08120114 CITY OF CUPERTINO
BUILDING DIVISION PERMIT "tCONTRACT(TR`INk'ORMATID '
BUILDING ADDRESS:- PERMIT NU.
10209 DANUBE TBD — TO BE OFTERMTNED
OWNER'S NAME: PERMIT ISSUE OATS
TN S A a 8 8 CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
moo LICENSED CONTRACTOR'S DECLARATION - Job Description 1 bereby affirm that 1 am lived under provisions of Chapter 9(commercial
with Secuon 70(XJ)of Division Sof de,Business and I'micstimu Code.and my ties.is
nfull forcemdcrt �f RESURFC SPA GFCI PROTCTN TO SPA LIGHT CODE APPRVD
)M_ License Cuss, t b- Lk.N �9d /Zi
Dam C.Ohnewr MAIN DRAIN COVERS
ARCHITECTS DECLARATION
�W� IUMersunJmyplwshall bcused upublic rteords ***COOL POOL SVC, INC. PD BUS LIC 12/17/8
SLicensed Professional
y 3OWNER-BUILDER DECLARATION
1 but oRrm that I am inerept from the Contractor's License Law for the
O O following rearon.(Section 71D 1.5.Busims and Profession Cale:Any city of county
5 L m_ which require a pumit m cmvuuct ober,Improve,demulish,m mpair any suu Lure
Z y prior te its isswrce,rm requires the applicant(or Coes permit te Sle se Law hays'9
< that me liccnudpursuantmthe ofDiviovprtheComunuesLicenseLaw(C Code)
Sq.Ft.Floor Area Valuation
I O (commencing Is exempt Osterman
rmaon]Ond the
Division r of the Busalleged
ess commit Professed.Any
lath)or
i�$ Nat he u exempt iMrmfrom and tM bvu for Use alleged esemption.Any vlolaUon of 2 rJ S S
Secdon 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
mo mere Nan five hundred dollars(SSW).
36949007 . 00
❑1,uw
oner of the prou property,or my employees with wages their sole compensation,
will do the work and the mmihom is not intended apffered for sale(Sec.70m.Business
and Pmresslnu Code:The Contractees License Law dm Out pply m an owner of Required Inspections
properly who builds.,improves thereon,mil who daessuchwarkhimulfar through his
own employers,provided that such improvements are not intended proffered for sale.IL
however.the building or improvement is mid within one year of completion,the amore,
builder will have Ute burden of proving that the did net build or improve for purpo a of
sale.).
❑1,u owner of the property,am exclusively contracting with liccnud contractors to
comuuct the project(See.1044.Business and Professions Code:)The Committees Li-
ceme Law dm mot apply...Owner of property who builds of impmves themom.Nd
who comracts for such pmjeeu wit a conuacuu(,)licensed pursuant in the Contractor's
License law.
❑1 am uempt under Sec .B&P C for this mazon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury ane of the following d"claatiw:
ham and will mainuin a Cetilicate of Consent to salf-Insure for Worker's Compen-
on,az provided for by Section 37W of the Labor Code,for the Performance of thc
work for which this permit is issuM
❑1 have said will maintain Worker's Compensation Insurance,as required by Section
37W of the Usha Code,for Ne performance of the woes for which this Permit Is issued. '
MYW..r 's Cpensuion Insurance carrier and Policy number
r�am
Cartiem ' Policy No.:tj it:
3 25 -6
CERTIFICATE
E)QiIMMON FROM WORKERS'
COMPENSATION INSURANCE
(rhis weenie nerd not be completed if mm permit is faone hundmAdollan(SIM)
err less)
I cadfy that in the Performance.(the work for which this permit is named,I shall not
employ any person in any manner an is m become subject to the Wmimes'Compevxtion
Laws of Califonia .Dam
Applicant
NOTICE TO APPLICANT:IL after making this Ccnificau or Exemption.you should
hecomm subject On the Worker's Compensation provisions or the Labe Code,you mum
.J O forthwith comply with such Provisions or this Permit shall b:decreed reveled.
z^ CONSTRUCTION LENDING AGENCY
[--�� Ihereby Mr.din there,I,.cormtrecOm lemdingagercy,for the perfurmance.f
Cli the work for which the permit Is issued(Sec.3097,Civ.C.)
W Q Lender's Name
= z Lcnd,e.Add.
