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09060118
�00 rop Z z -0 3 W 4gU k U. rO� �Ar77 y LOC °za EFC CITY OF CUPERTINO DIVISION PERMIT* 77777777, y�r h BUILDING BUILDING ADDRESS: 2nRnn 140MFqTFAT) Rn #R(- BU [j,T)FR PERMIT NO. OWNER'S NAME: _WEST PERMIT ISSUE DATE MHO �rAXFWO 9 19 9 CONTROL NO. 10 525-9378 ARCHIIECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 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 in full force and effect. VILLA SERA APT HOMES, (T7)CARPORTS, (9) TR.SH License Class Lic.ff DateContractor ENC . r (1) COPY OF SITE PLAN SHOWNG CARPORT/ 1 TRASH AHrrEcrS DECLARATION RC I understand my plans shall be used as public records ENC (1) '-OPY OF LIST OF STAMPD DRAWINGS TO BE Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 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 prior to its issuance, also requires the applicant for such permit to file a signed statement License Law 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 2 2 5 0 0 0 that he is exempt therefrom 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 (S500)_ 32609056 .80 0 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections win do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conuactors 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 are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- bui er will have the burden of proving that he did not build or improve for purpose of sa I, as owner of property, am exclusively contracting with licensed contractors to cons me the prof (Sec. 7044, Business and Professions Code:) The Contactors Li- cense Law doers n apply to an owner of property who builds or improves themon, and. who contra for projects with a contractor(s) licensed pursuant to the contractor's License La 0 lam ex pt n B& P C for this ason Owner Date ORK IS COMPENSATION DECLARATION I hem under penalty of perjury one of Ute following declarations: 0 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compcn- sation, as provided for by Section 3700 of the Labor Code, for the performance of tete work for which this permit is issued. 0 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 Workers Compensation Insurance carrier and Policy number am: Carrier: Policy No.: CERTIFICATE OF EXEMP ION FROM WORKERS' COMPENSATION INSURANCE (This section of be completed if the permit is for one hundred dollars (S 100) or less.) I certify that the work for which this permit is issued, 1 shall not employ any pt e pme subject to the Workcrs'Compensation Laws of CaliApplicantNOTICE *tOes TO making this Ccnificatc of Exemption, you should become subjpensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructinn lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lendces Name Lenders Address I certify that 1 have read this application and state that the above information is ' correct. I agree to comply with all city and county ordinances and state laws relating to ' building construction, and hereby authorize representatives of this city to enter upon the ? above-mentioned property for inspection purposes. (We) agree to save, inde'fy and keep harmless the City of Cupertino against nt liabilities, judgments, costs and ex which may in any way accrue against said City I in consequence of the granting of i it. " APPLICANT UNDERST D D ILL COMPLY WITH ALL NON -POINT Issued by. Date - f_ SOURCE REGULATIONS. Re -roofs T of R OOf Type Signature ofApplicant/Con Dare HAZARD ALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Munic' al Cote, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. C] Yes o If a roof ii installed without first obtaining an inspection, I agree to remove Will the applicant or future (wilding occupant use equipment or devices which fined by the Bay Area Air Quality Management emit hazardous air contamin7N. all new rr aterials for inspection. District? os c mad the hear taus materials requirements under Chapter 6.95 of the Califor- nia HS ty Code, Sections 25505, 25533 and 25534.1 undersived that if the building dnot docs have a tenant, that it is my responsibility to noUf the occupant of the requo hi must be met prior to issuance of a Cc'WrICA c o �eap erSignature IN of Applicant Date r _ All roof coverings to be Class'j.