08100109 CITY OF CUPERTINO -
BUILDING DIVISION PERNII'fCONTRAC�T,ORINFORMATIO'�N
BUILDING ADDRESS: � PERMIT NO.
U 2 Q rr is a d F O
'NER'S NAME: PERMIT ISSUE DATE
aco c"421- CS 1r�lel S/lam c= �P� ST /v- /-7- zcMd'
PHONE; SANrfARY NO. CONTROL NO.
ZS — 9^15. 0e00
ARCHrIECnENGINEER: BUILDING PERMR INFO
o 0 0
uoa LICENSED CONTRACTOR'S DECLARATION
WE1 hereby aRrm our I w limned under provisions of Chapter 9(commencing Job Description
with Section 7").f Division Sof On Business and Professions Code.and my licenm is
In.
full Parte sad eRm Lle.N o b
:;29z_ Clens Class '
nt-p Dam Conuacw
7th ARCHITECTS DECLARATION
< 1 undersand my plans shall W used a public record,
BGS Licensed Prefnssional
OWNER-BUILDER DECLARATION
i<y I hereby&from Oat I sm aerept from We Convector's License law for IW
too following mason.(Section 71D I.S.Business and Professions Code:Any city or County
$I! which rtqulmf s Permit m caNlnrtl-her,orprove.dermlish,ter mpalr my Surommm
to Priam itsissuams.alsu requires Oe applicant for such permit to file a signed Montreal
S
< Oat W is licensed'umoant to the provisions of tbo Conusemr'a License Law(Chame,9 Sq.F[. Floor Area Valuation
yFa dou MImfnjwin oomfor.and of DtvuiofroflWBudneuardon.Any
Cade)or
y�3 that W u esempt IMm(rom and Um buu for me alICBW exemption.Any violation of
Scamn 7031.5 by may applicant for a permit sobjecu du applicant m a Civil Penalty of APN Number Occupancy Type
not more man firs hundred dollars(1500).
will
Lu nworof the mep=nY•amycmned wiWwagesuthe'v sok Bonn.will do professions
woos.and Oe ate Com ra not Intended Licar ,Law ed roarsad.apply.to an B neer of
and conywhoW code:The Ca thearo r Lia who law ams ar apply lf an owner is Required Inspections
p =pWybuildsaimprovethereon,andwhodmasmh soak himself.,mrouyh his
awoern,due Wilding
gor Oatsudsimpmwmwitare not ear ofc maRered me sok IL
however,Ne buildingorimgownentg cast did orc year ofcompletion,Oe owe of
builder will have Ort burden of Proving Nat W did Out dtiW a imprwc for purpose of
ale.L
❑I.u owner of the PmperlY•am uclusiwlY cmuatting with limnsed Contrsemn b
cautmn the p Ojett(Sec.7044.Busiens and Professions Cade:)TW ConuanoYs U-
cense law does not apply to an owmr of property who Wilds or improvsa Ounce,and,
who mrtracu fa such project&with a conuscar(s)licensed pursuant In On Communes
License Law.
❑I oro exempt under See .B&P C for this reason
41 mr Data
WORKER'S COMPENSATION DECLARATION
1 Wmby affirm under penalty of perjury ors,of the following dedauatimu:
❑Ihawand will mdnuina Ce,df sof Comentmself-insurtfaWorkefsCampen-
ration,as provided for by Section TKI()of the Labor Code.far tiro performance of On
was for which this permit is issued.
�M1ave and will mdnuin Wakeh Compensation Insurance,u required by SecOm
$70O of the Labor Code.fa me,pe formanecof me were fawhieh this permit is ivad
My Workgo Compensation/Insurance canner end Policy number am:
Carrier. J..-�.-�r. Y'-sd Policy No.: ���0�'l7lJl)J
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crgs secOm need act W eomplcmd if ft souk is foram hunmNdollan(1100)
Ch,las)
I certify Out in me paformem of We work for which this Permit is issued.I shall na
employ any parson in any mamerse at to become saucer an the Workers'Compensation
Laws of Ct lifamia.Dau
Applicant
NOTICE TO APPLICANT:If.after mW ng this Ccnineam of EaemNion,you should
become object or the Worker's Compeouedon provisions of the labor Code,you mug
.J O foMwim comply with such provisions a Wu Permit shall W deemed mwkcd.
zt CONSTRUCTION LENDING AGENCY
[-. 1 bereby alErm ma thcrt is.Conswction lending agency for me peffumanceof
!Yi i me work for which door permit u issued(Sec.3097.Cin C.)
CQ Undoes Name
0 LCodera Adams,
U 0 I mangy Oat 1 have read this application W sum Na On above inumuuun is
LL.F cortin I agree w Comply with all city and county aNinmmes and sum laws reining an
DU Wilding construction,and hereby auWaria,migress aliw50f thin city in Cow upon ft
above-mentiomd property for impectim purposes
FC (We)agree to sane,indemnify rad keep harmless the City of Cupertino so=,
y
liabilities.Judgments,tofu andeapc...which may in any way amm against said City
or 0.'romms of this
U z APP 1 ANf UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S0 REGULATIONS.
MAS I r'0—i7 f9 c' Re-roofs /
Signature of ApplicanUCanuanor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Oe applicant m future Wilding mcupantco m or handle havasdoue material
de0md by me Cupeniw Municipal Cade.Chapter 9.12,and the Health and Saftty
ads,secdm 255320)? All roofs shall be inspected prior to any roofing material being installed.
