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09020028 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10171 LOCKWOOD DR SBLLOCK ENTERPRI OWNER'S NAME: PERMIT ISSUE DATE .O r SA CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH WTR HPR REPLCMNT C] D D D v o c LICENSED CONTRACTORS DECLARATION Job Description 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 o':*,'H in full force and effect C 65 l Y Dt;z License Clads Lic.S n—O Date f /rt w o Contractor S t ARCHITECTS DECLARATIONc at ts ' I understand my plans shall be used as public records � 7 y U /f} t�' P/�1M I r l`nil cH Licensed Professional y 3 OWNER-BUILDER DECLARATION n I hereby M. that 1 am exempt from the Contractor's License Law for the in O 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 y Zprior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation X IF-$ (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). ❑1,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 Contractor's License Law does 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(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law docs 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. ❑I 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 Workces Compen- -don,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 Workees Compensation Insurance carrier and Policy number ate: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section reed not be completed if the permit is for one hundred dollars($100) or less.) 1 certify that in the performance of the work for which this permit is issued,I shall not employ any pc n in any manner so as to beco c sub'ect to the Workers'Compensation Laws of Calif Date r Applicant NOTICE TO PP ANT:1,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 shalt be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY (~i 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.) Cwt A Leadces Name Z Lcndees Address U 0 I certify that I have read this application and state that the above information is LL►.r correct I 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 fSWr above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against CA liabilities,judgments,costs and expenses which may in any way scenic against said City V Z in consequence of the granting of this permit Q� �+ APPLICANT UNDERSTANDS AND W L COMPLY WITH ALL NON-POINT Issued by: Date SOURCEULATION Re-roofs _ Signature o Applican omractor Dare Zr_ HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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)? J- All roof's shall be inspected prior to any roofing material being installed. C]Yes 1p No /\ If a zoo: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 defined by the Bay Area Air Quality Management all new materials for inspection. .strict? N� [-]Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.I understand that if the building does not curendy have a tenant,dtat it is my responsibility to notify the occupant of the requiremc hich must Met r toissuance of a Certificate of Occupancy. Signatu:-e of Applicant Date ' 2_&_107 All roof coverings to be Class'n''or better Owner or authonizcd agent Date 0 oc> CITY OF CUPERTINO WATER HEATER CITPERMIT APPLICATION FORM CUP kINO :=Date- APN # , r �( 0 Building Address: Phone #: Owner's Name: z s--5—-- Phone #:Cqlo Contractor: Fax #: Cupertino Business License #: � Contractor State License #: 6(7-5-r/ y Contact: Phone #: V67-6,01C) C JC:c�� v�"t� Fax #: Building Permit Info: Plumb Mech Bld ❑ Elect ❑ Residential ❑ R Commercial`� Job Description: k144-e-c 4ekeuL �� qch � Strapped On Platform ❑ Bonded ❑'-�' New Location ❑ Replacement Valuation (cost of project): Ma or Project S. Express Standard ❑ Large ❑ j uildin : Please complete relevant portion of the Green Building sheet indist�,attach it to Green B g PI application or if applicable, include in plan set & the IGreen Buildin Points achieved. � — Revised 01/07/09 CITY OF CUPERTINO . WATER HEATER CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1 PCWHEATR Commercial -Water B PCWHEATR HeaterNent 1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B ,1 1 PRWHEATR Residential Water B PRWHEATR HeaterNent / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Pe;mit P 1 TRAVDOC Travel & B Documentation 1 BUSLIC Business Lic-.nse B M.1ndoDr Air Quality and Finishes 1.Use LowlNo-VOC Paint 1 IAQ/Hsalth pts y=yes D 2.Use Low VOC,Water-Based Wood Finishes 2 IAD/Health pts y--yes 0 3.Use Low/*VOC 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 6IAQ/Health pts y=yes D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQMealth pts y=yes 0 7.Seal ail d PaAWsbaaW or VA)F 4 IAQ/Health pts y--yes D B.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 D 10.Install Whole House Vacuum System 3 IAQ/Heslth pts y=yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapidly I3enewable: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 51AQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 i 1 1 Total Points Available: 1401 1301 57 Total Points Project Received: 0 0 0 let G:datalpmgstgraenbuildngguideiines/mmodelers/greenpointsfinal212.04proteotedxls Community Development - 10300 Torre Avenue �'. Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ''UPEkTINO Buildin jertment JOB ADDRESS: rr RMIT # D n OWNER'S NAME: g,�� ONE #CTOR: ; X# I am not using any subcontractors: Signature Date Please check a licable subcontractors and co m 77 - Fencing : SUBCONTRACTOR BUSINSS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation 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 SVM 3 1,40 b A5 Owner/Contractor Signature Date