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09090136 CITY OF CUPERTINO BUILDING DIVISION PERMIT GCJTAATCTRI� }�t 'Z'I�N: BUILDING ADDRESS: PERMIT NO. 10070 PENINSULA AVE JIPING ZOU OWNER'S NAME: PERMIT ISSUE DATE oH0 S A CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION l� O rtr I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z WE with Section 7000)of Division 3 of the Business and Professions Code.and my license is ?may in full force ane DRY ROS' REPAIR & REPLC LUMBER LIKE4LIKE Dul? License Class ke.X in Date on t' ARCHITE 4qQ W U I understand my tiQfbc used as public mcor� 4 C y Licensed Professional y S OWNER-BUILDER DECLARATION +�<2 1 hereby affirm that I am exempt from the Contractor's License Law for the L a O following reason.(Section 703 1.5,Business and Professions Code:Any city or county K,$9 which requires a permit to construct,alter,improve,demolish,or repair any structure A Z y prior 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 r (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y R E that he is exempt therefrom and the basis for the alleged exemption.Any violation of $499 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than eve hundred dollars(M). 3 2 6 2 5 0 2 . 0 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 and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections 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 nswct the project(Sec.7044,Business and Professions Code:)The Contractor's U. 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. ❑1 am ex em pn I Set B&P C r th' re n Owner "' ORK COMPENSATION DEC TION I hereby affirm u r penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- an,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 37 bor Code,for the perform it is issued. My Worker's Co carrier and Policy number am: Carrier. gy No.: CERTIFICATE OF EXEMPTION MMWORKEI& 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 nebcjomc syb�ert 1p the Workers'CompcnsaUon Laws of CaliComia.Darn 3 �?// Y Applicant �_ 07 T NOTICE TO APPLICANT:I Ze making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Codc,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a conswctirn lending agency for the performance of fY.> the work for which this permit is issued(Sec.3097,Civ.Q �W 0 Lender's Name Z Lender's Address V 0 I certify that I have read this application and state that the above information is Iy"' 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 U above-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way scenic against said City V Z in consequence of the granting of this permit. h" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _ SOURCE REGU�L pNS. / Re-roofs Signature of Applicant/Contractor Date 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)? "4No All roofs shall be inspected prior to any roofing material being installed. C:]Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hazardous air contaminants as dcfrncd by the Bay Area Air Quality Management all new mz terials for inspection. rict? \\��. ❑Yes Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,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 requiremc which must be met prior to issuance of a Ccrtf 1c of Ge,npane. � Signature c f Applicant Date U�` 70 o nr,horizedagent Dare All roof coverings to be Class'n"or better 0�0sO l3(10 F CUPERTI CITY O NO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # �� C) Date: c Building Address: O ei'L�n-S`zi/GZ A Ve v Mailing Address (if different from building address): Owner's Name: J1 f1 A 6 Z0(A Phone#: HOA: (Exterior work only) Yes ❑ No ❑ L12 27 d If yes, provide letter from HOA Contractor: Phone: pa)ke Y C.( i ( Fax: Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential ❑ Commercial El Job Description: Ty ac e iL �(,q y I � k C-., . 1 Building Permit Info: Bldg ffl` 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 ?--_ - Valuation: n �ry Square Footage: Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portiOL 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.buildits•een.or �' Revised 02/05/09 CITY OF CUPERTINO CUPEI�F GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Dei cription Fee Permit Type Group 1GENRES or 1GENCOM 1 STUCOAP Stucco Applications (up to 400 sf) B addition it stucco application l WINREP Replacement windows/sliding glass B door (eE. 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) 1 EPERMITFEE Electric<<1 Permit Fee E 1 MPERMITFEE Mechan:cal Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK 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 tand alone 1 BCBSC Cal Bld,; Standards Commission Fee B ALL PERMIT TYPES I BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel t� Documentation B 1BUSLIC Business License B 5 of 5 M.Indoor Air Quality and Finishes INPUT Resources Energy IAQ/Health 1.Use Low/14o-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 LowlNo 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 ExIosed PaidWelward or 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 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials t Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 1 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 l Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Available: 401 130 57 Total Points Project Received: ( 01 01 0� Jl 2 G:datalprogs gree ibuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xis Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITYbf Fax(408)777-3333 rUPEkTINO Buildi[rig Department JOB ADDRESS: c OV 7 0 �� /� PERMITa?D OWNER'S N PHONE # Z GENERAL CONTRACTOR: FAX # S �I am not using any subcontractors: Lc) Signature Date Please check applicable subcontractors and corn. lete the following information: SUBCONTRACTOR BUSI:vESS 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