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CITE' OF CUPERTINO
, DIVISICIN PERMIT
i� 7�g:A TOR I�U]G�Mt4TION�
BULLDIM1
BUILD NG ADDRESS:
PERMIT NO.
3400 VIA VENTURA UNIT 22
TBD — rO BE DETERMINED
07080161
OWNER'S NAME:
PERMIT L95UE DATE
HENRY LESSING
08/17/2007
4E:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job DOSCTIptIOn
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division3oftheBusinessandProfessionsCode,andmylicenseis
REPLACE LIGHTING IN KITCHEN, BEDROOMS, LIVING,
in full force and eft L
License C Lie.+►
HALLWAY AND ENTRY
Date Contractor
ARCHITECTS DELLA TION r.
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to conswct, alter, improve, demolish, or repair any structure
prior u) its issuance, also requires the applicant for such permit to file a signed statement
Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the
Section 7000) of Division 3 of the Business and Professions Code) or
$1500
(commencing with
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
pN Number
Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty ofa
not more than five hundred dollars ($500).
342550D7
0 I, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
q P
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. 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 build or improve for purpose of
sale.).
0 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
cense Law docs not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
0 I am exempt under Sec B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
,J I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
0 I have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
My Workers C mpensation insurance carrier and Policy � number are:
VE - 01
Carrier. Policy No.,I
CERTIFICATE OF EXEIvNMON FROM WOR ERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I cemtifv 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 Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a concoction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lenders Address
I certify that 1 have read this application and slate 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
j ahovc-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit. "
APPLICANT UN ERSTANDS AND WI L COMPLY WITH ALL NON -POINT
Issued b y: Date
SOURCE REGUL ONS
f fdo J( Qn. 9D�)
Re -roof:
Signature of Appfica;VComractor bate
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
All roof; shall be inspected prior to any roofing material being installed.
❑Yes 14 No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
.tit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new) materials for inspection.
District?
0 Yes %No
I have read the hazardous materials requirements under Chapter 6.95 or the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requirementswhi tbeAt tprioroiss Certificateofpan
Signatur-,y of Applicant Date
-
All roof coverings to be Class "B" or better
..
Owner or autl etized agent
T e
4 x�
a
CITY OF
CUPEkTINO
CITY OF (;
°res
20
a xx uta
�s;... `�•°'a C� '� t' '�i� � �'" �'�' MM-1
� �� �"^-'a' ,-n''°a' mT�z�K��'r�` ..,�.�Y �?�1., w��, ps.�'�a�''•T.�.s"' �* �. - �s a :.0 ..,.
CITY OF
CUPEINO _ r
Assessor's Parcel Number: 03 0 /
Name of owner. --T-- n n
Net square footage of lot.
Elia ti
Propose
Square footage: First floor:
Second floor:
Garage:
TOTAL:
t b 20 foot clear ;:paces inside the garage? �''`N
Are there at least two 10 foo y
Is privacy protection planting required for the :)roj ect? Y ,--,Tq--
On what floor(s) is work being done? 00
s Vi°�
Brief description of work.
-
r �
2001 C 2001 CMC (Y- N)
Code editions: 2001 CBC (�' _ ����� E
2001 CPC (Y t4TE CITY 01
CUPERTINO CODES AND ORDINANCES
SATE` -2-%
Effective 11/1/02 ,iCNEI� �
chis set of t 'n "Is Gr'� spr "ifications MuS.
0e I•Tept on i . job 91, ad lines End it is un
., lawful to e �.n; :�arines or a;tertion,
)n same wit r.�it ,,j i tcn parmission frog
T, Ure builc'in . ;,. City of "upertino.
the stamping of this pian and specification!
.)HALL NOT Ite he;d to permit or to be ar
;pproval of tie violation of any provision
it ihif +f,r C -tr : orn nr t�rritn t .�,v
Plan Review Process Work Book Page -g-Revised 9122/05
�� j E� ` �(] f
Phone. �14�' ` 6 7 7 =
(C'1 �f
C�
Contact person.
�—
Fax. r'I210 ? �
"��—J--
Net square footage of lot.
Elia ti
Propose
Square footage: First floor:
Second floor:
Garage:
TOTAL:
t b 20 foot clear ;:paces inside the garage? �''`N
Are there at least two 10 foo y
Is privacy protection planting required for the :)roj ect? Y ,--,Tq--
On what floor(s) is work being done? 00
s Vi°�
Brief description of work.
-
r �
2001 C 2001 CMC (Y- N)
Code editions: 2001 CBC (�' _ ����� E
2001 CPC (Y t4TE CITY 01
CUPERTINO CODES AND ORDINANCES
SATE` -2-%
Effective 11/1/02 ,iCNEI� �
chis set of t 'n "Is Gr'� spr "ifications MuS.