0y. o
Will me applicant or future Wilding Occupant use,equipment or c ins which If a roof is installed without first obtaining an inspection,I agree to remove
cmh ha>ada s air cmuminsou as&flood by as Bay Ama ter Quality Man,oro t all new materials for inspection.
District?
❑Ya czNo
I have mad he head materieb mquiremenuum ,Chapw,6.95afthe Califon _
nice Healmk Safety Codc,Sections 25505,25533 md=34.I understand thaif me Wilding G
does t curently haw a mourn,tAm It is my mspm libiliry tome unify mcupmt of ma 17,
e V V 1T
mH nIswhichmugbo or to issuanceafaCerti0cauof0ccupancy. Signature of Applicant Date
pd
Owner oumovrA,gea D {
nIIF
Gf�—D c� All ro.9f4overings to be Classor better
x Community Development
10300 Torre Avenue
Y Cupertino CA 95014
Hy M' Telephone(408)777-3228
CITY OF Fax(408)777-3333
QuEkTINO
Building De artment
JOB ADDRESS:ZOZ. eel✓erf �, U� L� S PERMIT #
OWNER'S NAME: 2&Z PHONE # 9zs-9r/s--o9w
GENERAL CONTRACTOR:C0Q(.,F,�.tic, rl?,,,,)' 04,4 FAX #
I am not using any subcontractors: Go-/7-v Y
Date
Please check applicable subcontractors and om lete the-followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
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
Ga l7- c7(?
Owner/r cto
ignature Date
X451 .SYtir.;9 i 1`.. -ti^'air `s+.w..b3c�1 Y"Cr s..:�qr-. e f• t- 'due irk
Nr
M pp .°XYZ ;,
-'4gv L3j--W�W" 1
"`S '{e y." 'SnL,a" ,i �c.r, +�.
R141
ESIDENTI '� MR
03ECT CO ER SHEET h'
swllry`s' a . . MA
: $'- '�.. N,
Assessor's Parcel Number: /�
Name of owner. 2e � UDe4 �9u�t " ;ev 1 1
Project address. 263 5 V,2/-4 c/r- V."
Contact person. ,L�y Phone. YYy- 6601
Fax. _ sro- Y✓3- X60 9
Net square footage of lot.
Existine Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
*e there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the project? Y�N
On what floor(s) is work being done?
Brief description of work. 94,,v+ura2e,�.ov4L s a �� �T: � solo v /b'L�F ,� cJoC(
C?lc
le, sV,dsi a�:( , +� S1cGlng� i 5���� s . �.n� �1 Tr:
Code editions:2008 CBC �-N)2008 CFC (Y -N)2008 CMC (Y-N)
2008 CPC (Y -N)2008. C (Y-N)
E
D D RDINANC
114 P&WRDANE'
Effective 1/1/08 wQE�1ND CDDES p% �
)AT n end pec t;os and RMS n
fis one phe t a�,a3n° of altatati+o0n O
Do nave M tssion
w t D Pty�t Jn t C p parmcstton'
•bu0vn. n a� a CT 1720
��pS bethedPv p ,tn�a Y pro o�
y l
;�ptal O mnance oto�tatP taW a H
1 anv Cdv
Plan Review Process Work Book Page-8-Revised 1/1/08
CITY OF CUPERTINO
• 3 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35719027 . 00
DATE ISSUED. . . . . . . : 10/17/2008
RECEIPT # . . . . . . . . . : BS000006385
REFERENCE ID # . . . : 08100109
SITE ADDRESS . . . . . : 202 CALVERT DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SEQUOIA EQUITY
ADDRESS . . . . . . . . . . : 202 CALVERT DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : EDWARD GREGORY
CONTRACTOR . . . . . . . : JEFFERY FOREMAN - PRESIDENT LIC # 30164
COMPANY . . . . . . . . . . : CALIFORNIA ROOF MANAGEMENT &
ADDRESS . . . . . . . . . . : 5115 E 8TH ST
CITY/STATE/ZIP . . . : OAKLAND, CA 94601
• TELEPHONE . . . . . . . . : (510) 261-4620
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 4, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1CLOSOPNEX EACH 1 .00 428 . 00 0 . 00 428 . 00 0 . 00
1SIDEOTHER SQ FEET 32 .00 367 . 00 0 . 00 367 . 00 0 . 00
------ ---------- ---
TOTAL PERMIT 795 . 50 0 . 00 795 . 50 0 . 00
•
'hum CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
" '3775-
PN #3775 I C1 02;7 UO Date:
Building Address:
v�i� �, Cl� � (09
Mailing Address (if different from building address):
Owner's Name: / Phone#:
cJ u i li:Y;a c fZv-- S'Y1 — 0S0 c7
Contr tor: Phone: Seo- 2 6 /- y6 2/o
Fax: &?'D - 2!61- VZVZ
Contractor License#: p �g L(qsr 3
Cupertino Business License #:
Contact: Phone: FZ s - s-7
• Fax:
Residential Commercial
Job Description: >
s1 c
54
Building Permit Info:
Bld )EI2 Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B _ 3
Valuation: ysU� _ Square Footage:
rprOjectize: Express ER-1--standard ❑ 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:
For help, contact Build it Green at www.buildit reen.or
Revised 7/01/08
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
i
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BBOILERI For the installation or relocation of ca M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1 BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 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 •
1 BBOILER4 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
1 BBOILER5 Install ation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH 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.
1 ELECINSP Other Electrical Inspections (per hour) E
IMECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour) S
1MEETINGIHR Application Meeting B