09100050 f
CITY OF CUPERTINO BUILDING PERMIT
F BUILDING ADDRESS. 10523 ESQUIRE PL CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100050
OWNER'S NAME: GODFREY&PATRICIA MUNGAL DATE ISSUED: 10/07/2009
`ER'S PHONE: 4089620254 PHONE NO:
❑
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class f� Lic.# to � /
f—�J�F�h�� MECH RESIDENTIAL � COMMERCIAL
�
Contractor iD/7
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL KITCHEN,SAME LAYOUT AND 3
(commencing with Section 7000)of Division 3 of the Business&Professions BATHROOMS,
Code and that my license is in full force and effect. REPLACE TRIMS&WALLS(FINISH),NO RE-ROOF&NO
STRUCTURAL;E&J GENERAL BUILDING CONT PD FOR BUS
1 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 Sq.Ft Floor Area: Valuation:$34000
permit is issued.
APPLICANT CERTIFICATION APN Number:32644023.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City Cupe o a inst liabilities,judgments,
costs,and expenses which may accnr gain said Ci in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Add' ' Il he plicant un rstands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point sour s� atio per e Cupertin Municipal Code,Section
9.18.
/` -7
Signature Date
/� 'l ® , Issued bDate:
L OWNER-BUILDER DEC)ARATION
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
I,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. 1 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(a)should I 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,l shall contaminants as defined by the Ba rea Air Quality Management District I will
maintain complian a ith the C er no Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Sal o ,Sectio 2550 ,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 e
forthwith comply with such provisions or this permit shall be deemed revoked. Date: ! /
APPLICANT CERTIFICATION CONSTR CTION LENDING AGENCY
I 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
i� ' -rnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
gr-sting 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
U
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32644023 . 00
DATE ISSUED. . . . . . . : 10/07/2009
RECEIPT #. . . . . . . . . : BS000008858
REFERENCE ID # . . . : 09100050
SITE ADDRESS . . . . . : 10523 ESQUIRE PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : GODFREY & PATRICIA MUNGAL
ADDRESS . . . . . . . . . . : 10523 ESQUIRE PL
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1318
RECEIVED FROM . . . . : ERNESTO PEREZALONSO
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 34, 000 . 00 2 . 00 0. 00 2 . 00 0 . 00
1BSEISMICR VALUATION 34, 000 . 00 3 .40 0 . 00 3 .40 0 . 00
1INSPPAR HOURS 9. 00 1134 . 00 0 . 00 1134 . 00 0 . 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1PREPPIPE FLAT RATE 7. 00 294 . 00 0. 00 294 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1517 .40 0 . 00 1517 .40 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 1, 517.40 #1050
---------------
TOTAL RECEIPT 1, 517 .40
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: 2- U
Name of owner. 6eP13�v mov�
Project address. l d�23 QCT! I �
Contact person. A�� Phone. Wb)
Fax. J7 J
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 gara ? N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done?
Brief description of work. h7v-D 3 A":7j -aX-PI S
21�b NL�Gc�a�1'Zq-t_ . /SDN ;�I'Lu� G ►>>'1.�6 ��,Y,;�5
?S �Code editions:2008 CBC �N)2008 CFGC9t-N)200 CMC (Y-N) 5,,,,o
l
2008 CPC EY}N)2008 NEC (Y -N)
Effective 1/1/08
10ISSFS
s�/�
COPY -.
i'Y Y
Plan Review Process Work Book Page-8-Revised 1/1/08
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RESIDENTIAL PROJECT COVER SHEET
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Assessor's Parcel Number: 2- L� L-(U
Name of owner.
