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09050154 CITY OF CUPERTINOr ~t � � '�' E} � BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: rini S4 22116 LINDA VISTA PL HUSSEY EROS I pEftivin'ISSUE DATE OWNER'S NAME: S A CONTROL NO. ^%LONE: ICA morTC' F_ 408) 733-6360 BUILDING PERMIT INFO A RCH I ECTIENGINEER: BLDG ELECT PLUMB MECH u p C LICENSED CONTRACTOR'S DECLARATION Job Description '00 vI hereby affirm that I am licensed under provisions of Chapter 9(commencing z Section 7000)of Division 3 of the Business and Professions Code,and my license is <cllforeeandefttx �- tr RPLC FUFNC & ADD/INSTL AIR CONDITIONING & UPGR 03� Z License �� Conuxtor f ELECTRCI� PANEL TO 200AMP Date A CHTiELTS DECIA O ro< I understand my plans shall be used as public records �yU 4 wo y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ❑O following reason.(Section 703 1.5,Business and Professions Code:Any city or county K m T' which requires a permit to construct,alter,improve,demolish,or repair any structure y rn prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation ?e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 12 00 tZ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or ARE.. that he is exempt therefrom and the buil 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)• L3560801) . 00 0 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 docs 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 arc 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.). O I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractoes 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 Contractors License Law. B&P C for this reason I am exempt under Sec. 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 workers Compen- on,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 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 WorkeeLCompensadon Insurance carrier and Policy number am- A-1 Carrier. '(_�L X Policy No.: A� I CERT—IFC—ATE LATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss) 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.after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY (.�Cn I hereby affirm that there is a construction lending agency for the performance of IYr> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name z L.cndees Address I certify that I have read this application and state that the above information is LUL correct 1 agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authorim 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 hit Cn liabilities,judgments,costs and expenses which may in any way accrue against said City / V z inconsequence of the ranting of this permit Date G t✓i ►+ APPLICANT UND ANDS AND WILL COMPLY WITH ALL NON-POINT Issued b;i: SOURCE REGU / L/ L(l Re-roof: Signature of Applicam/Contractor Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP 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 roof;shall be inspected prior to any roofing material being installed. C]yes f No If a roof is installed without first obtaining an inspection, 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. trio? Yes 1 have read 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 is my responsibility to notify the occupant of the Date requirements which must be met prior to issuance of a Cer ificate of Occupancy. Signatu)a of Applicant -20 All roof coverings to be Class' "or better ,421 Owner or auth ri gent Date INPUT Resources Energy IAO/Health M.Indoor Air Quality and Finishes 1.Use Low/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 Low/No 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 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 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 N.Flooring 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials t 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 1 1 1 Total Points Available: / 1401 130 57 Total Points Project Received: C% 01 0 0 0 ' G:data/progs/p enbuildngguidelines/remodelers/gre'gnpointsfina12.12.04protectedxls CITY OF CUPERTINO FURNACE/AC CUPEI�TINO PERMIT APPLICATION FORM APN #05 Date: �5 o . '57-u' v5 Buildin Vfe� Lit%okA4 Phone#: Owne s Nae: GoD r V I C I F ZS7-gay bRV1C �Alorv�,,a- t` Contractor: Phone#: 90 V731-&U v HV.3 S C in :D (VS_ hC,_ Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: 1 P 9-4 yG Q Ve V e V55 Fax#: yof 7.)L S9�q Building Permit Info: Elect. Plumb MechA -- Residential Commercial Job Description: �Nj Ja 1 i a r'C!�.d1�/I+�i��►� rcP�ct ,rrhare , acr'.1 V rX e Gyri�po p,4 K.e4o u u R For Residential Installations: Attic ❑ 1st floor 2"d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): 2, Strapped � 0U. On Platform Bonded New Location Replacement Project Size: Express Standard ❑ Large ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Revised 01/07/09 CITY OF CUPERTINO FURNACE/AC CU P TY OF O FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating applianze,refrigeration unit, cooling unit,absorition unit,or ea heating,cooling,at sorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliar..ce,refrigeration unit,cooling unit,'IAV boxes, absorption unit or ea heathing, cooling absorption,or eva:)orative cooling sys, incl install of controls regulated by this code. =JMCSUSHTRCommercial Instz=heater. =ea M suspended heater floor mounted un 1PGASCOM Commerical for ca gas piping System P 1-4 outlets 1BPGAS For each gas piping;i �a of 5 or P more per outlet. 1MCAPPVNT Commercial for the /relocate/ or M replacement of ea appliance vent installed &not incl in an appliance permit. 1BCBSC Cal Bldg Standwds Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic. B 1MRRAA Residential Rep,Lir/Alteration/Add to M ea heating appli�mce,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative coo'ing system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heate-r,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO FURNACEAC COF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Descripti,)n Fee Permit Type Grou AIR FURN/AC CONDITIONING 1BCAIRHAN Commercial A/C Units <= 1 O CFM B 1 MCRAA Commercial Moch Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Comm,;rcial B 1PGASCOM Commerical fot ea gas piping System P 1-4 outlets 1 PGASRES Residential for,;a gas piping system P of 1-4 Outlets 1 BPGAS For each gas r iping system of 5 or P more per outlet. Comm/Resid 1 BREMAIRHAN Residential A/C units<= l Ok CFM B 1 MRRAA Residential Mech Repair/alt/add M / 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT I TYPES 1BSEISMICR Seismic Residential B 1 1 EPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Per.nit M 1 PPERMITFEE Plumbing Perm t P I 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B Community Development 10300 Torre Avenue } �$ Cupertino CA 95014 ' Telephone(408)777-3228 Fax(408)777-3333 CITY OF f'UPEkTINO Builditt De artment JOB ADDRESS: PERMIT # q4, ro OWNER'S NAME: Gr©orV PHONE # �aff�s�goal GENERAL CONTRACTOR: v Ssr< <„ _ FAX I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the followinE BUSINESS LICENSE # 0— SUBCONTRACTOR BUSINESS NAM 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 TRofing lumbing o eptic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor ign e