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09100085I CITY OF CUPERTINO BUILDING PERMIT I I BUILDING ADDRESS: 10067 BYRNE AVE I CONTRACTOR: NORTHWEST ELECTRICAL I PERMIT NO: 09100085 1 OWNER'S NAME: JOSE MALDONADO 2625 REBEIRO AVE I DATE ISSUED: 10/13/2009 F.R'S PHONE: 4086905803 1 SANTA CLARA, CA 95051 ( PHONE NO: (408)243-8310 I 91 LICENSED CONTRACTOR'S DECLARATION � iJ License Class '�/`� Lic. # l. /% � Contractor �f/�J1,1%f'wpSt' L�LI Date `' J 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 l 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. Mitionally, the applicant understands and will comply with all non -point so ce regulations r the Cupertino Municipal Code, Section 9.18. Signature Date �� 3 Li OWNER -BUILDER DECLARATION I hereby affirm that 1 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) 1, 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: 1 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. 1 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 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 i nify and keep harmless the City of Cupertino against liabilities, judgments, 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 regulations per the Cupertino Municipal Code, Section 9.18. Signature_ Date BUILDING PERMIT INFO: BLDG F ELECT I— PLUMB f— MECH r— RESIDENTIAL I— COMMERCIAL I— JOB DESCRIPTION: UPGRADE MAIN ELEC PANEL FROM 125AMP TO 200AMP Sq. Ft Floor Area: I Valuation: $1000 APN Number: 35711003.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by:� Date: 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 I 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 & Saf Code, Sections 25505, 25533, and 25534. Owner authorized nt: Date: 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 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35711003.00 DATE ISSUED.......: 10/13/2009 RECEIPT #.........: BS000008907 REFERENCE ID # ...: 09100085 SITE ADDRESS 10067 BYRNE AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER JOSE MALDONADO ADDRESS 10067 BYRNE AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM NORTHWEST ELECTRIC CONTRACTOR KEVIN SOUZA LIC # 22163 COMPANY NORTHWEST ELECTRICAL ADDRESS 2625 REBEIRO AVE CITY/STATE/ZIP ...: SANTA CLARA, CA 95051 TELEPHONE (408)243-8310 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC -------------------- NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 1,000.00 -------------------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 1,000.00 0.50 0.00 0.50 0.00 1BUSLIC FLAT RATE 1.00 114.00 0.00 114.00 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1ERT<200 UNITS 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 ---------- ---------- 241.50 0.00 241.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- CHECK --------------- 241.50 #2081 TOTAL RECEIPT --------------- 241.50 CITY OF CUPERJINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # 26-711003, c' Date: U Building Address: Av L Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes LJ No HOA: Exterior work only) Yes ❑ No WEIf yes, provide letter from HOA Owner's Name: 44. PIV_e Contractor: Phone: Contractor License #: Cupertino Business License #: Contact:%/ / jL-i/n/ J " ✓ 7A - Phone: �� – – 3 3 – 7 Residential Commercial Job Description: Building Permit Info: Bldg ❑ Elect [3--` Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A5 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B 0 Valuation: X�U �-� Square Footage: Project Size: Express [g --'Standard ❑ Large ❑ Ma'or ❑ 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 contact Build it Green at �--7—_.. Revised 07/14/09 _�� alim I CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE 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 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 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 / /7 /t 7- < 5of5 1. Use Low/No-VOC Paint 2. Use Low VOC, Water --Based Wood Finishes 3. Use I.Dw/No VOC Adhesives 4. Use Salvaged A4aterials for Interior Finishes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde S. Use Exterior Grade PlNaood for Interior Uses 7. Seal atl. *t;wd or MIFF _ B. Use FSC Certified Materials for Interior Finish 9. Use Finger -Jointed or Recycled -Content Trim 10. Install Whole House Vacuum System N. Flooring 1. Select FSC Certified Wood Flooring 2. Use i3apidly Renewable flooring .Materials 3. Use Recycled Content Ceramic Tiles 4. Install Natural Linoleum in Place of Vinyl . 5. Use Exposed Concrete as Finished Floor 6. Install Recycled Content Carpet with Low VOCs 1 IAQ/Health pts y=yes 2 IAVHealth pts y=yes 31AQ/Health pts y --yes 3 Resource pts y=yes 61AQ/Health pts y=yes 1 IAQ/Health pts y=yes 4 Resource pts y=yes 1 Resource pts y=yes 3 IAQ/Health pts y=yes B Resource pts y=yes 4 Resource pts y=yes 4 Resource pts y=yes 5 IAQ/Health pts y=yes 4 Resource pts y=yes 4 Resource pts y=yes Total Points Available: Total Points Project Received: 1401 130 57 0 0� G:datalprogslgreenbuildngguidelineslremodelerslgreenpointsfina1212D4proteoied.zls l pCIV OF v V I Ek INO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: / v v (,7 /S '1/zi�� /�-tib' PERMIT # b as v e> OWNER'S NAME: . 0 J t-- PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: /�� Y ignature Date Plonco rbarV nnnliral,lP c,ihrnntrartnrS and comnlete the following information: Owner/ ontractor ature Date y �y SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork -"--,Cement Finishing Elec 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/ ontractor ature Date