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09040127 CITY OF CUPERTINO BUILDING DIVISION PERNIIT � � �� � BUILDING ADDRESS: PERMIT NO. 10555 MARY AVE CITY OF CUP nc)04ni 9.7 OWNER'S NAME: PERMIT ISSUE DATE oF 1:0309 TDRRE AVE A t.2 8 8 9 CONTROL NO. N : BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH u O p LICENSED CONTRACT'OR'S DECLARATION Job Description inI hereby affirm that I am licensed under provisions of Chapter 9(commencing U with Section 7000)of Division 3 of the Business and Professions Code,and my license is n y in full force and effect. RPLC SN 3L PRCLN SNK W/SNGL INTGRTD SNK& CNTR TOP& Z_ License Class ontractor N InDaDate Contractor MV CURNP GFI & TO NEW LOC& INSTL SENSR STYLE y ARCHITECTS DECLARATION I understand my plans shall be used as public records FAUCET DyU C i- Licensed Professional OWNER-BUILDER DECLARATION r I hereby affirm that I am exempt from the Contractor's License Law for the Ca O following reason.(Section 7031.5,Business and Professions Code:Any city or county y m 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 Valuation z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $q.Ft.Floor Area II-� (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $1500 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 fire hundred dollars(M). 32606052 LADIES ❑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 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.). ❑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 contractors)licensed pursuant to the Contractor's License Law. ❑lam exempt undqr Sea ,B&P CP C fothis reason Owner Date WORKER' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: LJ I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM 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 subjcfrkin the Workers'Compensation Laws of Califo2Date— 1 a 7 Applicant /'r "'.I' NOTICE TO LICANT.if,afskniaking 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 0-4CONSTRUCTION LENDING AGENCY [�rte. I hereby affirm that there is a construction lending agency for the performance of L>!i> the work for which this permit is issued(Sec.3097,Civ.Q W Q Lendces Name az Lender's Address V C—) I certify that I have read this application and state that the above information is V." 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 above-mentioned property for inspection purposes W W (We)agree to save,indemnify and keep harmless the City of Cupertino against tH,fn liabilities,judgments,costs and expenses which may in any way accrue against said City S U Z in consequence of the granting of this permit. Date r"r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. // �•7 ��� ey r/ Y�3L`j Re-roofs -- Signature of Applicant/Corpktor Date HAZARDOUS MATERIALS DISCLOSURE Type of Loof 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 roofs shall be inspected prior to any roofing material being installed. ❑Yes ,,'No-. Will the applicant or future building occupant use equipment or devices which If a roof:s installed without first obtaining an inspection,I agree to remove ..nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No 1 have mad 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 does not currently have a tenant,that it,4 my responsibility to notify the occupant M the requir�m�ich must be me prior issuance of a Certificate of cul? . Signature of Applicant Date 1/� All roof coverings to be Class" "or better Owner c authorized agent Date NO CITY OF CXPERTINO CITY Of CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # �� / _ � � (✓ Date: y/--)3 9 Building Address: - n Mailing Address (if different from building address): Owner's Name: �' w�C,� ��, Phone#: ef 7 ,z©.s 6,c,3 HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Phone: Fax: Contractor License#: iv/ Cupertino Business License#: Contact: n Phone: Fax: Residential ❑ Commercial ❑ Job Description: k?�fa/�r S/�-�% c< c �''' s �''" `-' 14 C u if jec,_,f G F<- c /N 4,41 Building Permit Info: Bldg ❑ Elect Plumb Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [ V2- —�? Valuation: ' Square Footage: �/5 00 Project Size: Expresso 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.builditgreen.or Revised 02/05/09 INPUT RL-ou-ces Energy IAQ,Health D.Exterior Finish 1.Use*sten** 9 Models at... 3 Resource pts y=yes 0 Ftd YVoed 3 Resource pts y=yes 0 2.Use Treaded WOW TW POes Nd WAK 1 IAQ/Health pt y=yes 0 a>i 1 IAQ/Health pt y--yes 0 4.Ilse er 'Smogs 1 3esource pt Y=Yes F 0 E.Plumbing 1.Install Water Heater Jacket 1 Energy pt y=yes 0 2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0 3.Rebuft all Faucets and Mme isads with Flaw ReMoam a.Fawo I[!pc iinit i",W0 2 poems) Up to 2 Resource pts. 0 b,Showefieatis(1 pokeach,Lip to 200okft) Up to 2 Resource pts, 0 4.Replaoe To#est with U"-Low Flush Tallets (1 point each,up lo 3 pants') Up to 3 Resource pts. 0 5.Install Chlorine Filter on Showerhead 1 IAQ/Health pt y=yes 0 6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0 7.Install Water Filtration Units at Faucets (2 points each,up to 4 points) Up to 4 IAQ/Health pts. 0 B.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0 ■ t 1 i r.tiecEncai 1.Install Compact Fluorescent light Bulbs(CFLs) (6 bulbs=2 points,10 bulbs=3 points,12 bulbs=4 points) Up to 4 Energy pts. 0 2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to 5 points) Up to 5 Energy pts. 0 3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0 4.Install High Efficiency Ceiling Fans with CFLs (1 point each,up to 4 points) Up to 4 Energy pts. 0 . G.Appliances i.Install Energy Star 01shwasher 1 Energy pt y=yes 0 2.Install Wasting Machine with water and Energy Conservation Features 1 Energy pt y=yes 0 3.Install Energy Star Refrigerator 1 Energy pt y=yes 0 4.Install Buift-In Recycling Center 3 Resource pts y=yes 01 1 H.Insulation 1.Upgrade Insulation to Exceed Title 24 Requirements a.Walls 2 Energy pts y=yes 0 b.Ceilings 2 Energy pts y=yes 0 2.Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0 a.Install'Recycled-Content,Fiberglass Insulation with No Added Formaldehyde 3 IAQ/Health pts y=yes 0 4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0 5.Use Cellulose Insulation a.Walls 4 Resource pts y=yes 0 b.Ceilings 4 Resource pts y=yes 0 6.Alternative Insulation Products(Cotton,spray-foam) a.Walls 4 Resource pts y=yes 0 D.ueiiings 4 Resource pts y=yes 0 M.Indoor Air Quality and Finishes 1.Use ta*No-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 Lowft VOC Adhe6ves 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.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0 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 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring it Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 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 1301 57 Total Points Project Received: 61 0 0 0 G:data/progs/gree nbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xis S-M Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .;UPEkTINO Building Department JOB ADDRESS: PERMIT # �j��j t-C 2-7 2 jC OWNER'S NAME: C --NYL 0 PHONE # - - 2 Uf DJ GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Si,Ka'ture 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 Rock Tile Owner/ actor Signature Date