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09050037 FOWNER'S OF CUPERTINO PERMIT ��� ����*�������• LDING DIVISION PriitMI r PERMIT NO. ADDRESS: 880 NORTHP T TBD BE T)F.TFRMTN— pERMIT ISSUE DATE NAME: S p CONTROL NO. r- MANAGEMENT NONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: RLDG ELECT PLUM MFCH Zed C TOR' LICENSED CONTR CS DECLARATION lob Description V I bereby affirm that I am licensed under provisions of Chapter 9(commencing iih tvisian3ofdtcBusiness and Profcssions an myBccnseis RMV & REPLC DECK BOARDS, JOIST ASSMBLY,.& ASSOC In :"2^ License Ci txractor r RAIL SYS &TWO SMALL STUCCO END WALLS TO BE REPLCD M Date — AR nEcrsDELLA oN LIKE4LIKE ee cad m use public records ;yU y C H qUin.Redpwfession OWN..,-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the o O following mason.(Section 7031.5,Business and Professions Code:Any city or county (v which requires a permit to construct,alter,improve,demolish,or repair any structure 't'H prior to its issuance,also requires the applicant for such permit to rile a signed statement IS -Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q Y.H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $15000 y that he is exempt themfrom 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). 3163620-3 . 00 ❑1.as owner of the property,or my employers 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 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 Contractor's Li- cense Caw 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 Contractor's License Law. B gr'P C for this reason [-]I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Consent to self-insure for Worker's Compen- m,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 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 Worker's Co " on Insu carrier and Policy number are: Cartier y(�t�0 (T li u' V Policy No.: W �' CERTIFICATE OF EXEMPTION FROM WORKERS' j(f,q 16" COMPENSATION INSURANCE ( l (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 s , sat 'a to the Workers'Compensation Laws of California.ILI Applicant �1 t NOTICE TO APPLICANT:If,after making tl entficatc of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z R CONSTRUCTION LENDING AGENCY [�►�. 1 hereby affirm that them is a construction ding agency for the performance of (Yi> the work for which this permit is issued(Sec.3 ,Civ.C) W Q Lender's Name �Q Lender's Address U 0 1 certify that 1 have read this appl' on and state that the above information is LL H torted.I agree to comply with all city d county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to curer upon the Uabove-mentioned property for inspection purposes. FL (we)agree to save,indemnify and keep harmless the City of Cupertino against o.j liabilities,judgments,toss and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date ►-r APPLICANT UNDERSTANDS AND WILL C( tPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. // Re-roofs Signature of Applicant/Contractor Date 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)7 �N All roofs shall be inspected prior to any roofing material being installed. ❑Yea o If a roof ,s 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 rlaterials for inspection. rice? ❑Yes No Lrrquimmcnts ad the hazardous materials requirements under Chapter 6.95 of the Califor- ety Code,Sections 25505,25533 and 25534.1 understand that if the building ly have a tenant.that it is my responsibility to notify the occupant of the Date co met prior to' uance of a CcrtiOcate of occupancy. . Signaturc of Applicant �✓ a8 0 All roof coverings to be Class'J `or better rized agent are CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN 31E36205 . 00 DATE ISSUED. . . . . . . : 05/ 08/2009 RECEIPT #. . . . . . . . . : BSC00007681 REFERENCE ID # . • . : 09C50037 SITE ADDRESS 10680 NORTHPOINT WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PMIS MANAGEMENT ADDRESS . . . . . . . . . . : 10189 NORTHSHORE SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0550 RECEIVED FROM . . . . : ALEX HALAJ CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- --------- 1BCBSC VALUATION 15, 000 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 15, 000 . 00 1 .50 0 . 00 1 . 50 0 . 00 1DECKRAIL EACH 1 . 00 428 . 00 0 . 00 428 . 00 0 . 00 1STUCOAPP SQ FEET 1 .00 428 . 00 0 . 00 428 . 00 0 . 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 858 .50 0 . 