�.'' ar better Owner antonzcdagent Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20800 HOMESTEAD RD #8C I CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09060118 OWNER'S NAME: PROMETHEUS ( R'S PHONE: 6509313457 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # p, \ 3't C Contractor jzT 3�' it beat, I a fi�(y7 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source r gulations the Cupertino Municipal Code, Section 9.18. Signature Date ❑ OWNER -B ILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ii ify and keep harmless the City of Cupertino against liabilities, judgments, C, ..nd expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 1608 4TH ST STE 120 BERKELEY, CA 94710 DATE ISSUED: 06/22/2009 PHONE NO: (510) 525-9378 BUILDING PERMIT INFO: BLDG f— ELECT F PLUMB I— MECH f— RESIDENTIAL I— COMMERCIAL r JOB DESCRIPTION:VILLA SERA APT HOMES,(17)CARPORTS,(9)TRSH ENC.,(1)COPY OF SITE PLAN SHOWNG CARPORT/1 TRASH ENC (])COPY OF LIST OF STAMPD DRAWINGS TO BE V_319 Sq. Ft Floor Area: I Valuation: $225000 APN Number: 32609056.8C I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Date: �v 2 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Date: !v r O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional An- CITY OF CUPERTINO BUILDING PERMITS /D BUILDING ADDRESS: 20800 HOMESTEAD RD M8C CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09060118 OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED: 06/22/2009 OWNER'S PHONE: 6509313457 BERKELEY, CA 94710 PHONE NO: (510) 525-9378 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. M t <<j Zr,- 3 OK r r r Contractor tb/� �k—�� 3 Date 9112-110 MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: VILLA SERA APT HOMES,(17)CARPORTS,(9)TRSH (commencing with Section 7000) of Division 3 of the Business & Professions ENC.,(1)COPY OF SITE PLAN SHOWNG CARPORT/I TRASH Code and that my license is in full force and effect. EN (I)COPY OF LIST OF STAMPD DRAWINGS TO BE 3 10 _ gew-a ^ f)LAyLCr rp1f 4S 2z (.q 4 -54""b 5ay1L- yu S I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's va,/Jq tom♦ Compensation, 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 provided for by Sq. Ft Floor Area: Valuation: $225000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 32609056.8C Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulati Cupertino Municipal Code, Section 9.18. Issued b� Dater ignature t% Date 12 ❑ OWNE BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(x) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must Owner d agent: Date: Z forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this pit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point rce re per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signatu Date t J Licensed Professional SIGN # CITY OF CUPERTINO BUILDING PERMTbAM BUILDING ADDRESS: 20800 HOMESTEAD RD #8C CONTRACTOR: WEST BUILDERS, INC. PERMIT NO: 09060118 OWNER'S NAME: PROMETHEUS 1608 4TH ST STE 120 DATE ISSUED: 06/22/2009 OWNER'S PHONE: 6509313457 BERKELEY, CA 94710 PHONE NO: (510) 525-9378 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lie. # ('S/� MECH r RESIDENTIAL r COMMERCIAL r Contractor Wag /n/C, Date Z D 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: VILLA SERA APT HOMES,(17)CARPORTS,(9)TRSH (commencing with Section 7000) of Division 3 of the Business & Professions ENC.,(1)COPY OF SITE PLAN SHOWNG CARPORT/1 TRASH Code and that my license is in full force and effect. ENC (1)COPY OF LIST OF STAMPD DRAWINGS TO BE 7/7/10 REV#3- ADD NEW TRASH ENCLOSURE,REVISE CARPORT LOCATION 1 hereby affirm under penalty of perjury one of the following two declarations: TO AVOID ADJACENT TREES -12/06/10 REV#3 ISS'D I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $225000 APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is APN Number: 32609056.8C Occupancy Type: correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature DaIssued b Date: ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should 1 store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after maldng this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. O auth r' d genl�l 10-11 t Date•Z�6 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional FM-0 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: FLR AREA s .ft. DATE: REVIEWED BY: BP FEES APN: BP#: `VALUATION: 1$6,000 PERMIT TYPE: Building Permit $0.00 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE; p 1 0.0 OVER THE COUNTER? 0 Yes (9 No APPLICATION 1 R3SFDADD/REM TYPE: MECHANICAL 0 Yes Q No PLUMBING ® Yes 0 No ELECTRICAL Q Yes G) No w a. 00 Permit Fee: $0.00 3� C) OT 0.0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s .ft. PC FEES PC FEE ID BP FEES BP FEE ID R-2 (Apartment) II-B,111-B,IV,V-B 0 $0.00 $0.00 1 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. C) OT 0.0 hrs $0.00 PME Unit Fee: $0.00 TOTALS: 0 $0.00 $0.00 $0.00 Uthtr1blech. M_vp. 1 Omni'. Pl�rrl (aleck- Ylrirrd'. Lisp. :r:-, ('lau (Irr ti, 0hay, hlyp. NOTE: These fees are based on the nreliminary information availahle and are only an estimate. Contact the Dent for addn'1 info FEE ITEMS (Fee Resolution 09-051 Ef/' 7,'1, 09) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. © OT 1 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. C) OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C on.ti traction Tax Acoustical Fee: Q Yes Q No $0.00 0 Work Without Permit? Q Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure Q 0 7"val"CI I, lociloiewation J t. <: Strong Motion Fee: 1BSEISMICR $0.60 0 # $633.00 Revision IREVRESADD Addition