09100121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:• 1180 ELMSFORD DR CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100121
OWNER'S NAME: CHRISTIAN PAQUET DATE ISSUED: 10/20/2009
PER'S PHONE: 4082534798 1 1 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#Q,�o MECH RESIDENTIAL COMMERCIAL
Contractor , ate 16&V 09
I hereby affirm that I am licensb coder the provisions of Chapter 9 JOB DESCRIPTION:KITCHEN REMODEL(300SQFT);CONTRACTOR
(commencing with Section 7000)of Division 3 of the Business&Professions CABINETRY BY
Code and that my license is in full force and effect. DESIGN PD FOR BUS LIC 10/20/09
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:$15000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36209007.00 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
I 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)
1,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
HAZARDOUS MATERIALS DISCLOSURE
declarations:
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
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. 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 Health&Safety Code,Sections 25505,25533,and 25534.
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,Iutho ized agent:
AT:
or aq
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. 0 Y
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
-rnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
gsgirting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
V
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36209007 . 00
DATE ISSUED. . . . . . . : 10/20/2009
RECEIPT #. . . . . . . . . BS000008971
REFERENCE ID # . . . 09100121
SITE ADDRESS . . . . . : 1180 ELMSFORD DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER CHRISTIAN PAQUET
ADDRESS 1180 ELMSFORD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4950
RECEIVED FROM . . . . : DOUGLAS GABRIEL
CONTRACTOR TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 15, 000. 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 15, 000. 00 1 .50 0 . 00 1.50 0 . 00
1BUSLIC FLAT RATE 1. 00 114 . 00 0 .00 114 . 00 0 . 00
1REMRESKIT SQ FEET 300 . 00 570 . 00 0. 00 570 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 686 .50 0 . 00 686 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 686 .50 VISA
---------------
TOTAL RECEIPT 686 .50
CITY OF CUPERTINO
=. ADDITION/REMODEL
CUPEkTINO PERMIT APPLICATION FORM
APN # y, Date:
2 6o 2,0 610 0-7 , c ) c� 6�_ 2_0 l S
Is a 2" unit being added? Yes ❑ No ffrlf yes, please fill out the permit application for 2" unit.
Building Address:
Mailing Address (if different from building address).
Owner's Name: Phone#
Contractor: o Phone#: 51®&3q0
Fax #:
Contractor License#:
Cupertino Business License#:
Contact: Phone#: d�
CDOM(dA Fax#:
Building Permff InfoNe.
Bldg. [:] Elect. Plumb. Mech. Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
Remodel Includes Re-Roof: Yes ❑ No Z If yes list number of squares
Remodel Includes Structural: Yes ❑ No 2"'
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch:_Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other
Type of Construction (Usage Class): Occupancy Type:
I-A, I-B ❑ II/III/V-A ❑ I1/III B, IV-HT, V-B
Valuation: �� Please check this box if the project is a
6 second-story addition ❑
Project Size: Express 2 —9 andard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
***For Office Use Only***
Over-the-Counter ❑ Revised 07/06/09
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
DECKS 1R3SFDADD OR
1R3SFDREM
1DECKWOOD Deck (Wood)-Each B
(Each)
I DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1 GARDTW<=1 K Wood Frame up to B
1,000 SF (each)
1 GARDTM<=1 K Masonry up to 1,000 SF B
(each)
1BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1 PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1PATIOENCLW Enclosed Wood up to 300 B
SF
1PATIOENCLM Enclosed Metal up to 300 B
SF
1PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1 REMRESBAT Bath Remodel up to 300 B "
SF
1REMREOTH Other Remodel up to 300 B "
� SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1 MECPLNCK Stand Alone Mechanical M
Pln Ck(hourly
1PLMPLNCK Stand Alone Plumbing P
Pln Ck (hourly)
IBCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
IBSEISMICRE Seismic Residential B
1 TRAVDOC Travel & Documentation B
1BUSLIC Business License B
In 'oor Air Quality and meshes
1.Use l owWVOC 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/4o VOC Adhesives 3 IAQ/Health 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 61AQ/Health pts y=yes
0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Egx*WRwWabowrdorkU)f 41AQ/Health. pts y=yes 0
8.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
1 1
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
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 i
Total Points Available: 1401 1301 57
Total Points Project Received: 0 0 0
G:datalprogs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xis
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RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner. Pt Qua
Project address.
s
Contact person. Phone. f
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
re there at least two 10 foot by 20 foot clear spaces inside the garage? x-�
Is privacy protection planting required fort E prof ect? Y----C— I
On what floor(s) is work being done?
Brief description of work. J V U izo4
Code editions: 2008 CBCN)2008 CFC N)2008 CMC d�S)N)
2008 CPC BY N)2008 NEC -N)
Effective 1/1/08 " `' 'vc f,
IN Ak.('('Pf '• J' t :,.'1 H tHF CITY OF
C:UPFF{lira +i,l:L>t b AND ORDINANCES
DATE_
SIGN
This set o4 plaol,3x1,1 'f'et Ifi ,th o>MUiT
be kept on thrh I(A I' III!4n1", and It IS t
unlaWttli to nlake 1: y t.4aihit", ,t .uteTatlons
on same wlthotA I(M from
the Kjil-;f11'9 „tirtn t•r,t ( a ±;'ilitorttr?o
The,Iarn inq<1[h_'f9w,rLi'� V"i ,1ti`,IfIk it”'
SHAT I NOT t" til tx•an
apOI"'•ss1.11 r v15fons
tut 3, " l"tt, }II"ivy,
Plan Review Process Work Book Page-8-Revised 1/1/08
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RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner. �/�1
Project address. D„ , ,n
Contact person. Phone. '
Fax.
Net square footage of lot.
C_
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
re there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required fort E prof ect? Y� --
On what floor(s) is work being done?
Brief description of work. Alo!2 9u, 42
Code editions: 2008 CBCN)2008 CFC N)2008 CMC �VN)
2008 CPC BY--
N)2008 NEC -N)
Effective 1/1/08
Plan Review Process Work Book Page-8-Revised 1/1/08
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