09010103 CITE'OF CUPERTINO
BUILDING DIVISION PERNIIT op--NM �I�N'.
PERMIT NO.
BUILDING ADDRESS:
7645 WATERFORD DR GODWIN.ELECTRICI 0"1010-1
PERMIT ISSUE DATE
OWNER'S NAME:
KELIGIA SA CONTROL NO.
.n0
BUILDING PERMIT INFO
ARCHrIECI'/ENGINEER: BLDG ELECT PLUMB MECH
UPGRADE ELECTRICAL SERVICE L D D D
u p p LICENSED CONTRACTOR'S DECLARATION PANEL TO 200 AMP Job Description
"-Z
u 1 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
H in full force and effecL3
License Class - h Lic•k 1 $
Date �' --
I Z_T_`I Contractor
ARCHITECTS DECLARATION
-a I understand my plans shall be used az public records
�yU
L 0 y Liccrhscd professional
n OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
COO following reason.(Section 7031.5,Business and Professions Code:Any city or county
K m which requires a permit to construct,alter,impmvc,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
< that he is licensed pursuant to the provisions of the Conuactur's License Law(Chapter 9 Sq
H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500)•
0 I,az owner of the property,or my employees with wages az 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 dots 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.).
I,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 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.
❑1 am exempt under Sec. B fit P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
1 hsve and will maintain a Certificate of Consent to self-insure for workces Compen-
sation,az 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 Workees Compensation Insurance carrier and Policy number arc:
Crier Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollars(S 100)
or less.)
1 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 becoTc subject to the Workers'Compensation
Law sofCalifomia
Applicant
N017CE TO APP :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 h'" CONSTRUCTION LENDING AGENCY
[~i►N-. I hereby affirm that there is a construction lending agency for the performance of
a+> the work for which this permit is issued(See.3097,Civ.C.)
pa Q Lender's Name
Lendees Address
V C) I certify that I have read this application and stare that the above information is
VL correct.I agree to comply with all city and county ordinances and state laws relating to
0Ubuilding construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
,E"t liabilities,judgmen ,costs and expenses which may in any way accrue against said City
U`Z in consequent oC granting of this permit. Date •-�
(,x
APPLICA U ERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by:
SOURCE U ATIONS. _ G
Re-roofs
'
Signatu f pp tcant/Contractor Dare Type of Roof
HAZARDOUS MATERIALS DISCLOSURE YP
ill the applicant or future building occupant store or handle hazardous material
az tloAned by the Cupertino Munici I Code.Chapter 9.12,and the Health and Safety
Cale,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
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 as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes I]No
1 have re hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Sal 17
ode.Sections 25505,25533 and 25534.1 understand that if Uhc building
L
I
y ave a tenant.that it is my responsibility to notify the occupant of the
must be met prior to iasuancc err a certificate art Oceapancy. Signature of Applicant Date
All roof coverings to be Class"J "or better
ized agent Date
Community Development
-' 10300 Torre Avenue
Cupertino CA 95014
F^ Telephone(408)777-3228
CITY OF Fax(408)777-3333
APEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: FG L I u ioi 6 L8P-j`rf I PHONE #
GENERAL CONTRACTOR: < C7ftj L FAX # .........
2-3 G S
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 Ro
Tile f
i'
e ntractor Signature Date
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36617085 . 00
DATE ISSUED. . . . . . . : 01/23/2009
RECEIPT #. . . . . . • • • : BS000007030
REFERENCE ID # . . . : 09010103
SITE ADDRESS . . . . . : 7645 WATERFORD DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . .
OWNER . . . . . . . . . . . . : FELICIA ALBRIGHT
ADDRESS . . . . . . . . . . : 7645 WATERFORD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JOHN GODWIN
CONTRACTOR . . . . . . . : JOHN GODWIN LIC # 30676
COMPANY . . . . . . . . . . : GODWIN ELECTRIC
ADDRESS . . . . . . . . . . : 7071 VIA PRADERA
CITY/STATE/ZIP . . . : SAN JOSE, CA 95139
TELEPHONE . . . . . . . . : (408) 888-5065
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- ------
1BCBSC VALUATION 1, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BELEC1001 METERS 1 . 00 119 . 88 0 . 00 119 . 88 0 . 00
1BSEISMICR VALUATION 1, 000 . 00 0 . 50 0 .00 0 .50 0 .00
1EPERMITFE 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 202 . 96 0 .00 202 . 96 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ----
CASH 202 . 96 CASH
---------------
TOTAL RECEIPT 202 . 96
f
CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
a0 0103
APN# Date: I a� 3 / 07
Building Address: 76 1 S W YV451" :�fl b b rZ-
C,,PC-X l A10 / C fi
Mailing Address (if different from building address:
Owner's Name: FEL i C I L g 216 HT- Phone#: g 7G 0 1
Contractor: Phone: 8 g " SO K's-
"0 VhjI
Fax: /~
Contractor License#: C-t o 86q ,83
Cupertino Business License#: 70679
Contact: Phone: <C ft- S-6
''',� C�°b``'r'✓ Fax:
Residential Er Commercial ❑
Job Description: rC zlSAL 2� �� �rE` `?j f"-
L)
P
"-vPFct �� sir
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
r-)
1-A, 1-B El II/III/V-A ❑ 11/111 B IV-HT, V-B '
Valuation: 0 ooa
l v 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.buildit reen.or
Revised 01/07/09
CITY OF CUPERTINO
Cin OF GENERAL BUILDING APPLICATION
CUPEkTINO 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)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
/ 1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE 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
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1BSEISMIC0 Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 of 5
. n oor rr ualrty and Finis es
INPUT RE?SLjr[�Es Enugy AD/Health
1.Use Lowft-VOC Paint 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 VOID 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 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7•$I ell ParticleboardorMDF 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 Rapdy 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=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes o
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
r r r
Total Points Available: 1401 130 57
Total Points Project Received: 01 01 0
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