, Q
Project address. l d�2-3 QIJI I L �
Contact person. Phone. S7D)
Fax. r 42 35YAY
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 gara ' �N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done? //��
Brief description of work. A�v-D 3 Aviran-ts pe!LDPI1A
Jib NL��Z�►'� . /VbN �>i'1J6 R w7, -e.
e6ukw W*-tA-* IIVJ-Y , 13,57,- roo r'-7-J, 10 h
Code editions: 2008 CBC N)2008 CFC -N)2008CMC (Y-N)
2008 CPC N)2008 NEC (Y -N) I
APPRO,,
IN ACCORDANCE V. c
CUPERTINO CODES i S
Effective 1/1/08 DATE
sf
This ant i - r
be kept on the jot,
unlawful to make an, S
on same Without\t
the Building Depart
The stamping of th ns
SHALL NOT be h,
approval of the v,. r1S
of any City Or
Aak
A
Plan Review Process Work Book Page-8-Revised 1/1/08
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# CITY OF CUPERTINO
ADDITION/REMODEL
CUPEkTINO PERMIT APPLICATION FORM
APN # 2 -� p Y U Date:
Is a 2"d unit being added? Yes No ❑ If yes, please fill out the permit application for 2° unit.
Building Address:16 12.5 IE5 au)"JZICPC461c_
Mailing Address (if different from building address):
Owner's Namq. Phone#
A172�Gt R1JW,6 Z-� d—- 2— 62.E
Contractor: Phone#: T_zJ_3
u)) J Pg COAG a-or' fi_ Fax #: �
Contractor License#: Q
Cupertino Business License#:
Contact: Phone#: 67W -7/V—f Zr-3
k9Lk1e3_ WSD Fax #: b 35 I OP
BuildinPermit Info:
Bldg. Elect. ❑ Plumb. Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)? / � t,� 1-A yd&rf—
? &�P-4-6 omits ¢ was
Remodel Includes Re-Roof: Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No
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:
1-A, 1-13 ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B EZL,,4V��r���� �
Valuationfe:
Please check this box if the project is a
/ second-story addition El
Project SiExress ❑ Standard ❑ 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
4- ADDITION/REMODEL _
CUPEI�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
1PLLONGRNGR Long Range PL
Planning/Residential
1R3INSP Dwellings Inspections B
1 R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B
Inspection
1 R3REPPLNC Dwellings Repeat Plan B
Check
1 R3HINSP Dwellings Hillside B
inspection
1R3HPLNCK Dwellings Hillside plan B
check
1 R3HREINSP Dwellings Hillside B
Repeat Inspection
1R3HREPLNC Dwellings Hillside B
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
l R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Disposal System
1 PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
1BPWSVCS Main Water Service P
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
iCommission Fee
1BSEISMICRE SeismicResidential B
1RER00FRES Residential Re-roof Each B
100 SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1 REMRES2 Remodel Residential B
Greater than 1000 sq ft
1REMRES3 Remodel Residential B
Greater than 2500 sq ft.
1REROOFRES Residential Re-roof Each B
100 SF
REMODEL PLNCK
1 STPLNCK(1-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTER PLAN CKS.
WINDOW/SLIDING 1R3SFDREM
GLASS DOOR
1 WINREP Replacement windows B
(ea 8 windows)
1 WINNEWNSTR New Window (non- B
structural)
1 WINMEWSTR New Window(Structural B
Shear Wall/Masonry)
1 WINBAYSTR Bay Window (Structural) B
SKYLIGHTS 1R3SFDREM
1 SKYL<10 SF Skylight less than 10 sf B
1SKYL>10SF Skylight greater than 10 B
sf or structural
1STAIRS Stairs-first flight/ea addt'1 B
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln E
Ck (hourly)
. 7 pr) PPrP
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)
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
/ 1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
.Indoor Air ua rty and Frnrshes
1.Use LOOkINOC Pati 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Lowltifo 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 p
p
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7-SeWai(fFVmWP, iebwo,arfltl�F 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 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapicly Renewable f=looring 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 i 1
Total Points Available: 1-4-Or 130 57
Total Points Project Received:
io/7/ o1
G:data/progstgreenbuildingguideeslremodelers/greenpo fina12.12.D4protected.xls
Community Development
10300 Torre Avenue
s .{ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
.'UPE�TINO
Building Department
JOB ADDRESS: PERMIT#
� /
, -�
OWNER'S NAME: �J PHONE # 62- ZS
GENERAL CONTRACTOR: 60-f�- AX #
I am not using any subcontractors: /")
43i
a e �CXIDate
Please check applicable subcontractors and complete the folloyzge 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