U Q 1 certify Nat I ham mad this application and sum the the shove information is
tL P conch.l agree to comply with sit city and county ordinances,and state laws raising in
0 U building confuucfion,and hereby authorise mpruenutives of this city in tear upon the
W ahove-mentioned property,for inspection purposes
py (We)agree m save,indemnify and kcep harmless the City of Cupertino agent
luddlidesj (�mnts.c and" ver,which may in any way accmc agsinsl said City
U z in co nee of Ne un f ts prrmiL
UND ST 5 AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CE REG TION
-'a M�� ( L I(>APk Re-roofs
Signamm of AppiicanmConuacmr Dam
/ HAZARDOUS MATERIALS DISCLOSURE Type of Roof 4
Will the applicant or future building occupant mom or budle lurasdous material
a5OcRned by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Cfdc.Section 25532(a)7
❑Yes All roofs shall be inspected prior to any roofing material being installed.
k' o
Will the applicant or future building Occupant use equipment a devices which If a roof is installed without first obtaining an inspection,I agree to remove
harantov air comumivncs as donned by Ne Bay Area Air Quality Management all new materials for inspection.
7
❑Yv Q7NV
I have mmaag�the N:not5orfr5alsmpiremcnts uaJer Chapur6.95.fOmCalifor-
nuHcalN&.Safcly 29S0s.2557J anJLSild.lundcuund their'Uu Wilding
docs nel<u U� a n(w it u my mspontibi)itY te netify tb aceupant pr'Ute
egmiyF m eh prmazaamepracmtir.mpraap y/ Signature of Applicant Date
(l./ � rob
All roof coverings to be Class'W'or better
�
Ow or authari'rrd agent Dain
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 36949007 . 00
DATE ISSUED. . . . . . . : 12/17/2008
RECEIPT # . . . . . . . . . : BS000006842
REFERENCE ID # . . . : 08120114
SITE ADDRESS . . . . . : 10209 DANUBE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CUPERTINO WATERFALLS HOA
ADDRESS . . . . . . . . . . : 10209 DANUBE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2141
RECEIVED FROM . . . . : COOL POOL SVC INC
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 2 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1FENCEMAS> LINEAR FEET 75 . 00 612 . 00 0 . 00 612 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 767 . 29 0 . 00 767 . 29 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 767 . 29 #13326
---------------
TOTAL RECEIPT 767 .29
•
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Lf
E 'J CITY OF CUPERTINO
CITY Of
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
n OUT o 3 Jv
Building Address: ( 0 7A9 rune de D✓ -
Mailing Address (if diffe ent from building address): /
o COs werSlLov't (?OO i ,' SLe o QeA 9-sl 2 S
Owner's N „.e: Phone #:
e,-
Cont actor: GOoL PnoL Sj:W(e-E [ TNc Phone: 6s-p 2V3S—
Fax: SZ) 4Y( 9 $qr
Contractor License#: ti°90 q 2 5-
Cupertino
Cu ertino Business License #:
Contact: �-o Phone: GSD `i'i`f Z,f 3 S
Fax: 65-0 q`(( ?3z?
• Residential LT Commercial 11 ( (oa $- &,5-0 ZZV- 6 3 V 3
Job Description:
6 Fc t pv-t-, q 4
a�'�'ro vep h iu.N �yL'ua1 �bv�s .
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-B
Valuation: 2 Soo Square Footage:
Project Size: Express ❑ 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 10/20/08
CITY OF CUPERTINO
CIN F
CUPERTINO GENERAL BUILDING A
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BBOILERI 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 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
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
1 BBOILER5 Installation/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.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B •
vYr x�.£ji 2c ' „"S„3P3fi '" f v :4 S" _ F`ia+wz+v v ,i•s' sr 1" akkrw.—mss +.
�'' y r ha'by+.�.��z; �+�,� fid' ;',2 �`TVF"-Y�'i" _'�f J'�' ✓,6- '�"t,t„��, stt� �{`zre L ,if a
4'r �S � wt z'Sd ;�`a•-x`•o� r x f� T� r .f fA. 3s mrt',��'N '" - ,v4f1 1�'ta ed.c'PI 'd�T' .'r-, at"�a:Y+a't� t tii��
By. QFC I�?ppg
Assessor's Parcel Number:
Name of owner. C,, ,Q e,
Project address. 10 ZO `7 ba�A",- bi-, .SD( `f
Contact person. k0 d,.z-Ue. Phone. 'IP 3 o 8 b
e 43rwrs�y., �1�t, Fax. ` OE `Ey 3 308 Y
Net square footage of lot. o
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
46e there at least two 10 foot by 20 foot clear spaces inside the garage. N
Is privacy protection planting required for the project?
On what floor(s) is work being done? \
Brief description of work. A4� to exec
ja�aC st. PZ1 co
Code editions: 2008 CBC �-N)2008 CFC N)2008 CMC (Y-N) SPa
2008 CPC (Y -N)2008 NEC -N) a^ Dn a
Effective 1/1/08 at!l2ev ro.-b &i te—
S�oa"e-zQ 0.-
Cs6��b
•
Plan Review Process Work Book Page-8-Revised 1/l/08