0e I•Tept on i . job 91, ad lines End it is un
., lawful to e �.n; :�arines or a;tertion,
)n same wit r.�it ,,j i tcn parmission frog
T, Ure builc'in . ;,. City of "upertino.
the stamping of this pian and specification!
.)HALL NOT Ite he;d to permit or to be ar
;pproval of tie violation of any provision
it ihif +f,r C -tr : orn nr t�rritn t .�,v
Plan Review Process Work Book Page -g-Revised 9122/05
10
Kitchen
At least 50% of the total wattage is high efficacI:
Fixture Type High efficacy RelamF ing x Quantity= High -efficacy or Low -efficacy
(y/n) wattage wattage wattage
x -
or
NJA
NO _
X —
or
0
❑
X =
or
_ x =
or
13❑
(Complies if A.> B) Total: A:
B:
Compliant?
YES ❑
NO
0
Additional requirements
YES
N/A
NO
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
❑
❑
❑
ASTM E283 or equivalent. Installation is airtigh' (caulking, gaskets).
High -efficacy and low -efficacy fixtures are switched separately.
Ed Bathroom(S)
YES
N/A
NO
❑
®
❑
All light fixtures are high efficacy.
Incandescent fixtures are switched with manuE I-on/automatic-off occupancy
sensors.
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
❑
El
ASTM E283 or equivalent. Installation is airtight (caulking, gaskets):
High -efficacy and low -efficacy -fixtures are switched separately.
❑
V]
❑
Sd Laundry Room / Utility Roam
YES
N/A
NO
El❑
All light fixtures are high efficacy.
Incandescent fixtures are switched with manuiil-on/automatic-off occupancy
®S
�J
❑
sensors.
Recessed fixtures installed in insulated ceilings are rated ICAT and certified ® M
ASTM E283 or equivalent. Installation is airtight (caulking, gaskets).
High -efficacy and low -efficacy fixtures are switched separately.
�ix
Garage
YES
NJA
NO _
❑
0
❑
All light fixtures are high efficacy.
Incandescent fixtures are switched with manual-on/automatic-off occupancy
13❑
sensors.
Recessed fixtures installed in insulated ceiling-, are rated ICAT and certified
❑
0
ASTM E283 or equivalent. Installation is airtig it (caulking, gaskets).
High -efficacy and low -efficacy fixtures are switched separately.
❑
®
❑
FA Bedroom(s) YES N/A NO
All light fixtures are high efficacy.
Incandescent fixtures are switched with manual -on/au�:omatic-off occupancy
El
sensors OR dimmer switch.
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
ASTNI E283 u- equivalent !n5tallaiior� is airiig! it (caulk I
Me
High -efficacy and low -efficacy fixtures are switched se �arately.
9 I
9d Living loom / Dining Room
YES
N/A
NO
❑
❑
All light fixtures are high efficacy.
All light fixtures are high efficacy.
Incandescent fixtures are switched with manual-on/automatic-off occupancy
❑
❑
sensors OR dimmer switch.
®
®
-.p
r
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
❑
ASTM E283 or equivalent. Installation is airtight (caulking, gaskets).
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
High -efficacy and low -efficacy fixtures are switched separately.
ASTM E283 or equivalent. Installation is airtight (caulking, gaskets).
91 Hallway(s)
YES
N/A
NO
❑
❑
All light fixtures are high efficacy.
All light fixtures are high efficacy.
Incandescent fixtures are switched with manual-on/automatic-off occupancy
❑
❑
sensors OR dimmer switch.
®
®
-.p
r
Recessed fixtures installed in insulated ceilings are rzted ICAT and certified
❑
ASTM E283 or equivalent. Installation is airtight (cau king, gaskets).
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
High -efficacy and low -efficacy fixtures are switched � eparately.
ASTM E283 or equivalent. Installation is airtight (caulking, gaskets).
Ed Entry Area / Foyer
YES
N/A
No
❑
❑
All light fixtures are high efficacy.
n,
Incandescent fixtures are switched with manual -on/ automatic -off occupancy
!�I
®
®
-.p
r
sensors OR dimmer switch.
C°
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
ASTM E283 or equivalent. Installation is airtight (caulking, gaskets).
®
®
0
CD
High -efficacy and low -efficacy fixtures are switched separately.
U)
LO
Outdoor Space(s)
YES
N/A
NO
All light fixtures are high efficacy.
ser sor with a manual-on/off switch
El!
(D
Incandescent fixtures are controlled by motion
AND photocontrol.
-°
N
Ul