Loading...
09010097 CITE'OF G PERTINO ��,�T �r T BUILDIt `VISION PERMIT PERMIT NO. BUILDING ADDRESS: PERMIT ISSUE DATE OWNER'S NAME: A 8 9 CONTROL NO. 'r-10 BUILDING PERMIT INFO ARCH1TECr/ENGINEER: BLDG ELECT PLUMB MECH 0 u p p LICENSED CONTRACTOR'S DECLARATION Job DOSCnptlOn m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z� with Section 7000)of Division 3 of the Business and Professions Code.and my license is 7=y in full force and effect RPLC WTR HEATER & 18" .PLATFORM IN GARAGE v�z License Class Lic•N n t-0 Dam Contractor ARCHITECI"S DECLARATION I�< 1 understand my plans shall be used as public records :J W 4 O y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following mason.(Section 7031.5,Business and Professions Code:Any city or county K which requires a permit to construct,alter,improve,dem"lich,or repair any structure prior to is issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq YH$ (commencing with Section 7000)of Division 3 of the B usiness and Professions Code)or i .. that he is exempt therefrom and the bass for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars($500). 32608070 . 00 ❑I,as owner of the property.or my employees with wages as their sole compcnsadon, 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.). Strumowner of the property,am exclusively contracting with licensed contractors to o tram 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 License Law C]I tempt oder Sea B&P C for this reason Owner • Date WORKER'S COMPENSATI DECLARATION I hereby affirm under penalty of pedu one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .ion,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 required by Section 3700 of the Labor Code,for dee 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 be completed if the permit is for one hundred dollars($100) or less.) 1 cenify 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'CompensadOn 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 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z � CONSTRUCTION LENDING AGENCY I hereby alrt that there is a construction lending cy for the performance of �i the work fur whit f�i C. 3 W Q Lender's Name r/t ] Lender's Address V C) 1 certify that I have read this application and sta Qty �(t due ah�le�a LL�r cormcL I agree to comply with all city and county ordi d s re a to Vbuilding construction,and hereby authorize mpresenuavcs of this city to enter upon the w above-mentioned property for inspection purposes. Ia. (We)agree to save,indemnify and keep harmless the City of Cupertino against „F,t W) liabilities,judgments,costs and expenses which may in any way scenic against said City U Z in consequence of the granting of this permit. Date J APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR EG TIONS. c 9 Re-roofs Signature of Applicam/Contractor Dam Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will dee 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. ❑Yes KNo 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 it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yes KN. 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand drat if the building does not currently have a tenant that it is my responsibility to notify the occupant of the require must be met prier to issuance of a Certificate of occupancy. Signature of Applicant Date All roof coverings to be Class'`'or better Owner or authorized agent Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32608070 . 00 DATE ISSUED. . . . . . . : 01/22/2009 RECEIPT #. . . . . . . . . BS000007016 REFERENCE ID # 09010097 SITE ADDRESS 10638 GARDENA CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ROBBIE K H. KANG ADDRESS 10638 GARDENA CT CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM ROBBIE K. H. KANG CONTRACTOR LIC # *OWNER* COMPANY ROBBIE K H. KANG ADDRESS 10638 GARDENA CT CITY/STATE/ZIP CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ------ 1BCBSC VALUATION 450 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 450 . 00 0 .50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 .00 40 .79 0 . 00 40 .79 0 . 00 1PRWHEATR UNITS 1 .00 24 .48 0 .00 24 .48 0 .00 1TRAVDOC FLAT RATE 1 . 00 40 .79 0 .00 -- -- ------0_00 ---------- ---------- TOTAL PERMIT 107 .56 0 . 00 107 . 56 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ----- CASH 107 . 56 --------------- TOTAL RECEIPT 107 . 56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- 518 WATER HEATER OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,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) Contractor Address/City Phone # State License # Type of work to 3. _ I will utilize unlicensed person(s) other 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' compensation must be on file at the City of Cupertino Building 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: jgz—�— �4 Date: Job Address: CZ al -ko L& 6/ Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. Community Development 10300 Torre Avenue `s.,: Cupertino CA 95014 Telephone(408)777-3228 cITY OF Fax(408)777-3333 ''UPEkTINO Building De artment JOB ADDRESS: PERMIT# e 3k &r4ft�A c`r TIT, <►k fr-r w � a OWNER'S NAME: R08 / PHONE # oY -3aS GENERAL CONTRACTOR: µ 1 T-P1 FAX # qa---SYY—9-qr 6 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 Oqc)I L90 7 CITY OF CUPERTINO WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: 3.6 67.AM 64A C-T CLi 01( t) Owner's Name: Phone #: V to . KA 14 4o�'-- 3 OP Contractor: 0,//7 Phone #: �0A Fax #: ��� � Cupertino Business License M Contractor State License #: Contact: Phone #: C1-oT 4t16 — 3 CLC-"7 0 13J� KA14 67 Fax #: §-ecl §-gs4 Building Permit Info: Bld ❑ Elect ❑ Plumb Mech ❑ Residential M Commercial ❑ Job Description: Strapped E�---On Platform ❑ Bonded New Location ❑ Replacement Valuation (cost of project): Project Size: Express © Standard ❑ Large ❑ Major Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points achieved: Revised 01/07/09 INPUT Resources • IAQIHealth I.Windows 1.Install Energy-Efficient Windows a.Double-Paned 1 Energy pt y=yes 0 b.Low-Emissivity(Low-E) 2 Energy pts y=yes 0 c.Low.Conductivity Frames 2 Energy pts y=yes 0 2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 1 0 1 1 1 J.Heating Ventilation and Air Conditioning 1.Use Duct Mastic on All Duct Joints 2 Energy pts y=yes 0 2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0 3.Vent Range Hood to the Outside 1 IAQ/Health pt y=yes 0 4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0 5.Install Solar Attic Fan 2 Energy pts y--yes 0 6.Install Attic Ventilation Systems 1 Energy pt y=yes 0 7.Install Whole House Fan 4 Energy pts y=yes 0 8.Install Sealed Combustion Units a.Furnaces 3 IAQ/Health pts y=yes 0 b.Water Heaters 3 IAQ/Health pts y=yes 0 9.Replace Wall-Mounted Electric and Gas Heaters with Through-the-Wall Heat Pumps 3 Energy pts y=yes 0 10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0 11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0 12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0 13.Retrofit Wood Burning Fireplaces a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0 b. Install/Replace Dampers 1 Energy pt y=yes 0 c.Install Airtight Doors 1 Energy pt y=yes 0 14,Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0 15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0 16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0 17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yesl 1 0 1 1 1 K.Renewable Energy and Roofing 1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0 2.Install Solar Water Heating System 10 Energy pts y=yes 0 3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0 4.Install Photovoltaic(PV)System (1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0 6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0 7.Install Radiant Barrier 3 Energy pts y=yes 0 1 1 1 L.Natural Heating and Cooling 1,Incorporate Passive Solar Heating 5 Energy pts y=yes ;L 0 2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0 3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0 1 1 1 "� "-22 - 1