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09100195 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 868 BRENT AVE CONTRACTOR:DAVE PARRETT PERMIT NO:09100195 OWNER'S NAME: DAVE PARRETT 868 BRENT AVE DATE ISSUED: 10/28/2009 VER'S PHONE: 4084975565 CUPERTINO CA,CA 950144553 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class Lic.# MECH f— RESIDENTIAL r— COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SHEETROCK ON 3 WALLS DUE TO (commencing with Section 7000)of Division 3 of the Business&Professions MOLD,ADD 2 Code and that my license is in full force and effect. OUTLETS(ELECTRICAL) I SINK, 1 FAUCET 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 Sq.Ft Floor Area: Valuation:$500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36924032.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. 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. Issued by: Date Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 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: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall jHealth.&-Safety de,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's I / Compensation laws of California. If,after making this certificate of exemption,I wne auth ager • n become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address ins' •riify and keep harmless the City of Cupertino against liabilities,judgments, C, nd expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION graining of this permit.Additionally,the applicant understands and will comply with all non-pojuroe re tions per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. i / d F �Q Licensed Professional Signature Date / CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36924032 . 00 DATE ISSUED. . . . . . . : 10/28/2009 RECEIPT #. . . . . . . . . : BS000009060 REFERENCE ID # . . . : 09100195 SITE ADDRESS . . . . . : 868 BRENT AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DAVE PARRETT ADDRESS . . . . . . . . . . : 868 BRENT AVE CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4553 RECEIVED FROM . . . . : PARROTT CONSTRUCTIO CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : DAVE PARRETT ADDRESS . . . . . . . . . . : 868 BRENT AVE CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4553 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 500. 00 1 .00 0 . 00 1. 00 0 .00 1BPFIXTURE NO OF FIXTURE 1 . 00 8 . 00 0 . 00 8. 00 0 .00 1BREMRECEP NO. OUTLETS 1. 00 42 . 00 0 . 00 42 . 00 0 .00 1BSEISMICR VALUATION 500. 00 0 .50 0 . 00 0.50 0 .00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 1TRAVDOC FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 177 . 50 0 . 00 177.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 177 .50 #1171 --------------- TOTAL RECEIPT 177 .50 0- �/ c)� � CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: t_.. Building Address: LJ girl CJe. � � i{ �� LJ/� Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes 0 No HOA: Exterior work only) Yes ❑ No If yes, provide letter from HOA Owner's Name: Phone#: Contractor Phone: a N c�l`T Fax: �`f 3l(-: - 736.5_ Contractor License t t jl& S `y Cupertino Business License#: Contact: Phone: Fax: Residential 1Z Commercial El v' Job Description: ')t f-e p1C; Le llrr ll /A\L Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B ❑ Valuation: Square Footage: 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.builditgreen.org Revised 07/14/09 51 n CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEI�TINO 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 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M r 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E I 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-stand alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 M.Indoor Mr Quality and Finishes 0 1 IAGMealth pts y-yes 0 1.Use LOw/No-VbC Paint 2 IAWaalth pts Mas 0 2,Use Low VOC,Water-Based Wood Finishes 3 iWHealth pts Mes 3.Use LOWINo VOC Adhesives 3 D Resource pts Y--Yes 4.Use Salvaged Materials for Interior Finishes 0 5.Use Engineered Sheet Goods with no added Urea 6 IAQIHealth pts Mes D Formaldehyde 1 IAQ1Health pts Mes p 6.Use Exterior Grade Plywood for Interior Uses 4 IAOJHaalth pts= as 7.Sed � oldxwd or MDF_ 0 4 Resource pts Mes 0 B.Use FSC Certified Materials for interior Finish p r Resouce Pts y=Yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 3 Resource P pts Y--Yes10.Install Whole House Vacuum System D D D N.Flooring0 B Resource pts y=YeS D 1.Select FSC Certified Wood Flooring 4 Resource pts y=yes 2.Use Bapidiy Renew,, Flooring Materials D 4 Resource pts y=Yes 0 3,Use Recycled Content Ceramic Tiles 5 IAQJHealth pts y=yes 4.Install Natural Linoleum in Place of Vinyl D 4 Resource pts y=YeS D 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6.Install Recycled Content Carpet with Low VOCs D D D 140 1 W 57 Total Points Available: 0 Total Points Pro'ect Received: r-�G!/ c G:datalprogslgreenbuildingguidelineslramodelerslgreenpointsfinal212D4proleoied.xls ETIAoT � R 7. za Assessor's Parcel Number: Name of owner. Project address. �, _`,-�_" Phone. �a�� )Ln - 7 3�,5� Contact person. )A�'-� Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: / e there at least two 10 foot by 20 foot clear spaces inside the garage? Y Is privacy protection planting required for the project? Y On what floor(s) is work being done? c f Brief description of work. _ nom cet 2008 CFC k-N) Code editions:2008 CBC � N)2008 CMC (Y-N) Aro 0", 1 � 2008 CPC -N)2008 NEC Effective 1/1/08 ' 1�. Plan Review Process Work Book Page-B-Revised 1/1/08 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. Project address. r Contact person. Phone.;- 'e i Phone. �(D& Fax. Net square footage of lot. Existing Proposed Square footage: First floor: .,�. Second floor: 4r Garage: TOTAL: , L� 4. 1 re there at least two 10 foot by 20 foot clear spaces inside the garage? Y Is privacy protection planting required for the project? Y 5fi1,. _ On what floor(s) is work being done? f,� Brief description of work. _�, �ic� -=�: `/�<'�-�� ( 'ci ce.t Code editions:2008 CBC N)2008 CFC (Y -N)2008 CMC (Y-N) 2008 CPC -N)2008 NEC N) S,,/u,- )-I u,/-f iii Effective 1/1/08 IN A; ('.OF�t iA')tCITY OF CUPS H I IN(;(-O[)I AND UHDINANCES DATE SIGNED This Set of Plat)"' nMUST be kept on th.•1-1),V d1 r,-e- rnd.t is rations r {It �. A�r unlawful to make dl,y . on Sime withou+ w.,tt.. I,«, +„„ron from ` !/ the Building Deprirl- ,,t ,f Cupertino The stamping of this icat ions SHAH NOT be held!,>{n'rr pit or to be an approval of the;v1,`-V-' ,,f.#nv;-wvrsit>ns of my City i t.or `.,t,,te law. Plan Review Process Work Book Page-8-Revised 1/1/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 „UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # �� c"a OWNER'S NAME: v ieP PHONE # � - 31 - 7 3 S GENERAL CONTRACTOR: FAX # I am not using any subcontractors: /o_zk_6f Signature Date Please check applicable subcontractors and complete the follow* 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