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07050074 CITY OF CUPERTINO ' BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 10196 CAMBERLEY LA MARTIN LARRY W AND JUDITH H 07050074 PERMIT ISSUE DATE OWNER'S NAME: MARTIN LARRY W AND JUDITH H 05/09/2007 SANITARY NO. CONTROL NO. ONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a a a 0 1W p LICENSED CONTRACTOR'S DECLARATION Job Description Lu I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z�d with Section 7000)of Division 3 of the Business and Professions Code,and my license is BATHRM CABINETS, SINK, PLUMBING,ELECTRICAL `e 0- in full force cn j Z License Class d effect. Lic.x OUTLET,ADD GCF I OUTLET :Ftp Dam Contractor +a ARCHITECTS DECLARATION 7 C2 a I understand my plans shall be used as public records UJ L) ' U.l- Licensed Professional O j OWNER-BUILDER DECLARATION i�CO 1 hereby affirm that I am exempt from the Contractor's License Law for the Ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county <m which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq..-'t.Floor Area $8000 ti F a (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type not more than five hundred dollars($500). 3 4 2 4 2 01 8 . ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of Q p 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.). [jy!!llrowner of the property,am exclusively contracting with licensed contractors to .g TARY construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li. cense Law does 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 Contractor's r License Law. ❑lam exempt a de See. B&P C for this mason Owner ¢¢-�A4.4Date exempt COMPENSA71ON DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workces 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 Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is fpr one hundred dollars($100) or less.) I certify,that in the performance of the work for which this permit is issued,1 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,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY (-r rA I hereby affirm that them is a construction lending agency for the performance of a > the work for which this permit is issued(See.3097,Civ.C.) aA Lender's Name Z Lender's Address U 1 certify that 1 have mad this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to UU building construction,and hereby authorize representatives of this city to enter upon the � above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against V) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. ( Date ►' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE RE ULATIONS. 46?-:Z Re-roofs Signature ofAppli ontractor� Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE 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 roofs shal I be inspected prior to any roofing material being installed. ❑Yes Will the applicant or forum building occupant use equipment or devices which If a roof is in!talled without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes L]LW-- I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,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 reyuiremenhich must be met prior to issuance of a Certificate of Occupancy. Signature of 1,pplieant Date t w, =9ZI6_7 All roof coverings to be Class "B"or better Owner or autbd ved agent Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34242( 18 .00 DATE ISSUED. . . . . . . : 05/09/ 2007 RECEIPT #. . . . . . • • • : BS000(,01258 REFERENCE ID # . . . : 07050(74 SITE ADDRESS . . . . . : 10196 CAMBERLEY LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MARTIN LARRY W AND JUDITH H ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPER-INO CA, 95014-2633 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : MARTIN LARRY W AND JUDITH H ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPER-INO CA, 95014-2633 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- BPFIXTURE UNITS 2 .00 18. 00 0.00 18 . 00 0 .00 BREMRECEPT NO. OUTLETS 2 .00 2 .40 0.00 2 .40 0 .00 BSEISMICRE VALUATION 8, 000.00 0. 80 0 .00 0 . 80 0.00 EPERMITFEE FLAT RATE 1 .00 38.37 0 .00 38 .37 0.00 PPERMITFEE FLAT RATE 1 .00 38 .37 0 .00 38 .37 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 97. 94 0 .00 97 .94 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------------- CHECK 97. 94 1285-LARRY MARTIN --------------- TOTAL RECEIPT 97. 