area Valuation
5 a
(consummating with Section and of Division S of the egad Business and Proon.Myons Cade)or
that W b..pt therefrom and sive bub for the alleged exemption.My violation of
Secdm?031.5 by any Applicant far a permit mbjeces the applicant to a civil penalty of APN Number Occupancy T
not Wduo R.hundred dalWs(S(3500). P Y YPe
ort
❑1,u owner of the property,a my cWployev witio wage u theirsale compensation,
will do the work and d eswcture is imtineended oraRerad Ramada(Sex.7041,Business
and Pmresnoa code:The Committee License Law does Out apply W an owner or Required Inspections
property who buildsor(mpmvu theme.and who doesmuchworkhimselfathmugh his
own employees,pmvided situ such impmwmva tae rot inu nded oroRered for sale H,
however,the Wilding ar improvement b sold within and,yea of sampmtim.the owner.
Wild.will have the hurdm of pmring that W did Out Wild or Improve fw purpose of ,
ssle.} ._
Los owmr of the properY.am exclusively contracting with licensed mntracmrs to -
construct the proJect(Sec.?064,Business am Professions Cade:)net Cmuavos.U.
.Law dna at apply Mo..of pmpeny what Wilds or improves dar am,and,
who contracts for such projests with a"Wasm r(U licensed Personal m the Convenor's
License law.
❑Ism esempt(W��Pr Sm Bk PCforthisnemn
own. \ A Dam 1—/1'be�_
DICER'S COMPENSATION DECLARATION
l Wmby,firm odder Formally of perjury one of we fallowing declaatiens:
DI haw trod vest Wainum.Cmdfiamaf Co..,m self-Nan.for Worker'sCompen-
an,u provided far by Section 37M of the Labor Cade,for due performance of the
wart for which thin Fait Is Issued.
❑1 have and will maintain Worker's Compsnssuon Iuunnce,as resulted by Section
3700 of we Labor Coda,for the performance of the wart far which rob R.I,41ssw1 '
My Worker's Compensation Insurance artier and Polies number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Inds secHm wed Out he completed If the permit in fauna hundredaa0an(SIM)
of lett)
I eerily that In the performance of the work for which this Permit is issued,l shell not
employ any person in my manner an as oma subject W the Worker'Compensation
I.of Cs11fo15L Dat
Applicant ll ll b
NOTICE TO A CANT.IL arwr making this Cenincaw of Exemption.you should
become subject in the Worker's Comwnsmtion previsions of the LaWr Cada,you most
.J O forthwith comply with such provislom w this Permit shall W e
dammed reked.
CONMUC11ONLFNDINGAGENCY
'Tr which
this
mat Vert bamuwNnn7,Cing agersy Ter the penormarm of
Ul > the wort rte wnmh this Permit b issued(sex.3891,civ.e)
CL Q lender',Nee
0 z Lender's Address
V 0 1 cendly that I Mw read this application and m c that the above I.[..do.I,
11, E comm 1 agme m comply with all city and county ordinances and slow[am relating m -
-0SU' Wilding construction,and Wmby mmonm representatives of this city to enter upon the
[t7 .hove-mentiomd mopony for inspection purpoxea
gy (We)agree to saw,indemnify tad keep harmless the City o(Cuperino against
rr IA Ilabllides,Judgmanb,eom andenpan...wMO may in any wayaccruesgama amid City
U in comogwme of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (J-�
SOU REOU�`TIONS. �,
aJP I—eo—o's— Re-roofs
Signs,urteOTApplicarO ConOmcWr Dow /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding aceurnant ams or handle haystdons material
an defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
Code,Senior 23532(e)?
❑Ya 176N. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant um equipment or devmrs which If a roof is installed without first obtaining an inspection,.l agree to remove
L haaNnu air contaminants U defined by the Bay Amo Air Quality Management all new materials for inspection.
uict?
❑Yom �l Nu
1 have mad the hmrdons runmol,reithr mores under Chopmr 6.95afthe Califor-
nia Had"Safciy Cade,Sce6ow 35505,25533 md25534.1 undersand twelfths Wilding
law t curmnd haw a mnan�that I,b s w
My reSpOnamility W notify dcuP at of Ian
rt eau which mutt W mel or W ssumn,of a CeNncem iof Occu
Tri .�a Signature of Applicant Date
Owner or authorirnd agent Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
l 005
APN# I O l� ) Date.
