09010034 CITY OF'CUPERTINO
BUILDING DIVISION PERMIT �� *
BUILDING ADDRES A: PERMIT NO.
OWNER'S NAME. PERMIT ISSUE DATE
HO SA CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
PANEL UPGREADE NEW COUNTERS
u o c LICENSED CONTRACTOR'S DECLARATION & APPLIANCES (M,E, P) Job Description
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with S..I..7000)of Div mon 3 of the Business and Prof ons Code,and my license is
=y in full force and effect f C O �
r�Z License Class L—� _Lic.8 d
Contractor_fIcAXy I> h t
TARCHITEcrS DECLARATION
I understand my plans shall be used as public records
C6
C Licensed Professional
a y 3 OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors Liccnsc Law for the
COO following reason.(Section 7031.5,Business and Professions Code:Any city or county
K$ which requires a permit to constroct alter,improve,demolish,or repair any structure
y Z prior to its issuance,also requires the applicant for such permit to file a signed statement
=c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
yet— (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or
5a that he is exempt therefrom and the basis for the alleged exemption.My 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(S500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work ands estructureisnotintendedorofteredforsale(Sec.7044,Business ns Required Inspections
and Professions Code:The Contractors License Law docs 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.).
❑1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(See.7044.Business and Professions Code:)The Contractors U.
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 Contractors
License Law.
❑I am exempt under Sec. B&P C for this mason
OwnerDate
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued
My Workers Compensation Insurance artier and Policy number am:
Cartier. f�A 4-e- C-0"/ Policy No.: Z-39 o O 0
/7 1
3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less)
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'Compcnsation
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 dcemcd revoked.
z" CONSTRUCTION LENDING AGENCY
(~i►�-� I hereby alum that there is a construction lending agency for the performance of
L7r the work for which this permit is issued(Sec.3097,Civ.C.)
a0 Lenders Name
Z)
z Lenders Address
U 0 I certify that I have read this application and state that the above information is
LI."0 correct 1 agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
Gia above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rF-m liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit
r"m APPLICANT UNDERSTANDS ND WILL PLY WITH ALL NON-POINT Issued by: Date 1 �/
SOURCE REGULAMONS. CO
/ Re-roofs
Signature of Applicant/Contractorqte o y Type of Roof
HAZARAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant store or handle haiardow material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes /If-7 No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants at defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0Yes le
1 have read the ha=*ms materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
docs not currently ha a tenant that it is my responsibility to notify time occupant n[the
requirements which be t prier issuance ora Certificateof Occupancy. Signature of Applicant Date
Owncrorautharize agent/ Dates f All roof coverings to be Class'J�"or better
Community Development
10300 Torre Avenue
s Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
.,,UPEf�TIN0
Building Department
JOB ADDRESS: PERMIT # 0(007
OWNER'S NAME: PHONE # `&,r C/
GENERAL CONTRACTOR: See co�� c -'or, FAX #
Z-
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/Contractor Signature Date
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner. -S�e ✓�e—
Project address.- 2150 C,
Contact person. J/�"� s S �s Phone. L10 I? S^(!�'l — cl f)z
Fax. 4,,-o P i! /
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage: --
TOTAL:
re there at least two 10 foot by 20 foot clear spaces inside the garage? Y,- f�C
Is privacy protection planting required for the project?
On what floor(s) is work being done?
j_
Brief description of work.
Code editions:2008 CBC N)2008 CFC N)2008 CMC N)
2008 CPC -N)2008 NECM)M AeU�'Iri�3`lka-*
A N AwDCt�RDpNCE'wRHE
N T .....�
G i'nNO CODES AND
Effectiven1:ipwomp- e v S 4t't✓
C,vv K 4� SEL
��; , rations MUS
Th18 set of p.a i l-
�� S •� tae kept on too , t��'idS and it is un
� . �_: or alteration
lawful to ma! �■��
on saw wltti ;;ermission iron V
" the building LAP--, „ipertino.