94 CITY OF CUPERTINO 1n of PERMIT APPLICATION FORM CUPS TiNO �? / C�•�� � �/ ADDITION/R]��MODEL tt// APN# Date: Building Address: Q 9 (g Cc,,,, 6e-(- 1,4�1 Za xe C,-puri-IAO) CA . `i5© I4 Mailing Address (if different from building address): Owner's Name: Phone#: -4 116 10.5 Contractor: Phone: State License#: Fax: Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: c � aa,., X-42 x CJAC41CA I>VV A\ Bldg ❑ Elect Plumb Mech ❑ -�- � Job Description: What is being added? New z / I S"q,itn OGc�� p� C S.e G� b Ccc K Pcc 9 rCC,-'t What is being remodeled? ,Sc'n k F (k rK ^ l 011 ;c4A 0V\eVQ 6:, e c12c�r�cw .' f� R Q v 'M�i y /� ( i T o� ©n.9- 1s�1 T 2 �ccflcGa� d •1 2 i e S� �C� Residential Commercial ❑ Remodel Includes Re-Roof: Yes❑ No Remodel Includes Structural: Yes El No Lam^ u s fi rep f a L Square Footage: Addition: Remodel: Garage: Porch: Deck: Other: RO .8Occupancy Group- Cost of Project: Q rv � • Type of Construction: . a e- Please check this box if the project is a ' second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ *For office use only* ElOver the counter 1 of 3 CITY OF CUPERTINO CinOFPERMIT APPLICATION FORM CUPEf�TINO ADDITION/REMODEL Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> M to 1.75 M Btu MECHANICAL BBOILER5 Boile:-> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Olf/Comm/Quasi BUILDING BCONSTAXB Con. Tex for BQ Zone BUILDING BCONSTAXH Hot,-1 and Motel BUILDING BCONSTAXR Constar—Resi/Mobile BUILDING BELEC1000 Elec 6)OV <= IOOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. =lousing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Ins a;tion Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg,Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Pi-)ing System Fee PLUMBING BPINTERCEP Ind Waste Interce for PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT ' Alt of Drain &Vent PLUMBING BPWATER InstaB/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Mair. Water Service PLUMBING 2 of_; afftCITY OF CUP'ERTINO f OF PERMIT APPLICATION FORM CUPEkTINO ADDITION/RI-MODEL Quantity Fee ID Fee Description Fee Group BREINSPECT Reins pection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Unit;; <= 10,000 cfin MECHANICAL BREMAPPLI A l ance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fuinace> IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Miss,Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Dovice/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Reloc ation of Hood MECHANICAL BREMREPALT Re-pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remode: Signs, Marquee ELECTRICAL BREMTHEATR Theatrii;al Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb 3 ecific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem oirr ary Bldg Permit BUILDING BTEMPSVCS Ter-1p Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumhng Permit Issue PLUMBING PPLBG Plumbing F e sq foot PLUMBING PLLONGRNGC Planning LI:Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Ad 3ress Chane BUILDING 3 of'� i DOLU CUPEkTlNO �w .. _._ ... Assessor's Parcel Number: ?Name of owner- ^a r 4 Project address. ( 96 Pte. Contact person. Fax. y C, C Net square footage of lot. Existing Proposed Squars footage: First floor: Second floor: ' Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? ] Is privacy protection planting required for the pro]e ct? On what floor(s) is work being done? Brief description of work. r f(e F G Code editions: 2001 CBC (y -�- 2001 CFC -N)2001 CMC (Y-N) 2001 CPC (Y - 1)2001 NEC (0-N) Effective 11/1/02 O/P 000 y PlanReview Process Work Book Page-8-Revised x/28/04 _ SiI�E �i R��JC � _ CUPEkTINO Assessor's Parcel Number: �^ Name of own-er. /�``'`rr - Project address. ` Contact person. y $ `� ax. Net square footage of lot. Existin ; Proposed Square footage: First floor: Second floor: T— Garage: TOTAL: 0 foot by 20 foot clear space:,inside the garage? Are there at least two 1 ec:t? Is privacy protection planting required for the pr o J On what floor(s) is work being done? Brief description of work. 2001 CFC N)2001 CMC (Y-N)Code editions: 2001 CBC (Y -X2001 NEC �-N) 2001 CPC (Z' - rNGNUS ACCORDANCE NIITliT CUPERTINO COD f HE C1TY S AND ORD IN Effective 11/1/02 )ATE ANCE, >ICNEU his Sti arra �.j;� e ke the �r d p;crfications a bVfUi p en h a I times NJUS; to make r<n; ;�— or sam ,�R&C. and itis nn tool 5 Q �+� ,t, e wrthou' va,iiiEnb y o or alieratiorr, E bu;lding Dr; r,; p�'missi f on The s"ampinb cfihi� y of Cnrertino. fron _.. ..