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12040064 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10643 GASCOIGNE DR CONTRACTOR:YOUNG'S CONSTRUCTION PERMIT NO: 12040069 OWNER'S NAIVE: PAULSON KIRK I TRUSTEE 14839 CONWAV AVE DATE ISSUED:04111/2012 OWNER'S PHONE: 6507436754 SAN JOSE,CA 95124 PHONE NO:(408)377-6839 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class_ Lic.q,�J� /CJ C. '�. r r r - _ , 4 , �' MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SINGLE FAMILY DWELLING BATH(40SQFT)& (commencing with Section 7000)of Division 3 of the Business&Professions KITCHEN(200SQFT)REMODEL,REPLACE Code and that my license is in full force and effect. TWELVE(]2)WINDOWS;NON-STRUCTURAL;REPLACE EXISTING I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insum 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. 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 Sq.Ft Floor Area: Valuation:$28000 permit is issued. APPLICANT CERTIFICATION APN Number:37528018.00 Occupancy Type: I certify that I have read this application and stale 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, - costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Dale i. �I Z / Issued by: Date: tom, / �-� . - ❑ OWNER-BUILDER DECLARATION RF.-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,1 agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Dale: I,as owner orlhe property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material. Additionally,should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the perfom once of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to became subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation Imes of Califamia. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I mustOwner thorind agent: ( r/sem forthwith comply with such provisions or this permit shall be deemed revoked. - - -"-1eo�—tiZ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGF-NCV 1 certify that 1 have read this application and slate that the above information is I hereby affirm that there is a construction lending agency for the perfomtance of work's correct.1 agree to comply with all city and county ordinances and stale laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify mid keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION 172 ADDRESS: 10643 gasscoigne dr. DATE: 04/11/2012 REVIEWED BY: bobs. APN: BP#: 'VALUATION: $28,000 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD Or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK sfd bath and kitchen remodel replace 12 windows non structural replace existing 100 amp electrical SCOPE panel. i .11;ch. Ilan('hce k Phurih. Plea Checb Elec. Plan Check 0.0 hrs $0.00 Mech. Permit I've. 1,61mh. Pcrmil F.c: Elec. Permit Fee: IEPERMIT Other Alceh. Inv,. Other Plumb Insp, Li Other Elec. Insp. LLO hrs $44.00 Ilath. Imp. Fec: phnnh. Liep. Fee: lifer-.Insp. Fce: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . These&q are based on the prelimina in ormation available and are only an estimate Contact the Dept for addn'I info. FEE ITEMS (Fee Re.solalion 11-053 Ffl.' 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 200 s.f. Remodel, Kitchen (<=300 sf) Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0,00 $588,00 IREMRESKIT PME Plan Check: $0.00 F40 s.f. Remodel, Bath(<=300 sf) Permit Fee: $0.00 $588.00 1REMRESBAT Suppl. Insp. Fee:Q Reg. 0 OTTO-OThrs $0.00 = # Window/Sliding Glass Door PME Unit Fee: $0.00 $522.00 I iVINREP Replacement PME Permit Fee: $44.00F-100 amps Electrical COII.Sll'll(410P7 Tia: IE $44.00 RT-200 Services Administrative Fee: !ADMIN $41.00 0 Work Without Permit? Yes 0 No $0.00 0 Advanced Plannim Pee: $0.00 Select Non-Residential Q Building or Structure 0 Travel Documentation Fee: ITRA VDOC $44.00 A Strove Motion Fee: IBSEISMICR $2.80 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $133.80,$1,742.001 TOTAL FEE: 1 $1,875.80 Revised: 04/01/2012 Building Department City Of Cupertino 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 LIST JOB ADDRESS: PERMIT OWNER'S NAME: PHONE# GENERAL CONTRAC OR: BUSINESS LICENSE # ADDRESS: =3 - TY/ZIPCODE: *Our municipal code r quires all business s working in't a city to Aave a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE STAINED A CITY OF CUPERTINO BUSINESS LICENSE. / 1 am not using any subcontractors: �r Signature Date Please check applicable subcontractors and.complete the following information: ♦/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Shect Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec,: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 37528018. 00 DATE ISSUED. . . . . . . : 04/11/2012 RECEIPT #. . . . . . . . . : BS000016518 REFERENCE ID # . . . 