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09100125 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10186 MANN DR CONTRACTOR:CLIFF W COUEY PERMIT NO:09100125 CONSTRUCTION `IER'S NAME: CAPENER CHRISTOPHER L AND LYNN 7608 WATERFORD DR DATE ISSUED: 10/20/2009 OwNER'S PHONE: 4084460333 CUPERTINO,CA 95014 PHONE NO:(408)252-0753 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I— PLUMB License Class Z G Lic.# 11r � 333 r ` MECH RESIDENTIAL COMMERCIAL Contractor Q:Ti � ��t'�'�'� Date � 2'� G I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODELHRLL BATHROOM,REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions TUB/SHOWER INCLUDE Code and that my license is in full force and effect. MIXER VALVE.REPLACE VANITY&SING,REPLACE EXHAUST FAN.REPLACE 36"X12"WINDOW WITH 36"X18# 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:$11000 permit is issued. APPLICANT CERTIFICATION APN Number:32619010.00 Occupancy Type: 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 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 s per the Cupertino Municipal Code,Section 9.18. Date �l/lJ D 1 a/Zo O� Issued Date:/fl 2��� ature ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that 1 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 1 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 1 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 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 wouthpriz ent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: b Zo t)� APPLICANT CERTIFICATION CONSTRUCTION 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 i the above mentioned property for inspection purposes.(We)agree to save .;mnify 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 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32619010 .00 DATE ISSUED. . . . . . . : 10/20/2009 RECEIPT #. . . . . . . . . BS000008977 REFERENCE ID # • • . : 09100125 SITE ADDRESS . . . . . : 10186 MANN DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CAPENER CHRISTOPHER L AND LYNN ADDRESS 10186 MANN DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1138 RECEIVED FROM . . . . : CLIFF W COUEY CONST CONTRACTOR . . . . . . . : CLIFF W COUEY LIC # 24792 COMPANY CLIFF W COUEY CONSTRUCTION ADDRESS 7608 WATERFORD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 252-0753 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 000 . 00 1 . 00 0.00 1. 00 0 .00 1BSEISMICR VALUATION 11, 000 . 00 1 .10 0. 00 1. 10 0 .00 1REMRESBAT SQ FEET 1. 00 570 .00 0. 00 570 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 572 .10 0 .00 572 .10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 572 .10 #2625 --------------- TOTAL RECEIPT 572 .10 CITY OF CUPERTINO ADDITION/REMODEL OF CUPERTINO PERMIT APPLICATION FORM APN # Date: Is a 2" unit being added? Yes ❑ No 4 If yes, please fill out the permit application for 2" unit. Building Address: IDiB( titin Dp—,vee eA ciSO1¢- Mailing Address (if different from building address): Owner's Name: Phone# L4 0 Contractpr• Phone#: o �Z 10 C_i Y4. 0 C_°ue C��✓' Fax #: Contractor License#: �r ! q333 Cupertino Business License#: -2.4 79)- Contact: o e Phone#: Y o 7�-- ° Fax#: L4 o cix - 2-218 Building Permit Info: Bldg. Elect. '�"�~ Plumb. Mech. ❑� Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? /5�.��-►ems ►v��.1, M"Ato, ✓P(VC_ . RPPi�e-- Vaw.f ) * S;',k; W1VJ,0-- WA, 36"f- t$" �✓►wQ-stn, Remodel Includes Re-Roof: Yes ❑ No P] 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 Af O Remodel: Kitchen Bath t—K- Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ . IUIIUV-A ❑ IUIII B, IV-HT, V-B J '0j` 1�7' Valuation: ®�©�� Please check this box if the project is a second-story addition ❑ Project Size: Ex ress ❑Lgiandard ❑ Large ❑ Ma'or❑ 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 aot, ADDITION/REMODEL CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD 1PLLONGRNGR Long Range PL Planning/Residential 1 R3INSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP 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 1R3ALTPLNC 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 Commission 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 DECKS 1R3SFDADD OR 1R3SFDREM 1 DECKWOOD Deck (Wood)-Each B (Each) 1 DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1GARDTM<=1K Masonry up to 1,000 SF B (each) 1 BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER 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 �.J 1REMRESBAT Bath Remodel up to 300 B 66 I SF 1REMREOTH Other Remodel up to 300 B SF Indoor tr ua tty an inlshes 1•t%b L-VOC Pam 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Lowft VOC Adhesim 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 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 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 I I 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes I 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapkfy Renewable Filoorin Matmiah 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 1 Total Points Available: 1 1401 130E- 57 Total Points Project Received: 0 0 0 G:data/pmgs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.04protecte .Is r-c>11, .b�ZOb + L ,n v\e(� 101G6 CLA-eer4-, V*N,�, y aov -cum AM �e arc e ► X eJ� V G 1V'c- t Li oni �e.�'lac t,. ✓U n,-�� Cad�v�.'� L'S�� �;�� v,,,yl wftilelnw (1F'c (,JI) new L e � � 5 pe 3 s � '� .�.�� ��5-x-0,1 � Y1�w Iz x 1Z C,Qr�w►Iv . W}1 Yrs w�- � 6,44 J s APPH rVE D C IN ACCORI;ANCf v'vrTH THE Cl / R��� S <J CUPERTINO C()Ut A����rWtV+�NC �� �/ r V1 ©` I �v 0 Q. DATE_ 1 Y1�� vvv, v loss � 0 SI This set of plans and s -r c, h s MUST V � , be kept on the lob at all r s and it is w {t r unlawful to make ar,y changes,or alterations L..�J� �� C' �V on same without written permission from 26©7 the Huilding Deparimt-o (,ity ;)t Cupertino. 'i( 3 The stamping of the,,ptar and specifications 2 SHAL L NOT b, hel�1 to permit or to be an approval of the violation _�f any provisions �(� Q� �� of any City()rdrnance ur State Law- �_. will fie. 2- u s I CAN{- y Community Development =`' µ` - 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 VEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: (.-L,cib PHONE # V08' kj7 L Zog GENERAL CONTRACTOR: L ) C.o eAc FAX# to 21S'Z D 3 I am not using any subcontractors: w G e- 2 o/ 1007 Do7 Signature Date Please check applicable subcontractors and complete the following 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