09080424CITY OF CUPERTIr O BUILDING PERMIT I
BUILDING ADDRESS: 10211 COLBY AVE
r,-'NER'S NAME: FELIX KWOK
O W NER'S PHONE: 4088886887
❑ LICENSED CONTRACTOR'S DECLARATION
License Clas / Lic. # �1Z2,�j
Contractor
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.
l hereby affirm under penalty of perjury one of the following two declarations:
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
wrformance of the work for which this pen -nit is issued.
l 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
oermit is issued.
APPLICANT CERTIFICATION
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
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. Additionally, the applicant understands and will comply
with all non -point a regulat' s per the Cupertino Municipal Code, Section
9.18.
S, -ture. Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I 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)
I, 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:
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.
1 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.
I 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
he above mentioned property for inspection purposes. (We) agree to save
h .mify 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. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date.
CONTRACTOR: NORTHSTAR PERMIT NO: 09080424
CONSTRUCTION
430 CARNEGIC DR. DATE ISSUED: 08/31/2009
MILPITAS, CA 95035 PHONE NO: (408)945-8350
BUILDING PERMIT INFO: BLDG ELECT f— PLUMB
MECH RESIDENTIAL f— COMMERCIAL
JOB DESCRIPTION: 100 TO 200 AMP ELECTRICAL UPGRADE;
NORTHSTAR
CONSTRUCTION RNEWD BUS LIC 8/31/09
Sq. Ft Floor Area: Valuation: $2500
APN Number: 31628041.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b Dater3 l
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 & Safety Code, Sections 25505, 25533, and 25534.
Ow r or th a
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
SN--o
CITY Of
CUPER,TINO
CITY OF i�UPERTINO
GENERAJL BUILDING
PERMIT APPLICATION FORM
olog oq;14
APN #� p t � � v � (
f l p
Date:
Building Address:
a
Mailing Address (if different from building ad(fress):
Are Hazardous Materials being used as part of this project? Yes No
HOA:(Exterior work only) Yes ❑ No
If yes, provide letter from HOA
Owner's Name:
Phone #:
-O/ff
Contractor: L/
'✓7
Phone:
Fax: d
�'I L�/ p
r b
Contractor License #:
Cupertino Business License #:
Contact: 1
Phone:
Fax:
Residentia Commercial
Job Description:
,"e<"
e-�� r4
Building Permit Info:
Bldg ❑ Elect ❑
Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V- B Er
� —
Valuation: /
Square Footage:
Project Size: Express Standard ❑
Large ❑ Major ❑
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:
IFor help, contact Build it Green at www.builditpi,een.or
Revised 07/14/09
CITY OF
CUPEf�T1NO
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)
additiona: stucco application
B
1 WINREP
Replacerr ent windows/sliding glass
door (ea 3 windows)
B
1 WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee)
B
IEPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1PPERMITFEE
Plumbin€; Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1PLMBLNCK
Stand Al,)ne Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourl -st and alone
B
1BCBSC
Cal Bldg Standards Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICR
Seismic Pesidential
B
1BSEISMICO
Seismic Commercial
B
1 TRAVDOC
Travel &. Documentation
B
1BUSLIC
Business License
B
ISI 5of5
1. Use LowMo-VOC Paint
1 IAQ/Health pts
y --yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes.
3. Use Low/No VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
y=yes
Formaldehyde
61AQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
7. Seal all Exposed Particleboard or MDF
4 IAQ/Health pts
y=yes
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
3 Resource pts
y=yes
2. Use Rapidly Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total Points Available: I 1401 1301 57
Total Points Project Received: 01 0 0
G:datalprogslgre:nbuildingguidelinestremodelerslgreenpointsfinal2.12.D4protected.xls
CITY OF
.;UPEkTINO
Buildi.n
JOB ADDRESS:
le
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Department
PERMIT #
OWNER'S NAME: PHONE # 40k 9VZ l_ sl
GENERAL CONTRACTOR-_,". �,1--
I am not using any subcontractors:
Please check applicable subcontractors and
"// 4ee�� 531,-,O:z
?Ignature Date
co=)lete the following infni nni-inn-
PZ.
weer/Contractor Signature Date
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
PZ.
weer/Contractor Signature Date
I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21350 COLUMBUS AVE
OWNER'S NAME: SHEADE MARC R
:R'S PHONE: 4082555276
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
Date
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.
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.
1 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 I have read this application and state that the above information is
correct. 1 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. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
6 OWNER -BUILDER DECLARATION
1 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).
1 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
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 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.
I 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 1 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, wmd hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
it ;fy and keep harmless the City of Cupertino against liabilities, judgments,
ct:_ , „nd expenses which rue against said City in consequence of the
granting of this perurce
ditionall , the applicant understands and will comply
with all non-pointc6lations per the Cupertino Municipal Code, Section
9.18.
CONTRACTOR: TBD - TO BE DETERMINED PERMIT NO: 09080170
DATE ISSUED: 08/18/2009
PHONE NO:
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH (_ RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: SERVICE UTILITY BOX & CHANGE BUS. BAR
FROM 100A TO
200A
Sq. Ft Floor Area: Valuation: $1800
APN Number: 36205008.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
ssued b ; Date:
RE -ROOFS:
ill roofs shall be inspected prior to any roofing material being installed. If a roof is
i istalled without first obtaining an inspection, I agree to remove all new materials for
i ispection.
c ignature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
( alifornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
e)npliance 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 1 will
rr aintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
11 ety Code, Sections 25505, 25533, and 25534.
O e r thori a agent:
_ Date• I i
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
Li nder's Address
ARCHITECT'S DECLARATION
I t nderstand my plans shall be used as public records.
Li:ensed Professions,
1�', - aM,
CITY Of
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
DC( Q e 0 1-7 `�
APN #,3 � )—,o �5—b 0 � 6 L,
Date: C6' _ l _ O Y
Building Address:
� t3Sb CA q�;O r
Mailing Address (if different from building address):
S44 -f-1 -e—
Are Hazardous Materials being used as part of this project? Yes No
HOA: Exterior work only) Yes F1No ❑ Ii' es, pro id letter from HOA
Owner's Name:
S heo-dL M, i�,r c j
Phone #:
4056 as-';
� v
Contractor:j/ Cd
Phone: 4 og 3-7(-
Fax:
Contractor License #:
Cupertino Business License #:
Contact:
Phone: A+o g 4 u -A
Fax:
Residential Fq Commercial
Job Description:
�' ✓ J std � 1� cam 't!w► (M A +o Z o h
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B
Valuation: .i Square Footage:
Project Size: Express Standard ❑ Large ❑ Major ❑
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.builditgreen.or
Revised 07/14/09
j2
CITY OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE S(:HEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1 WINMEWSTR
New Window -structural shear
wall/mas (includes plan ck fee)
B
I
1 EPERMITFEE
Electrica Permit Fee
E
1 MPERMITFEE
Mechanical Permit Fee
M
1PPERMITFEE
Plumbing; Permit Fee
P
I 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
when not over counter)
Standard Plan Check (when no E/M/P)
hourly-stsmd alone
B
1BCBSC
Cal Bldg Standards Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICR
Seismic Lesidential
B
1BSEISMICO
Seismic Commercial
B
1 TRAVDOC
Travel & Documentation
B
1 BUSLIC
Business License
B
,Tr 7 <� 2 v
5 of 5