00 858 .50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------ CREDIT CARD 858 .50 MC --------------- TOTAL RECEIPT 858 .50 C r") CITY OF CUPERTINO CUPEkTINO GENERAI, BUILDING PERMIT APPLICATION FORM APN # ., �- Date: �i � � U e; � s1,9161 G Building Address: CD3�fl 6v0 Mailing Address (if different from building address): Owner's Name: �-A L /�4C,-ke d'"_� Phone#: 6/ HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: A ,6—, l�-f- � ev'pr 1--,>e-5 57D— S�6 Fax: �To s7a Contractor License 9 Cupertino Business License#: Contact: Phone: Fax: ResidentialDC Commercial _ Job Description: �e11'lb Ve- Cc 110 CQ Ce �,� GJ b e r c�S a ou f` aSy5ekll I X og — Ct,r o(,'u+4 f4- 1 c,'wkM, Two e m.& �f-vtco e0A walks Building Permit Info: Bldg W Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B ❑ Valuatio Square Footage: c—p0 ( S goo -- Project Size: Express __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.builditp_reen.or Revised 02/05/09 CITY OF CUPERTINO CITY Of GENERAL BUILDING APPLICATION CUPEkTINO 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 :3 windows) IWINMEWSTR New Winlow-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbin€;Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E IMECPLNICK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Al ane Plumbing Pln Ck (hr ly) P I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-s1 and alone 1 BCBSC Cal Bld€, Standards Commission Fee B ALL PERMIT TYPES l BSEISMICR Seismic Residential B 1 1BSEISMICO Seismic Commercial B ITRAVDOC Travel 6c Documentation B IBUSLIC Busines3 License B 5 of 5 M.Indoor Air Quality and Finishes 1.use -VOG P*t I IAQ/Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes ?IAQ/Health pts y=yes. 7 0 3.Use Lowft VOC Adtv►es 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 31AQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7,Seal all f3praed Pati labawd.ar MDF 4 IAQ/Health. pts y=yes 0 S.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 1,Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 3 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y—yes 0 i 1 1 End Total Points Available: 1 1401 1301 57 Total Points Project Received: I 0 01 0 G:data/progslgre:nbuildingguidelines/remodelers/greenpointsfinal2.12.D4protec d.xls t - 10, RE St,IDE ' P � f.. .F ,�..•d, „ < x Assessor's Parcel Number: Name of owner. 1A 1 L ¢ Project address. f g R I 04-A-Y1 bIOfi ��� R aJu� Phc ne. 6�(� 10 3 Contact person. �Z 3 Fay. Net square footage of lot. N /I Existin; Proposed Square footage: First floor: — Second floor: Garage: — TOTAL: — Are there at least two 10 foot by 20 foot clear spaces inside the gara N privacy protection planting required for the project? On what floor(s) is work being done? Z rn� oa � a.� Totted description of work. o� M� Y`�P/� t e �-X 6 LK �� uv et 11 S 2)(g 'Snt31-5 Alv S 6` - 2008 CFC (Y -N)2008 CMC (Y-N) �ri- Code editions:200s CBC 0(y a,W 2008 CPC (Y -N)2008 NEC (Y -N) 11 ACCORDANCE WITH Effective 1/1/08�UPERTINO CpDEe THE CITY I Ardr) ORDINANC'`: �qT rhis set c. ee kOPt on lawful to m> - ss yl: rn same w;<<; tr rab,., rho bbmr }s�;r, REC EI�TEI� stamppi rlg. 'HALL NOT be Pec,ric�lc' MAY 0 8 2009 'pgroval of the vj„1:,, r "� ,' to tj4 RSV ritVr ' G ly provis, nma ,; BY: Plan Review Process Work Book Page-8-Revised 1/1/08 REDETIA� IOC ' R IET Assessor's Parcel Number: Name of owner. C� j�--C Project address. f g g Q � b(--yit Contact person. �� fT a/uT Phone. �Sn^ 30-3 — ?-Z Fa::. Net square footage of lot. Existin Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces in,,ide the gara N privacy protection planting required for the project? On what floor(s) is work being done? D6 Brief description of work. �?mov-e Tatted �k� Y`�P/�. �'a Xho M ,�.wb ��� �� "z-�l$ 'Sn� tS= �Jv Mui©� tcv�fi�v�l Code editions: 2008 CBC n(Y -N)2008 CFC (Y -N)2008 CMC (Y-N) "(Li'Ke 2008 CPC (Y -N)2008 NEC (Y -N) Effective 1/1/08 tJ� tlO YA Y 0 8 2 00,0 n 0 Plan Review Process Work Book Page-8-Revised 1/1/08 Community Development 10300 Torre Avenue a : ; Cupertino CA 95014 Telephone(408)777-3228 an OF Fax(408)777-3333 flff TINO Buildin De artment JOB ADDRESS: PERMIT # � 10,320 ktff-h &(v - W u OWNER'S NAME: L_ c✓tcL ,,,�,�/�` PHONE # 60 303 2Z GENERAL CONTRACTOR: h r c3e FAX # I am not using any subcontractors: oq q Signature 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/Contractor Signature Date