Bldg; Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.60 $633.00 TOTAL FEE: $634.60 Revised: 6/30/2010 circ o� CUPEkTINO CITY OF CUPERTINO REVISIONIDEFERRED PERMIT APPLICATION FORM APN # Date: Original Permit #: Building Address: -f ca o L� lzd Mailing Address (if different from building address): Owner's Name: Phone #: D.J 6s-O - T-31 - :3-f s 7 Contractor: Phone: r'/0 ---7 -?? — o -77 a o, x: -7'1G Contractor License #: S' 3 Cupertino Business License #: VF '�-6 / Contact: g C �,.,-rrz-e_c-r e�•r� Phone: Fax: Building Permit Info: Bldg C4,,PElect ❑ Plumb ❑ Mech ❑ Residential R Commercial Job Description: ,,4 P P c i d j res �, r -U o �-► /2n � Lv� � rt Vevl s -e.. `o c4A ..) ICA Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B Valuation (cost of project): OGS Project Size: Exp ss E 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.builditgreen.org Revised 01/07/09 -- 1 at CITY OF CUPERTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1REVCOMNEW Revision Commercial New B 1* 1 REVCOMTI Revision Tenant Improvement B I* TI 1REVSFDWL Revision SFDWL B 1R3SFDW 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1 DEFINSP Deferred Submittal not R-3 Inspection B IDS 1DEFPLNCK Deferred Submittal not R-3 Plan Check B IDS 1DEFR31NSP Deferred Submittal Inspection B 1DSR3 1DEFR3PLNCK Deferred Submittal R-3 Plan Chk B 1DSR3 Plan Review Process Work Book Page -12-Revised 3/25/08 Green Building Plan Check Index of Green Building Points/Categories A. Category Example of an Index or Table of Green Plan Sheet or Page Points Building Points Categories that must be shown and referenced on the Project Plans 1. See below B. Site 9. Install H.E. Irrigation, (details/spec)' L-1 2 points 11. Permeable Paving, Note L-1 2 points C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points D. Structural 3. Uses Wood I -Joist, (See Spec.) S-2 2 points 5. Use Truss with heels, (detail) S-2 2 points 6. B. OSB Sheathing, detail S-2 2 points E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points 4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points 5. Tankless W.H., (Note/Spec.) A-2 2 points 11. A 2500 Gal. Tank, (Note/Spec L-1 10 points G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point 3. Energy Star Refrigerator, (Note/Spec. A-3 1 point P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS 40 points Plan Review Process Work Book Page -12-Revised 3/25/08 1T1' OF CUPERTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM ZE APN # Date: c3 Original Permit #: Building Address: p�� p-�N� CA- Mailing Address (if different from building address): Owner's Name: Phone #: b9:--) - ckSl - SA 5l- F M P. A XV -- Contractor: Contractor: Phone: Skb --2-12 -lT3b(. =s -f v4c�Y—S Fax: Contractor License #: -525 %qq S Cupertino Business License #: 2496 Contact: Phone:,\;Z> -;:t - -Z - (V�U Fax: `- QS' Building Permit Info: -vS S l moo-, c Bld R Elect ❑ Plumb ❑ Mech ❑ Residential Commercial Job Description: Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: �(PL V Nc�,o � �z►��n 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B ❑ Valuation (cost of project): 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 hel , contact Build it Green at www.buildit reen.or Revised 01/07/09 4 CITY OF CUPERTINO CUPEkT1NO REVISION/DEFERRED PERMIT APPLICATION FORM FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 REVCOMNEW Revision Commercial New B 1* 1REVCOMTI Revision Tenant Improvement B 1* TI 1 REVSFDWL Revision SFDWL B 1R3SFDW 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1DEFINSP Deferred Submittal not R-3 Inspection B IDS 1 DEFPLNCK Deferred Submittal not R-3 Plan Check B IDS 1DEFR3INSP Deferred Submittal Inspection B 1DSR3 1DEFR3PLNCK Deferred Submittal R-3 Plan Chk B 1DSR3 Plan Review Process Work Book Page -12-Revised 3/25/08 Green Building Plan Check Index of Green Building Points/Categories A. Category Example of an Index or Table of Green Plan Sheet or Page Points Building Points Categories that must be shown and referenced on the Project Plans See below B. Site 9. Install H.E. Irrigation, (details/spec)* L-1 2 points 11. Permeable Paving, Note L-1 2 points C. Foundation 1. Use 15 % Flyash Concrete, (note) S-1 5 points D. Structural 3. Uses Wood I -Joist, (See Spec.) S-2 2 points 5. Use Truss with heels, (detail) S-2 2 points 6. B. OSB Sheathing, detail S-2 2 points E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points 4. B. Fiber Cement Siding, (Note/Spec. A-4 2 points F. Plumbing 1. Insulate all H.W. pipes, (Note/Spec.) P-1 2 points 5. Tankless W.H., (Note/Spec.) A-2 2 points 11. A 2500 Gal. Tank, (Note/Spec L-1 10 points G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points H. Appliances 1. Energy Star Dishwasher, (Note/Spec.) A-3 1 point 3. Energy Star Refrigerator, (Note/Spec. A-3 1 point P. Other 1. List Green Features on Plans A-1 1 point TOTAL POINTS 40 points Plan Review Process Work Book Page -12-Revised 3/25/08