09020042 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � � �� '
PF-RM1T NO.
BUILDING ADDRESS:
10784 GASCOIGNE, BE P1�tM1T LSSUE DATE
OWNER'S NAME.
A 9 CONTROL NO.
BUILDING PERMIT INFO
ARCHITECC/ENGINEER: BLDG ELECT PLUMB 0
v p p LICENSED CONTRACTOR'S DECLARATION Job Description
u 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
� y RE-LOCA.' WTRHTR, NEW GAS LINE FOR WTRHTR,RE-PIPE
in full force and effect
Z License Lic•R
E-0—p Datc
ARCHrrECPS DECLARATION MN
I understand my plans shall be used as public records BTHRM ONLY; I FXTR &FELOCT LAUNDRY
0.
Oti f tensed Professional
m V2 OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
o which requires a permit to construct,alter,improve.demolish,or repair any structure
13 prior to its 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
zF (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
y $ 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). 37529043 Q O
I,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 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
sats.).
O I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
I am exempt under Sea B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aMrm under penalty of perjury one of the following declarations:
,r
1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
provided for by Section 3700 of the Labor Code,for the performance of the
Nwohich 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 carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
('Ibis 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 f r wh It is pc t is iss d•I shall not
employ any person in any nc so as to bcco c su jc to the rkers' ompensa' n Y O
Laws
of California.Date
Applicant
NOTICE TO APPLICANT:If,atter making this crtificate of Excm n,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z R CONSTRUCTION LENDING AGENCY
f~" I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
a z (.enders Address
I certify that I have ad this application and state that the above information is
GUL H to
construction,
I agree to comply with all city and county ordinances and state laws relating to
0 U building consction,and hereby authorize representatives of this city to enter upon the
0 U above-mentioned property for inspection purposes
a (We)agree to save,indemnify and keep l City of Cupertino against
„Hy
liabilities,judgments,costs xpenses which ay in an way accnhc against said City6(&W ^'
(�,'� inconsequence of the gran ng this permit Date `
►4 APPLICANT U sT N AND WILL MPL WITH ALL NON-POINT Issued try:
S U CE GULATIO
Re-roof s /L -
Sig atu f Applican ntrsctor are T of Roof /
HAZARDOUS MATERIALS DISCLOSURE Type
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 roo's shall be inspected prior to any roofing material being installed.
[:]Yes No
Will a roof is installed without first obtaining an inspection, agree to remove
ll the applicant or future building occupant use equipment or devices which
t hazardous air contami7N.
defined by the Bay Area Air Quality Management all new materials for inspection.
Act?
Yes
1 have read the hazardous materials require rats un r Chapter 6.95 of the Califor-
niaHealth&SafetyCode,Secti 505.25533an 25534.1 ndcrstandthatiCthcbuilding
does not currently have a tcn t it is my MW
ts which must be m r issuance a Signature of Applicant Date
All roof coverings to be Class' or better
Ow r or utho zc gent
CITY OF CUPERTINO
ADDITION/REMODEL
CUPEkTiNO FEE SCHEDULE
APN # _ w J J Bate: z /j 16 169
Building Address: +O� GrAs
n ,
[)R.
Mailing Address (if different from building address;:
SAmF A\1W6_
Owner's Name: Frld �r , s 1,o J (fP— Phone# : 310 _ O /1 '
HOA: (Exterior work only) Yes ❑ No;<
If yes, provide letter from HOA
Contractor: ` Phone#: -Z-fZ- Z.Z-+Z
ns 1 1 Plumb/AaO S Fax #: I Z-
Contractor License#: gZ6-4-56
Cupertino Business License#:
Contact: Phone#:
M1 Ve Fax #: (� �{-
Building Permit Info:
Bldg. E�' Elect. ❑ Plumb. Mech. ❑ Hillside ❑
Job Description: L, ,,
Addition-What is being added?(Be Specific): �� � G�-t�,n of w v4eakee ueto os l i VI e
�o•x�-u2� feloca� 1c.�
y u�,
What is being remodeled (not including addition)?
it
10
Remodel Includes Re-Roof. Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ N i,
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your plannin;,, approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-13 ❑ II/III/V-A ❑ IUIII B, IV-HT, �'-B f
Valuation: ZI
d� Please check this box if the project is a
50. XK second-story addition ❑
Project Size: Express [Standard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:,
include in plan set& the sheet index.