12040064 SITE ADDRESS . . . . . : 10643 GASCOIGNE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . OWNER . . . . . . . . . . . . : PAULSON KIRK I TRUSTEE ADDRESS . . . . . . . . . . : 7765 N SILVER CREEK RD CITY/STATE/ZIP . . . : PARK CITY, UT 84098 RECEIVED FROM . . . . : BURTON H YOUNG CONTRACTOR BARTON YOUNG LIC # 22763 COMPANY . . . . . . . . . . : YOUNG'S CONSTRUCTION ADDRESS . . . . . . . . . . : 14839 CONWAY AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE (408) 377-6839 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- --- --------- ---------- -ADMIN HOURS 1.00 41. 00 0. 00 41. 00 0. 00 1BCBSC VALUATION 28, 000.00 2. 00 0. 00 2.00 0. 00 1BSEISMICR VALUATION 28, 000.00 2.80 0. 00 2 .80 0. 00 1EPERMITFE FLAT RATE 1 .00 44.00 0.00 44 .00 0. 00 1ERT<200 UNITS 1 .00 44..00 0.00 44 .00 0.00 1REMRESBAT SQ FEET 40 .00 588.00 0.00 588 . 00 0.00 1REMRESKIT SQ FEET 200 .00 588 .00 0. 00 588 . 00 0. 00 1TRAVDOC FLAT RATE 1.00 44 . 00 0. 00 44 . 00 0. 00 1WINREP EACH 8 12 .00 522 . 00 0. 00 .522 . 00 0..00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1875. 80 0. 00 1875 .80 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- ------ -------------------- CREDIT CARD 1, 875.80 VISA --------------- TOTAL RECEIPT 1, 875.80 RESIDEN ' A .PROJECT COVER SHEET Assessor's Parcel Number: i ti Name of owner. / �I � - r Project address. � � &4 K Contact person. Phonk QZ ax. Net square footage of lot. T Existine Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y RECF,gv�D Is privacy protection planting required for the project? Y N APR 1 1 2012 Build it Green Total Points 13Y: On what floor(s) is work being done? Brief description of work. ���� "l ( `G(�L`j of (il I�c 1 �i�IO�F CZcJ y�bleeC� Ci?cl Code editions: 2010 CBCN)2010 CFC N)2010 CMC N) V 2010 CPC (CV-N)2010 NEC N) California Green Building Standards Code 2010 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO Effective 1/01/1>m APPROVED is set of plans and specifications MUST be kept at the c, r job site during construction. It is unlawful to make any changes or alterations on same,or to deviate therefrom,without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law. 11--10 �� / DATE 2 PERMIT NO. iZ DD Plan Review Process Work Book Page-8- Revised 12/21/10 b . S: 4- 3'vO 2 I � APR S lllq— lo� JW - C � - � � � �(� � �►' �� £'fit-�'�,. �-7 b � o CONSTRUCTION PERMIT APPL ATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DMSION I�� OO r _ r 10300 TORRE AVENUE•CUPERTINO, CA 950143255 V,"� CUPERTINO (408)777-3228• FAX(408)777-3333• buildingftupertino.orD ❑NEW CONSTAUCIION ❑ ADDMON ALTERATION/TT ❑ REVISION/DEFERRED 0RIG1KAL PM1,aT R FROLECr ADDRESS ) APN a 2n -D OWNER NAME ( PHO ✓ 1 •./ESM 1 STRPfTADDRESSCITY.SPATE T1P \ FAX 1 WNTACT NAME ONE In '2N V,N. STREET 0 QTY,STATE. IIP ieT 11 OWNER 13 OWNER-BUILDER ❑ OWNEAAGFM CoNRUCTOR ❑COMIUCTORAGENT ❑ ARCRRECr ❑FNOwEI ❑ mvmoPER ❑TENAHT CON'IRACIOR. LI NUMBER LICENSE TYPE BUS.L:CP COMPANYNAME S� E- DOMAE FAX ` STREET Ah /I CITY.SPA 9 ARCHTPER/ENGINEER 1`LICENSE NUMBER S� BUS.uc l / COMPANY NAME E-MAD. FAX STREET ADDRESS CITY,STATE ZIP PHONE DESCRIPTION OF WORK otivl I �ytd a Q t laC �r o <1 Dr,t r e �ac-p -+� 7'/�Al�h -2n�'cQ ccs e:2 as ►m EXL7040 PROPOSED USE CCNSMTYPS 0STURDES USE. TYPE OCC SQ-Fr. VALUATION(S) FASTO LJ-Cf•/• RZOR r DFMD TOTAL AREA AREA AREA NETAREA 1• OTHER - REMODEL _ /,n RFMODELARFA / REMODEL RFMOOp. V A t? �(7 l.' Cc6� PORCHAAEA DEtXAREA TOTAL OECWPORCH AREA OARAGEARPA: DETACH `-[. / ATTACH O DWkiJ-DIG UNTR: ISA SECONDDMT YEs 56 0"31`ORY YES _ REGIO ADO®x ONO AODrn r, ONO FRE-APPLICATRRV OYES rFMPROvma COPYOF, iSTEESLOOAN CI YE RECEIVED BY. TOT "V U ON: PNANNINOAPPLP ONO PLANNING APPROVAL LETTER KICBLaRBOMBx ONO —1 By Oxy sipatore below,I cer-tify to each of the following: I am the property owner or Ruth.. aeent tD act On the pryTLerty,awnds behalf. have tad this applicalian and the mfotmatim I have Provided is cetrect I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ardm®ces and stateawn lrelating m hurl ' m tc=tiaa I authorize repre5mtatives of Cupertino m eater the above-ide rtl5ed property for mspecd.On purposes. Sigoa�e LITE Applicant/Agent: Dam: SUPPLEMENTAL INFORMATION REQUU= PLAN CBECKTYFR ROUMNG SLIP New SFD or Multifamily dwellings: Apply for demolition permit far CT-'— o ,�CooM,� �LM W eaistmg building(s). mi g(s). Demolition pert is required prior to issuance of building permit for newbutlding. ❑ mt7R= ❑ PLANNING PLANREvLZW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ SEAMARD ❑ PUBLIC WORM Farm if any Hazardous Materials are being used as part of this project ❑ LARGE ❑ Fins awr _Copy of Planning Approval Letter at Meeting with Planning prior to ❑ MA.toa ❑ sANrrARY Da rxrR submittal of Bwld n Permit application. ❑ EISv11tOMMIETAL HEALTH. BldgApp Z011.dx revised 0612j111