__..... _- 3HI LL N "Pan �a c NOT be he; °'L peafication; ` 3Apr ova! of d to permit the violation of .ny or to be at 'f a►V CfW Orainarrce or ytare provisrn, Page-B-Revise4/28/04 Plan Review Process Work Book d Community Development 10300 Tone Avenue Cupertino CA 95014 Telephone(408)777-3228 CFax(408)777-3333 '"UPEkTINO Building Department All Cupertino building permits must meet zertain conditions related to maintainir)g environmental quality and public peace an J 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 3tormwater 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. StormwatE!r 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 storrnwater pollution include: • Dripped oil, fuel, and antifreeze from ✓ehicles and heavy equipment; • Construction debris, including dirt, concrete and paint; • Landscaping runoff containing pesticides or weed killers; and • Any material dumped or spilled into s':reets or storm drains The property owner and the contractor share ultimate responsibility for activities occurring at a construction site and will be held responsible for any environmental damage caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations section of the City of Cupertino web site at: http://www.cupertino.org/city government/departments and offices/ environmental services COMMUNITY NOISE CONTROL The basic noise control requirements for construction sites are as follows: • Typical construction work hours are: - Weekdays - 7 a.m. to 8 p.m. - Weekends - 9 a.m. to 6 p.m. • Construction other than street construction is prohibited on holidays. • Residential daytime noise levels from complaint site - 60 dBA • Nonresidential daytime noise levels from complaint site - 65 dBA For more information on noise contro , please see Chapter 10.48 of the Cupertino Municipal Code, which can be accessEd at http://www.amlegal..com/cupertino ca/ Greg Casteel Building Official OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (perent,spouse or child) will perform A. _ All the work authorized by this permit B. A portion of the work C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete section below) Contractor1 ,MI5,esT Phone # State License # Type of work to b ( 3s'�f c �° 716a 5 6O 9 f darn=a 3. _ I will utilize unlicensed person(s) oth ar than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers compo isation must be on file at the City of Cupertino Budding Department office. Person/Firm Address,/City Phone Number Type of work to be performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). Property Owner's Signature• G✓ Date: Job Address: J 9 �a (� �� j ti �a '` Permit# Any changes to the.information provided on thi;;form shall be submitted to the City of Cupertino Build Department. Community Development 10300 Torre Avenue E Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Buil din ; Department JOB ADDRESS: / Rs,,(4, PERMIT # OWNER'S NAME: LA rr L. 1 l PHONE # "72- 7 4,3 9 GENERAL CONTRACTOR: 0 6 FAX # 402? R 9 6-- 3 S I am not using any subcontractors: Signatuxe Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINES,13 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 r ou,9 CX SXR r d -,2 6 �s Roofing Septic Tank Sheet Metal Sheet Rock Tile -7 Owner/Contractor Signature Date JUL-12-2007 15:08 MARK THOMAS CUP 4082535173 P.01i01 DISTRICT MANAC+E.R•ENGINE>=F2 B OARD OFr DIRECTORS ' MARK THOMAS&COMPANY,INC. DAVID£.1055 w� STE'Ptife'N C.ANDREWS -� WILLIAM A.BOSWORTH "F JOHN M.GATTO DISTRICT COUNSEL CURTIS B.HARRISON ATKINtSON•FARASYN,LLP. WSNDELL H.K£RR,JR. HAROLD S-TOPPF_L. 20888 STEVEN$CREEK BOULEVARD,SUITE,104 CUPERTINO.CALIFORNIA 9501"1 S4 14012537071 PHONE - 1308)2535''13 FAX www.cupertinosanitarydistrict.com File: CuSD—MOP Building Dept. Cupertino City of Cupertino Attn.: Building Department 10300 Torre Ave. Cupertino,CA 95014-3202 Subject: Batbroom Remodel Name: Martin Residence Address: 10196 Camberley Lane APN: 342-42-018 Permit No.07050074 ,No additional conditiolWrequirements by the District Inspector: George Santos (} l �V C Date:...07-12-2007................... Sanita Sewer Luca 'on: cc: Property Owner TV inspection waived. SUPPLYING SANamy SEwMAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITFS OF SARATOGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCO ZPORATED AREAS TOTAL P.01