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09010003 CITY OF CUPERTINO " T BUILDING DIVISION PERMIT y #r� T � fi a; s: PERMIT NO. BUILDING ADDRESS: 1105 ELMSFORD DR AMERICAN HOME 09010003 PERMIT ISSUE DATE OWNER'S NAME: A O. CONTROL NO. (858) 457-4500 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 Q p p LICENSED CONTRACTOR'S DECLARATION Job Description m C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Codeand my license is '`4y in full force in tee 7,9e� RMV&RPLC 7 WINDWS;RETRO—FIT SIZEFOR 2 License Class �7 Lle•S C—a Dam _ Contracto SIZE,LIKE4LIKE RCHITECCS DEC ATION -t 1 understand my plans shall be used as public records �yU iu.y Licensed Professional 01 OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the p Ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county o ${i which requires a permit to construct,alter,improve,demolish,or repair any structure y- rn prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation =G rac that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 E Sq.Ft.Floor Area E r (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $16755 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 APN Number Occupancy Type not more than five hundred dollars(5500). 36206007 . 00 ❑1,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 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.). ❑1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's 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 Contractor's License Law. ❑I am exempt under Sec. B tit P C for this reason Owner Date WORKER'S COMPENSATION 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 Worker's Compen- tion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Whave 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 Workees Compensation Insurance carrier and Policy number are: CartierPolicy No.: .7 CERT KATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 100) or Icss.) I certify 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,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you mast ,J O forthwith comply with such provisions or this permit shall be deemed revoked. 7- CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (Yr the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lendees Name z Lender's Address U 0 1 certify that I have read this application and state that the above information is V.H cored.l agree to comply with all city and county ordinances and state laws relating to Obuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes f>~ (We)agree to save,indemnify and keep harmless Otc City of Cupertino against *_�w HrA liabilities,judgments,costs and expenses which may in any way accrue against said City �r V Z in consequence of the granting of this permit. 06Date /d �_4 AF;PL!p NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Sc C REGULATI NS. I y�� Re-roofs Signature of Applicant/Contractor Dam Type of Roof HAZARDOUS MATERIALS D CLOSURE yP 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 shall be inspected prior to any roofing material being installed. 0 Yes f o (f 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0Yes / o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia d6r-ntly have a tenant.that it is my responsibility to notify the occupant of the is which must met pri t issmanee of a certificate of Occupancy. Signature of Applicant Date -CP All roof coverings to be Class'n"or better Owner or authorize gent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36206007 . 00 DATE ISSUED. . . . . . . : 01/05/2009 RECEIPT #. . . . . . . . . . BS000006894 REFERENCE ID # . . . : 09010003 SITE ADDRESS . . . . . : 1105 ELMSFORD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CATE THOMAS M AND EDNA P ADDRESS . . . . . . . . . . : 1105 ELMSFORD DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4908 RECEIVED FROM . . . . : EDWARD A GREGORY CONTRACTOR . . . . . . . : BRADLEY A. SMITH CEO LIC # 29801 COMPANY . . . . . . . . . . : AMERICAN HOME CRAFT INC ADDRESS . . . . . . . . . . : 6335 FERRIS SQ STE B CITY/STATE/ZIP . . . : SAN DIEGO, CA 92121 TELEPHONE . . . . . . . . : (858) 457-4500 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- -- 1BSEISMICR VALUATION 16, 755 . 00 1 .70 0 . 00 1 .70 0 . 00 1WINREP EACH 8 1 . 00 367 . 00 0 . 00 367 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 368 . 70 0 . 00 368 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 368.70 VISA --------------- TOTAL RECEIPT 368. 70 1213012008 17:49 American Home Craft Inc. (FAX)9164817111 P.0031003 RX Date/Time 12130/2008 1122 510 732 9808 P.002 From:AHCI HAYWARD 510 732 9808 12/30/2008 10:36 #686 P.0021002 j N 12.33 33'333 : �► C, v • .. o'o• oio• •0:0:070.0 0• o o' � a$og000'ogoog ` ` '' C00.070 0 f3 C1' OC 000. 00-O:C G C OOOO C -Y . (+ J rte• �,1(�(C,- k l[ ( 4 i r Na•j-v M,o P m CM O:-h A'V hIDN aDO •e-iVn'+e in - • �i • rte-r r r rr.�•r 'NCV NN {f` i W<(aF 00 ® ® o �W QLu go o.� _ d 2 N LL 009 L Ca til ' o a 0 Lf) �--t O 4 a� ur U0, 0� , 1. q a O 00 s G ' s oFlo y. y IL �.J W N '� ►J� � � � � '�G Y p v 4 °a oaf o �0 - i c m yx 1ss E A o0 4b .�. Z)N J OO '� :F;3 ......_ Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIT1f OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: / I PERMIT # 4 1/0,5- /iMsrd Dr (-)Q o1 OWNER'S NAME: C'a�� PHONE # -- 3 �0 GENERAL CONTRACTOR: ,,, 1-1010n,,= FAX # l=F y I am not using any subcontractors: 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contract r Signature Date CITY OF CUPERTINO CUPEk ANO GENERAL BUILDING PERMIT APPLICATION FORM APN# j, o LS�. (�'� Date: / �- _ LI% �� Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: d,1 a Cale Ila Contractor: Phone: �/ _ 90- 14 m el t'c 4y 11-01",e �/� Fax: !�/6- 11-rif- Z 7 3 Contractor License#: 9 O 70 ? Cupertino Business License#: `� `1 Contact: M u y Phone: t4 CP Fax: Residential Commercial Fj Job Description: `7 Al d 0�-J -- Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/II1/V-A ❑ II/III B, IV-HT,V-B KJ << Valuation: 1673,S- 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.builditgreen.org Revised 7/01/08 CITY OF CUPERTINO Cin OF GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application / 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck'fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone i 1BSEISMICR Seismic Residential B 1BSEISMIC0 Seismic Commercial B l TRAVDOC Travel &Documentation B 1 BUSLIC Business License B 5 of 5 lr M.Indoor Air ua ay and-Fin-res 1.Use Low1No-VOC Pain 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal au Exposed Parfdaboad or MDF 4 IAQ/Health. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yesj 0 S.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 ! ! Total Points Available: 1 1401 1301 57 Total Points Project Received:1 1 01 0 0 41 -P res Gre.W y G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected-xis