***For Office Use Only***
Over-the-Counter 0 Revised 02/05/09
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
ADDITIONS 1R3SFDADD
PLLONGRNGR Long Lange PL
Planning/Residential
1R31NSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B
Inspec.ion
1R3REPPLNC Dwellings Repeat Plan B
Check
1 R3HINSP Dwellings Hillside B
inspect ion
1 R3HPLNCK Dwellings Hillside plan B
check
1 R3HREINSP Dwellings Hillside B
Repeal Inspection
1 R3HREPLNC Dwellings Hillside B
Repeal Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1 PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Dispo�al System
1 PRSEWER Sewer;; P
1 BPSPRINK Lawn P
Sprinkler/Backflow
1BPWSVCS Main Water Service P
1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
r 1 BSEISMICRE Seism cResidential B
1REROOFRES Residential Re-roof Each B
100S]"
CITY OF CUPERTINO
ADDITO:v/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
1 REMRES2 Remodel Residential B
Greater• than 1000 sq ft
1REMRES3 Remodel Residential B
Greate:•than 2500 sq ft.
1REROOFRES Reside ltial Re-roof Each B
100 SF
REMODEL PLNCK
ISTPLNCK (1-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTERMAN
CKS.
WINDOW/SLIDING 1R3SFDREM
GLASS DOOR
1 WINREP Replacement windows B
(ea 8 '"indows)
1 WINNEWNSTR New Window (non- B
structu-al)
1 WINMEWSTR New Window (Structural B
Shear`1Vall/Masonry)
1WINBAYSTR Bay Window (Structural) B
SKYLIGHTS 1R3SFDREM
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 B
sf or structural
1STAIRS Stairs-:first flight/ea B
addt'l
1EPERMITFEE Electri;al Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
j 1 PPERMITFEE Plumb ng Permit Fee P
l ELCPLNCK Stand Alone Electric Pln E
Ck (hourly)
/ P i2 h-42c-t-Y
/ R P c,
/3 P
CITY OF CUPERTINO
ADDITON/REMODEL
FEE S1111EDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
1 MECPLNCK Stand done Mechanical M
Pln Ck (hourly
1 PLMPLNCK Stand Alone Plumbing P
Pln Ck (hourly)
1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1 BSEISMICRE Seismic- Residential B
1 TRAVDOC Travel & Documentation B
1 BUSLIC Busine,,s License B
INPUT Resources Energy 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 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
B.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=yes I I 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
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0
3.Plant Deciduous Trees on the West and So h Sides 3 Energy pts y=yes 0
t
. Y
RSIDTTIA�L PtO C.T Ca�ER SHEET
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Assessor's Parcel Number: 0
Name of owner.
Project address. 10 -79/4 C---TcJ SCoi
Contact person. 1 � Phone. &2 ) P9 - 790 G
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage?
privacy protection planting required for the project. Y N
On what floor(s) is work being done?
Brief description of work. YI eG
1 lel rY
Code editions:2008 CBCN)2008 CFC -N)2008 CMC (Y-N)
2008 CPC N)2008 NEC Ct-N)
Effective 1/1/08
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Plan Review Process Work Book Page-8-Revised 1/1/03
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Assessor's Parcel Number: 7 S - 2- qO 4.1
Name of owner. k Fed S 11
Project address. 1 T �'S�')c jC,J
Contact person. Phone. -(4 0 Z1� - 790 G
Nets square footage of y�
q g lot.
_Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage?
privacy protection planting required for the project< Y N
On what floor(s) is work being done?
Brief description of work. eG
t lA bQa Ci Y
Code editions:2008 CBCi` bt N)2008 CFC � ..N)2008 CMC (Y-N)
2008 CPC N)2008 NEC (Y N)
N
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Effective 1/1/0$j-T qtr lh�yq 4
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Plan Review Process Work Book Page-B-Revised 1/1/08
Community Development
10300 Torre Avenue
"i,7M
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
UPEkTIN0
Buildi[ng Department p qc2.�oc) -
JOB ADDRESS: 10 - CQSCa J PERMIT #Am q 9 9
_
OWNER'S NAME: —(' ` L` C PHONE # SIO Z�Z ZZ77—
GENERAL CONTRACTOR: cot j ►n.,�, FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI:"-TESS 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