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09020101 CITY OF CUPERTINO BUILDING DIVISION PERMIT � ZI� r PERMIT NO. BUILDING ADDRESS: 10218 MANN DR FIVE STAR WIND PERMTT ISSUE DATE OWNER'S NAME: 1450 DELL VE STE G 2009 NWAkMIN6. CONTROL NO. HONE: (408) 370-3331 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH Z O Z LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Divisi 3 of the Business and Professions Code,and my license is REMV&R F L C 7 WNDW S & 2 DORS LIKE 4 L I K E y in full fora and cffec� ' C,I'� 7 , I , s-in Date—, Clara) Contractor =M Date ARCH S DECLARATION e < I undcrstan my Inns shall be public records �yU LO y Licensed Professional rn� O NER- ( R DECLARATION I hereby estrum that 1 a excm m the Contractor's License Law for the Cp O following reason.(Section 7031.5,Business and Professions Code:Any city or county Z $9 which requires a permit to construct,alter,improve,demolish,or repair any structure rior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation z_1' that he is licensed Pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $8500 ,5_ that he is exempt therefrom and the basis 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(5500). 32619012 . 00 0 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 conuactoes 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 sate.). 0 1,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 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. 0 1 am exempt under Sec B&P C for this reason Owner Date 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 forworkees compen- .hon,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Cade.for the performance of the work for which this permit is issued. My Wor Compensation Insurance carrier and Politym urare: Carrier . 5 Policy No ! v 3 g b CERTIFICATE OF EXEMPTION FR WORKERS' COMPENSATION INSURANCE (This 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 for which this permit is issued.I 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,alter 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 0r CONSTRUCTION LENDING AGENCY Fr C4 I hereby affirm that there is a construction lending agency for the performance of {x> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name �z L.cndees Address t certify that I have read this application and state that the above information is ;Z," correct.l agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes >4 Wa ( c)ogee to save,indemnify p harmless the City of Cupertino against CA liabiliti ,judgments,costs and expo w ich may in any way accrue against said City V Z in con ue f the tin f a r Date ? Z APPLI UNDE D A LL COMPLY W N FPOINT Issued E y: SO R II Re-roof - Sig u f A plicant/Contracto Da T of Roof HAZARDOUS MATERIALS DISCLOSURE Type ill the pticant or future buildi occupant store or handle hazardous material as defy d by Cupertino M�umcCodc,Chapter 9.12,and the Health and Safety Cede, i 5532(a)? All rools shall be inspected prior to any roofing material being installed. 0 Yes Will the applicant or future bui g occupant use equipment or devices which If a roo 7 is installed without first obtaining an inspection, agree to remove it hazardous air contaminants fined by the Bay Area Air Quality Management all new materials for inspection. strict? 0y Nu 1 ha read the astir materials re mmcnts under Chapter 6.95 of the Califor- nia Health of Its 5 and 25534.1 understand that if the building does not c have a ten t t ponsibility,to notify the occupan of require which et 'oto of Signatu-eofApplicant Date d All roof coverings to be Class'"or better 1111 Owne or autho xc agent Dare CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# r. C, ( � o c� Date: 0 Building Address: /0;9 / FS n k�-" ue, Mailing Address (if different from building address;: Owner's Name: Phone#: —/V F—0 7- 5 77-L Contractor ):�/- , e r Phone: V _ �-�� — 33a S)� V 0 Fax: �-OCJE5 7 —c-3-/ 10 Contractor License#: &9-Z9331 Cupertino Business License#: 0`•33(eqo Contact: ( 'P/Gjq�a r7A Phone: —z�)-Q— 333 XJ-C� Fax: Residential Commercial Job Descrion: �- covS Building Permit Info: Bldg,0' Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: (� I-A 1-B II/III/V-A ❑ II/III B, IV-HT, V-B �3 T Valuation: Square Footage: Project Size: ExpreA Standar Largs; ❑ Major ❑ — Green Building: Please complete relevant portio:a 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.buildiUreen.or Revised 01/07/09 CITY OF CUPERTINO CITY of GENERAL BUILDING APPLICATION CUPER,TINO 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) 1 WINMEWSTR New Window-structural shear B wall/me sorry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E I MPERMITFEE Mechar,ical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E IMECPLNCK Stand Alone Mechanical Pln Ck (hrly) M IPLMBLNCK 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-;sand alone IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1BSEISMICR Seismic.Residential B 1BSEISMICO Seismic; Commercial B 1 TRAVDOC Travel &Documentation B IBUSLIC Busine,;s License B 000-/oaq s-I r 5 of 5 M.Indoor Air Quality and Finishes INPUT Rescxc�s Energy !ADI'Heafth 1.Use towlN voc Paw 1 IAQ/Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Lowft VOC 1ldhe was 3 IAQ/Health pts Ayes 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 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seel all ppowd.P leboard or 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 IAQIHealth pts y=yes I0 ' 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 6 Resource pts y=yes 0 2.Use Rapidly 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 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Available: 1 1401 130r---5-71 Total Points Project Received: 1 01 01 0 G:data/progs/gieenbuildtngguidelines/r odelers/greenpointrfina12.12.040rot.cted.xis ��J E Sl'4•P Shining Above The Competition aATA Family Owned and Operated since 1983 1450 Dell Ave., Ste., C, Campbell, Ca 95008 Clearlyrhebest. Tel 408-370-3331 Fax 40<;-370-3110 License # 628381 DATE: JOB NAME: i1'K1u3 s l�Yt iZ�`3'1�S o _ ti.T' fi't � "ORD, rS ( RDINANCES o vUP�IN3 U c—__ tinsM ,,„ This set . .nd it is un ne kept on alteration` �' I lawful t(I �issl0n iron �n some ,wino, ne buiidirr"- ,e�ficetaon rC::) rhe stamping r to be af MALL NOT bl, n 4 gpfdyg Of tt8 viUld3WUoa lU �arovisi©� IzS- �nV 'l r1 n•.an,�f� ��r AW '�...a C� A B M SHI 0 1 Never Promising More Than We Can Delivor. Striving To Deliver More Than We Promise Shining Above The Competition Family Owned and Operated since 1983 as 1450 Dell Ave., Ste., C, Campbell, Ca 95008 Clearly the best. Tel 408-370-3331 Fax 408.370-3110 License # 628381 DATE: JOB NAME: 16215 W h n b iine Z"Ifl WNI Q� C Qi' VA r.. � e o Cil f c Never Promising More Than We Can Deliver. Striving To Deliver More Than We Promise