09050029 CITY OF CUPERTINO
BUILDING DIVISION PERMIT GIAU � � � r
BUILDING ADDRESS: PERMIT NO.
20697 SUNRISE DR A PERFECT CLIMATE - 09050029
OWNER'S NAME: PERMIT ISSUE DATE
''ONE: SA CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
ADD A,'C TO EXSTNG SYS BLDG ELECT PLUMB MECH
a p C LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
VTC with Section 7000) r that
3 of the Business and Professions Code,and my license is
CA in full force and ef�cL
Z Licen a%' Lic.#—0 Dam 21 It -Contractor
al- ARCHITECTS DECLARATION
o.
V I understand my plans shall be used as public records
4 G Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
COO following mason.(Section 7031.5,Business and Professions Code:Any city or county
.4 V which requires a permit to convect,alter,improve,dcmolLth,or repair any structure
Z y prior to its issuance.also requires the applicant for such permit to file a signed statement
Uthat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
y F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
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 OCC
not mote than five hundred dollars(55Occupancy P Y Type
❑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
and Professions Code:The Contractors License Law does 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.U.
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
convect the project(Sec.7044.Business and Professions Code:)The Contractors 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 dee Contractors
License Law.
C]I 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.
1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
_.ron,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑T 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.
Mx Wor s Compensation i carrier and Policy number are:
0'' PolityNo.:W-NDOIC50`
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less)
1 Certify that in the performance of the work for which this permit is issued,1 shalt 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
Oforthwith comply with such provisions or this permit shall be deemed mvoked.
Z i--r CONSTRUCTION LENDING AGENCY
[~—r►�-� I hereby affirm that there is a construction lending agency for the performance of
�r the work for which this permit is issued(Sec.3097,Civ.C.)
W 0 L.endces Name
0 z Lenders Address
U 0 I certify that I have read this application and state that the above information is
M.►' 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
a above-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit ' e
0'4 APPLICANT UND ANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULA S.
XA A.
-7-3 Re-roofs /
sign; rc ApplicaDam
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)?
❑Yes No All roofs s hall be inspected prior to any roofing material being installed.
Will the applicant or building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contamin;N.�
astied by the Bay Area Air Quality Management all new materials for inspection.
;trio?
❑Yes
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 n currc have a tenant at it is my responsibility to notify the occupant of the
urrem nts measleior to issuancc ofa Certificate of Occupancy. Signature of Applicant Date
Ow r o authorized agent Dat All roof coverings to be Class" `'or better
CITY OF CUPERTINO
C' FUI�NACE/AC
CUPEI�TINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
2 c.3 `1 7
Owner's Name: Phone#:
46 c o8- 93 2 3- 1720
Contractor: Phone#: wog_86 j"cjSN s'
r
Fax#:
Contractor License#: Cupertino Business License#:
> g
Contact: Phone#: ilb�--
Fax #: —�%
Building Permit Info:
Elect IS Plumb Mech
Residential Commercial
Job Description:
For Residential Installations:
Attic ❑ 1"floora?), 2nd 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):
fid`y�c�b L/(
Strapped On Platform Bon ied -New Location Replacement
Project Size: Express Er 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
CUPEk INO FEE SCHEDULE
Quantity Fee ID Fee Descriptioa Fee Permit Type
_
Group
AIR FURN/AC
CONDITIONING
1BCAIRHAN Commercial A/C Units<= IOk CFM B
1 MCRAA Commercial Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICO Seismic Commercial B
1PGASCOM Commerical for,:a gas piping System P
1-4 outlets
1 PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1BPGAS For each gas piping system of 5 or P
more per outlet. '—omm/Resid
1 BREMAIRHAN Residential A/C units<= l Ok CFM B
1 MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standa ds Commission Fee B ALL PERMIT
/ TYPES
I 1BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
1 MPERMITFEE Mechanical Permit M
1PPERMITFEE Plumbing Permit P
1 TRAVDOC Travel Documentation B
1BUSLIC Business License B
M.Indoor Mr Quality and Finishes INPUT ReSDurces Energy IAQ/Health
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 IAQMealth 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 p
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
1 1 1
N.Flooring I
1.Select FSC Certified Wood Flooring 8 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
1 1 1
Total Points Available: 1 1401_ 130 57
Total Points Project Received: 01 01 0
r
G:data/progs/gre;nbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.zls
µ Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
"'UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
G sE�ra":3 G
OWNER'S N A PHONE
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
S ignature Date
Please check applicable subcontractors and corn lete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
1/ 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