The sttMnpinB of rh.s p 1 specrfication
3HALL NOT be he a ,r to be a i
,pprMl of the violettun any proves,
anv City CWII "ri`p
Plan Review Process Work Book Page-B-Revised 1/1/08
CITY OF CUPERTINO
CUPE(�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
Cqa 1063 �
APN # Date: �®�D
Building Address: ---7
C � �, p e �l
Mailing Address (if different from building address):
Owner's Name: Phone#: -
Contractor: Tj e r-1 Phone:
_ o t:r, -7 el 0 ! z y
Fax: — 2— l— l �
Contractor License#: - 8'3 O V? O
Cupertino Business License#:
Contact: _ Phone:
Fax:
Residential Commercial
Job Description: ��n e- 5 �, C
Edi, h -Pr-
Building Permit Info:
Bldg ❑ Elect Plumb f3 Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, I-B ❑ IUIII/V-A ❑ II/III B, IV-HT, V-B [g---
Valuation: Square Footage:
Project Size: Express tandard ❑ 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.buflditgreen.ory.
Revised 01/07/09
CITY OF CUPERTINO
Carr OF GENERAL BUILDING APPLICATION
CUPEI�TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
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/ 1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK 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
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 of 5
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types,assigning a"total points'value to a project to be considered environmentally friendly is
not feasible.However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for'greening'your project.
IAO/HealthINPUT Resources Energy
A.Site
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
2.Salvage Reusable Building Materials 4 Resource pts y=yes 0
3..Remodel for Mixed Use,Adaptive Reuse,and
Historic Preservation 4 Resource pts y=yes 0
4.Protect Native Soil 2 Resource pts y=yes 0
5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0
6.Implement Construction Site Stormwater Practices 2 Resource pts y=yes 0
7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
8.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0
9.Reuse Materials/Use Recycled Content Materials
for Landscape Areas 2 Resource pts y=yes 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts -y=yesl 0
1 1 1
B.Foundation
1.Incorporate Recycled Flyash in Concrete
25%Recycled Flyash=2 points;Add 1 point for every 10%
increase of flyash,up to 5 points up to 5 Resource pts 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes 1 0
1 1 1
C.Structural Frame
1.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource pts y=yes 0
2.Use FSC Certified Wood for framing
(For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0
3.Use Wood I-Joists for Floors and Ceilings 2 Resource pts y=yes 0
4.Use Web Floor Trusses 2 Resource pts y=yes 0
5.Design Energy Heels on Trusses 6"or more 2 Energy pts y=yes 0
6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0
7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0
S.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0
9.Use Structural Insulated Panels(SIPs)
a.Floors 3 Energy pts y=yes 0
b.Wall 3 Energy pts y=yes 0
c.Roof 3 Energy pts y=yes 0
10.Apply Advanced Framing Techniques 4 Resource pts y=yes 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y--yes 0
12.Use OSB'
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt y=yes 0
1 1 1
CITY OF CUPERTINO
9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36213005 . 00
DATE ISSUED. . . . . . . : 01/09/2009
RECEIPT #. . . . . . . . . . BS000006933
REFERENCE ID # . . . : 09010034
SITE ADDRESS . . . . . : 7950 FALL CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BERNSTEIN STEVEN M
ADDRESS 7950 FALL CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4114
RECEIVED FROM . . . . : SIERS CONSTRUCTION
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
---------- ------------- ---------- ---------- ---------- ---
1BCBSC VALUATION 16, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BELEC1000 METERS 1 . 00 59 . 94 0 . 00 59 . 94 0 . 00
1BSEISMICR VALUATION 16, 000 . 00 1 . 60 0 . 00 1 . 60 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
1MPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00
1PGASRES OUTLETS 1. 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 400 . 89 0 . 00 400 . 89 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 400 . 89 2032
---------------
TOTAL RECEIPT 400 . 89