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09060060 CITY OF CUPERTINO ..7777777777777.... BUILDING DIVISION PERMIT � �� �' � � BUILDING ADDRESS: PERMIT NO. 10210 N FOOTHILL TBD - OWNER'S NAME: PERMIT ISSUE DATE iGHNSON n0 S R CONTROL NO. I INFO ARCHITECTIENGINEER: BUILDING PERMITPLUMB BLDG ELECT PLUMB MECH 0 0 a a u0p LICENSED CONTRACTOR'S DECLARATION Job Description 1,42 I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is � y in full force and effect. REPLACE: 2X6 DECK BOARDS AND 4X8 JOIST AND LEDGER j iR? License Class Lic. :Fwo Date Contractor BOARDS REPLACE MISC PLYWOOD DAMAGED BY WATER ARCHrrEcrS DECLARATION O I understand my plans shall be used as public records INF I LTE'AT I ON REFLASH PAPER, WIRE AND STUCCO DW W y Licensed Professional n y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Cp O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Zprior 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 Yt— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or81000 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 five hundred dollars(5500). 1,as owner of the property,or my employees with wages as their sole compensation, 32615125 .B 2 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 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.IL 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.). as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044"Business and Professions Code:)The Coatnctor'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 contractor(s)licensed pursuant to the Contractor's License Law. &P C f r this ^w 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 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 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 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 forrnance of the work for which this permit is issued.I shall not employ any person to an to become subject to the Wo 'Compepgation Laws of California.Date Applicant NOTICE TO A CAM:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,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 construction lending agency for the performance of IY. the work for which this permit is issued(Sec.3097,Civ.C.) W A L.endce Name z Lender's Address U 0 I certify that I have read this application and state that the above information is IL h" correct.I agree to comply with all city and county ordinances and state laws mlating to 0 E"' building convection,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. Date 6 / ►�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: TIONS. w� G• (�. Re-roofs Signature of Applicant/Contractor Date Type of R oof HAZARDOUS MATERIALS DISCLOSURE 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. 0 Yes P'No Will a roof is installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new IT aterials for inspection. District? O Yes Nu 1 have mad the harardtws materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,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 which must oc mel prior to issuance era certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class'J "or better 7mcms or authorircd agent Datc' all CITY OF CUPERTINO CITY Of CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM 9a APN # Date: 3 /5— /zS, 4�;2-- Co X D - 09 Building Address: Mailing Address (if different from building address): Owner's Name: Phone#(&&So) HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Contractor: Phone: Fax: Contractor License#: Cupertino Business License#: 1 O 1514 Contact: 69m,aaaa Mq..o%%%Ja► Phon `Sod rML- d R$ K�ssspwwaa - Ate' �`l`G.ct �'`{ JtF�-�rzr, - r�cys•�: 1K: D'> -N, - ,AcVSk Residential ❑ Commercial El Job Description; R4-v l��.P�.�cc-�. rn�sc P`--two©+� ba�.�Al�4t� "�1 wca.:-�t. �v..�c-��'�2ael.o.a .�e.�Asy�► � 1P w t v t-z.. Vl%- > IS V%-,>C-c.o c�F= G 9.c.`n,+� C�Wl"a,s . Po s.%N\.ow �Y%S -%-a V O�rJ �'Ac"t'zat O prey%A&t i�`3�--Psi,,. C��..oc.r�►r►+�- bra S��.t�PS-+ P�..a�►s A3 Roc.�. Building Permit Info: Bldg Z Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-13 Valuation:-O Square Footage: Project Size: Express EK 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.buildit reen.or Revised 02/05/09 CITY OF CUPERTINO CITY of GENERAL BUILDING APPLICATION CUPEI�TiNO FEE S(:HEDULE Quantity/Sf Fee ID Fee Des rription Fee Permit Type Group 1GENRES or 1GENCOM 1 `/ 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/mas:)nry(includes plan ck fee) 1 EPERMITFEE Electrica: Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing; Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stmd alone I BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT J TYPES I BSEISMICR Seismic 1,esidential B 1 BSEISMICO Seismic Commercial B I TRAVDOC Travel & Documentation B 1 BUSLIC Business License B 5 of 5 M.Indoor Air Quality and Finishes 1.Use L3owmo-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/%VOCAdhesives 3 IAQ/Health pis 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 D 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes i.Seal el osed,Patolabow d or MDF 41AQ/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 i 1 N.Flooring 1.Select FSC Certified Wood Flooring 3 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 f f ! Total Points Available: 1 1401 1301 57 Total Points Project Received:1 1 01 01 0 G:daWprogs/grei!nbuildngguidelinWremodelers/greenpointsrinal2.12.04protected.xis Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C1T1f OF Fax(408)777-3333 XPERTINO Building Department JOB ADDRESS: �� ��L�.�- �L NPS PERMIT#ao•.,►.,u �ti�fl � �6006a OWNER'S NAME: '=',ti,�, . PHONE #1,50 3 2-1 -96L GENERAL CONTRACTOR: FAX # I am not using any subcontractors: .>r�-c.�.�'S. 4 asp. ' 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 �. CITY OF CUPERTINO REPIPE/SEWE:R./MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# Date: 1 �� f l5 _�9 Building Address: 05-�( Coo Owner's Name: Phone KAccw (!;6 Contractor* Phone#: -3-2, 8 t L'5 r) e--K Fax #: G - 4C Contact: ' ^ Phone#: -7-6---Z� Fax #: Contractor License#: S —?, Cupertino Business License#: 2 7- Job Description: 74)e �5)fd f [Residential Commercial ❑ Valuation: L Project Size: Express Standard Large Major 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. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary:,ewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial GE.s Piping System P 1-4 Outlets 1 BCBSC Cal Bldg Stand irds Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF (;UPERTINO REPIPE/SEWEIUMAIN SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Resident:al P 1 1PRSEWER Residential building P 1RPSS J sewer/sanitary sever 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping Systein 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B J 1BUSLIC Business License B