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09100111
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10211 MILLER AVE CONTRACTOR:DELTA ELECTRIC PERMIT NO:09100111 OWNER'S NAME: BOB SHERRY 724 COLLEEN DR DATE ISSUED: 10/19/2009 'ER'S PHONE: 5863065355 SAN JOSE,CA 95123 PHONE NO:(408)224-0176 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Li..# F Z� Z— MECH � RESIDENTIAL� COMMERCIAL Contractor Date —>5 I hereby affirm t am 'cense under the provisions of Chapter 9 JOB DESCRIPTION:UPGRADE SERVICE TO 200AM;DELTA (commencing with Section 7000)of Division 3 of the Business&Professions ELECTRIC RENEWED Code and that my license is in full force and effect. BUS LIC 10/19/09 1 hereby affirm under penalty of perjury one of the following two 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 Sq.Ft Floor Area: Valuation:$1500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36914020.00 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-poi source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: �---�-« Date: Signature Date Cl '69 L 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 1 am exempt from the Contractor's License Law for one of installed without first obtaim' an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,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 COVERING 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& 1 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,I Owner or authorized agent: 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 1 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 i- -nify and keep harmless the City of Cupertino against liabilities,judgments, L, and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION 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 CITY OF CUPERTINO 5 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36914020 . 00 DATE ISSUED. . . . . . . : 10/19/2009 RECEIPT #. . . . . . . . . : BS000008957 REFERENCE ID # • • . : 09100111 SITE ADDRESS . . . . . : 10211 MILLER AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER BOB SHERRY ADDRESS . . . . . . . . . . : 10211 MILLER AVE CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 RECEIVED FROM . . . . : DELTA ELECTRIC CONTRACTOR . . . . . . . : SANDY FRANKS LIC # 24971 COMPANY . . . . . . . . . . : DELTA ELECTRIC ADDRESS . . . . . . . . . . : 724 COLLEEN DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 224-0176 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 500 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 1, 500. 00 0 . 50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1. 00 114 . 00 0. 00 114 . 00 0 . 00 lEPERMITFE 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 199.50 0 . 00 199 .50 0 . 00 CITY OF CUPERTINO CITY Of CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# Date: Building Address: v2k t 0 1 L L C v- 4V � Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes El No HOA: (Exterior work only) Yes ❑ No [ es, provide letter from HOA Owner's Name: Phone#: Ca S'-3 J'S 5 (4-e J Contractor: Phone: 1Y C� 2 2- t 7 k? Y—f Fax: Contractor License#: G i o V ZR '17 zCu ertino Business License#: Z Contact: 1 Phone: r> V' Q I Fax: Residential 171 C mmercial Job Description: J vin 2 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Cl ss): Occupancy Type: 1-A, I-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B Valuation: Square Footage: 6©o Project Size: Express Standard ❑ Large ❑ Maj 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 help, contact Build it Green at www.buflditgreep.org Revised 07/14/09 i, -I SN CITY OF CUPERTINO C U CITY OF O GENERAL BUILDING APPLICATION 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) 1WINMEWSTR New Window-structural shear B wall/masonry (includes planck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1 PLMBLNCK 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 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B 12 e9 0 5 of 5 M.In oor Air Quaft and Finishes 1.Use Low/No-OC Paint 1 IAD/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAOJHealth pts y=yes 0 3.Use Lowft VOC Adhesives 3 IAOJHealth pts y=yes D 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D 5.Use Engineered Sheat Goods with no added Urea Formaldehyde 61ADMealth pts y=yes 0 6.Use Exterior Grade PlNvood for Interior Uses 1 IAQ/Health pts y=yes D 7.Sed aifjys ditv+oWbaajdor1ADF 4IAG/Health. ots y=es D B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D 10.Install Whole House Vacuum System 3 IAQ/Health pts Y--yes 0 1 1 1 N.Fiooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Hapidiy fianewaWa Flooring Materials 4 Resource pts y=yes D 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 D 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes0 1 1 1 Total Points Available 1 1401 1301 57 Total Points Project Recelved: 01 0 0 G:data/prooslgreenbuildmgguidelineslramodelers/greenpointsfinal212D4prote lad.zls Community Development NM1 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'UPEKTINO Building Department JOB ADDRESS: PERMIT # 091 OWNER'S NAME: PHONE # GENERAL CONTRACTOR t -e-L,47L-,e C- FAX # -Z--Z -3 0 Z- 3 I am not using any subcontractors: ?-/ 7-07 igna a Date Please check applicable subcontractors and complete the Lowing information: 60 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 ile A2,11 - 'Q) r/Contractor Signature Date