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09010023CITY OF CUPERTINO DIVISION PERMIT���� BUILDING BUILDING ADDRESS: PERMIT NO. 1040 P BAYHIL OWNER'S NAME: PERMIT ISSUE DATE PHOkkNPA ND MARjGRIE 14 262 MA14—ST SWNtVA ftltCONTROL NO. moTT 650) 948-5900 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full form and effect C FURN RPLCMNT , SAME LOC , 6 0 , 0 0 0 BTU License Class Lic.#1 Date Contractor ARCHITECTS DECLARATION �n I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from dw Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the (commencing with Section 7000) of Division 3 of the B usiness and Professions Code) or $3798 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 31633033 .00 ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (See. 7044, Business and Professions code: The Contractors 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 constnrct the project (Sec. 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. ❑ 1 am exempt under Sec. B & P C for this reason OwnerDate 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 Workers Compen- an, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 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 Workers Compensation Insurance carrier and Policy number am: carrier S1'rkn-CaviA3k,05;Arf•- Policy No:­�I✓-00-;;?505Y CERTIFICATE OF EXEMP 1ON FROM WORKERS• COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a constnudnn lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lenders Address j I certify that I have read this application and state that the above information is correct 1 agree to comply with all city and county ordinances and state laws relating to building consouction, 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 j liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this p=iL APPLICANT ANDSAND WILL COMPLY WITH ALL NON -POINT Issued by: Date WUR SOURCER. Re -roofs _ Csf % icanucontractor Date HAZARDOUS MATERIALS DISCLOSURE Sig=Will �— Type of Roof pplicant or future building occupant store or handle hazardous material as defined by rte Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Cole, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes o 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 ,it hazardous air contaminants as de d by the Bay Area Air Quality Management all new materials for inspection. trict? ❑ Yes u 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 that if the building docs not curenlly have t that it is my responsibility to notify the occupant of the requirements which CL prier to issuance of a Certificate of Occupancy. Signature of Applicant Date fir/ 7 All roof coverings to be Class'n" or better Owner or orecdagcnt Date 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 31633033.00 DATE ISSUED.......: 01/07/2009 RECEIPT #.......... BS000006916 REFERENCE ID # ...: 09010023 SITE ADDRESS .....: 10400 PRUNE TREE LN SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER KANDA KUNIO AND MARJORIE M TRU ADDRESS 10400 PRUNE TREE LN CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2023 RECEIVED FROM ....: RICARDO P VALDERRAM CONTRACTOR .......: RICARDO VALDERAMA LIC # 30480 COMPANY BAYHILL HEAT & AIR ADDRESS 262 MAIN ST CITY/STATE/ZIP ...: LOS ALTOS, CA 94022 TELEPHONE ........: (650) 948-5900 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 3,798.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 3,798.00 0.50 0.00 0.50 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 1MRRAA UNITS 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 ---------- 225.85 ---------- 0.00 ---------- 225.85 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 225.85 --------------- 225.85 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CUPERTINO FURNACE/AC CUPEkTiNO PERMIT APPLICATION FORM APN #5 1 ,� �� ` 1 Date�,� B ildi ng Address: )0 � � � (R LAJ O is Name: ^ Pho e #: _ Contracto &(—Y&t & Phone �1 I� Fax #: Contractor License #: Cupertino Business License #: 9� Contact: k r';l i �'' Phone i Fax Building Permit Info: Elect 0�_ Plumb Mech Residential Commercial ❑ Job Description:60, 0 r For Residential Installations: Attic ❑ 1St floor E?-"' 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): .U�.200L, # 3 � Z-�Is Strapped ❑ On Platform ❑ Bonded ❑ New Location ❑ Replacement Project Size: Express ]Standard ❑ Large ❑ Major ❑ Valuation: 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. Revised 6/16/08 CITY OF CUPERTINO FURNACE/AC CUPERTINO FEE SCHEDULE Quantity Fee ID I Fee Description I Fee I Permit Type Group FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. P 1BSEISMICR Residential Seismic B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h M 1MFRN>100 Furnace Syst > 100k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h M IEPERMITFEE Electric Permit Fee E ` 1MPERMITFEE Mechanical Permit Fee M ( 1PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B Quantity Fee ID I Fee Description I Fee I Permit Type 1. Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes 3. Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes, 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes B. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y --yes N. Flooring 1. Select FSC Certified Wood Flooring 6 Resource pts y=yes 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl . 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Avai ab e: Total Points Project Received: 140 1301 57 01 01 01 G:data/progs/greenbuildingguidelinestremodelerstgreenpointsfinal212.04protected.xis 5 M CITY OF rUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: Q�p �� © PERMIT # OWNER'S NAME: ` (� PHONE GENERAL CONTRACTOR: FAX .# I am not using any subcontractors: O'j O 15 Signature Date PI ase check a licable subcontractors and complete the following information: e 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 4 r on actor Signature //C - 7 o Date