Building Address: . W
Coq (1 F*, c.7 C- -. LV(>rr,jJ, 'jnd r C.CA- . to
Mailing Address(if different from building address):
Sarr.�
Owner's Name: Phone#:
?CL-t 408 - 446-22,47
Contractor.5o,Q--o:.Ae Ekca+.Lc Cc...pn^-1 Tor c. Phone:-4o9'- 2-50 3�-S -r
K-t-644n R. Swwhson Fax: yob - Srlo - 32�1Z
Contractor License#: C -%o -a 9 r;L v y
Cupertino Business License#:
Contact: C<X*J%,( S\r+e"--,r Phone: 404x- 14Ll (c- 2L147
• C-.a I r
Faz:
Residential Commercial
Job Description: Zpo fi-nP Pa,v-j .C�Pgra�
View 2-6n5 X '7
1i,ylgll new Gavage F/voresreK} Iz��ls X4
L�sf:�)t New -door 131. x S
Building Permit Info:
Bldg ❑ Elect [$I/ Plumb ❑ Mech❑
Type of Construction(Usage Class): Occupancy Type:
1 FR, 11FR 11 111 V-IHR 11 111 1V V-N I`--3
Valuation: y — Square Footage:
Project Size: Standard ETLarge❑ Ma'or
•
J CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BTEMPPER Temporary Building Permit (good for B
30 days)
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
• & incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower.
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLM13INSP Other Plumbing& Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
CITY OF CUPERTINO
CUPEI,TINO GENERAL BUILDING
PERMIT APPLICATION FORM'
APN# Date:
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#:
Contractor: Phone:
Fax:
Contractor License#:
Cupertino Business License #:
Contact: Phone: .
Fax:
Residential Commercial
Job Description:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N ❑
Valuation: Square Footage:
Project Size: Standard ❑ Large ❑ Major ❑
•
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
1ACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1 CHHVINEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL.>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION .
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
IRETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
IRETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1SIDEST/BK Siding, Stone & Brick Veneer B
interior/exterior •
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
I SKYL>1 OSF Skylight greater than 10 sf or B
structural
ISTAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B
I SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 so B
additional stucco application
•
4of5
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
I STPLNCK-(3 Hr Min Standard Plan Check (when no E8W) B
when not over counter) hourly-stand alone
1TRAVDOC Travel &Documentation B .
1BUSLIC Business License B
•
5 of 5
' 1
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31630080 . 00
DATE ISSUED. . . . . . . : 01/10/2008
RECEIPT # . . . . . . . . . : BS000003660
REFERENCE ID # . . . : 08010058
SITE ADDRESS . . . . . : 19911 FIG TREE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PAT SHEFFER
ADDRESS . . . . . . . . . . : 19911 FIG TREE CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CATHERINE SHEFFER
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC . # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 6, 000. 00 0. 60 0. 00 0 . 60 0. 00
1ELECINSP HOUR 2 . 00 244 .76 0. 00 244 .76 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 326.94 0 . 00 326 .94 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------- --------------- --------------------
CHECK 326 . 94 # 2135
---------------
TOTAL RECEIPT 326 . 94
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
ffCUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
149 Q FIG Veer c.-r. 1 69 S-' o foo s"
OWNER'S NAME: e EP-- PHONE #
GENERAL CONTRACTOR: SAFE$1Di ELre'T(6e- CaM na FAX # qog - sl(,, 528 2—
I
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical $nFF D� klECfrzle Co
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
o^v+:
> . Community Develop;Hent '
4 ;,-• : 10300 Torre Avenue
:1
Cupertino CA 95014
CITY OF Telephone(408)777-3228
Fax(408) 777-3333
. CUPEkj1NO
Building Department
All Cupertino building permits must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORMWATER POLLUTION CONTROL
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water District control stormwater pollution. Educating local
residents and businesses and enforcing stormwater pollution control laws are key parts
of the City's compliance efforts.
Stormwater pollution prevention, It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife
dependent on our waterways, for people living near streams and baylands, and for the
local water supply. Common sources of stormwater pollution include:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• Landscaping runoff containing pesticides or weed killers; and
• Any material dumped or spilled into streets or storm drains O
The property owner and the contractor share ultimate responsibility for activitiesC�
occurring at a construction site and will be held responsible for any environment
damage caused by subcontractors or employees. PjLfl
For more information on construction-related stormwater requirements, see the u
Stormwater Quality Regulations section.of the City of Cupertino web site at: v
htti)://www.cui)ertino-org/city government/departments and offices/ �l r�7
environmental services I - n
FLJI
COMMUNITY NOISE CONTROL O
The basic noise control requirements for construction sites are as follows:
Typical construction work hours are:
- Weekdays - 7 a.m. to p.m,
6
- Weekends - 9 a.m. to 6 p.m. 1
Construction other than street construction is prohibited on holidays.
Residential daytime noise levels from complaint site - 60 dBA JAN 1 0 pppg
Nonresidential daytime noise levels from complaint site - 65 dBf
For more information on noise control, please see Chapter 10.48[�of the Cuperti o
Municipal Code, which can be accessed at http'//www.amlegal.com/cuoertino ca/
Greg Casteel
Building Official
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