09080181 CITY OF CUPERTINO BUILDING PERMIT
s
BUILDING ADDRESS: f 0-036 CRESCENT RD CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09080181
OWNER'S NAME: IWAI IASHI DAVID S AND LINDA G DATE ISSUED:08/19/2009
!7— ,-R'S PHONE: 4087532937 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION f— r
I BUILDING PERMIT INFO: BLDG ELECT PLUMB
I License Class__ Lic.# _ „...
MECH I- RESIDENTIAL r COMMERCIAL l
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE WINDOWS&PATIO DOORS.
(commencing with Section 7000)of Division 3 of the Business&Professions TEMPERED&EGRESS
Code and that my license is in full force and effect. AS REQUIRED
hereby affirm under penalty of perjury one of the following two declarations:
I 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:$17000
Sectiop.3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32617035.00 Occupancy Type:
I APPLICANT CERTIFICATION
I certifv 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 biith aldmg construction,and hereby authorize representatives this city enter PERMIT EXPIRES IF WORK IS NOT STARTED
J upon on tb above mentioned property for inspection purposes. (We)agree too save
9
indemnify
expenses keep harmwhiless
may accrue againof st sand Certino ity nn liabilities,
judgments,omeWITHIN 180 DAYS OF PERMIT ISSUANCE OR
cost'granting of this permit. Additionally,the applicant understand=and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municinal Code..Section
9.18.
Issued by: Date:
Signature ____ Date_
!�. OWNEF.-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1 hereby affirm that 1 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.
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 Ccde)
I,as owner of the property,am exclusively contracting with lic;msed contractors to
construct the project(Sec.7044,Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A”OR BETTER
1 herebv affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
1 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
11 Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534, 1 will maintain
performance of the work for which this permit is issued. -ompliance 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 %dditionally,should I use equipment or devices which emit hazardous air
permit s issued. :ontaminants as defined by the Bay Area Air Quality Management District 1 will
`1 certify that in the performance of the work for which this permit is issued,1 shall naintain compliance with the Cupertino Municipal Code,Chapter 9.'.2 and the
-lealth&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 Jwe o aut orized.agen
`become subject to the Worker'a Compensation provisions of the Labor Cade,1 must L�L��, M j Date: iC4
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
i APPLICANT CERTIFICATION 1 hereby affirm that there is a construction IPnding agency for the performance of work's
I certify that 1 have read tris 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_
Sto 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+ I -nify and keep ha*mless the City of Cupertino against liabilities,judgments,
:nd expenses which may accrue against said City in consequence of the
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. ` t p�
Signature �* Date_ �S �) Licensed Professional
()qO 00
CITY of CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APP]--JICATION FORM
APN# _70 Date:
Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes LJ No
HOA: rExterior work only) Yes ❑ No If es, provide letter from HOA
Owner's Name: Pho e#:
IJ A
Contractor: Phone:(y 0i, C, b 11 ClC-
�' Fax:
Contractor License#: U al
Cu ertino Business License#:
Contact:
Phone:
t"1 )C Fax:
Residential Er Commercial
Job Description:
Building Permit Info:
' Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ®---- F—
Valuation I$
11 ),:�, Square Footage:
Project Size: Express Standard ❑ Large [] Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
Points Achieved: to the application or if applicable, include in plan set& the sheet index.
For help, contact Build it Green at www builditgreen.or
Revised 07/14/09
CITY OF CUPERTINO
CITY of GENERAL BUILDING APPLICATION
CUPEkTINO
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)
1 WINMEWSTR New Wir.dow-structural shear B
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
lELCPLNCK Stand Alcne Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1STPLNCK-(3 Hr Min Standard flan Check (when no E/M/P) B
when not over counter) hourly-staid alone
1BCBSC Cal Bldg 'Standards Commission Fee B ALL PERMIT
I 1BSEISMICR Seismic R,sidential B TYPES
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel &I)ocumentation B
1 BUSLIC Business License B
5 of 5
INPUT
M.Indoor Air Quality and FmResources • ���s es "
1.Use Imrv/NO-VOC Paint 1 IAQ/Healthis y=yes
2.Use Low VOC,Water-Based Wood Finishes P yy 0
21AQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes
4.Use Salvaged Materials for Interior Finishes 0
3 Resource pts y=yes p
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Healthis es
6.Use Exterior Grade Plywood for Interior Uses P yy 0
1 IAQ/Health pts y=yes 0
7.Seal 4 ECpOsad aboard Partidor MDF 4 IAQ/Health. Y=Yes
is
P
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 p
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y—yes 0
10.Install Whole House Vacuum System 3 IAQ/Healthis — es
P Y—Y 0
N.Flooring
i 1 1
1.Select FSC Certified Wood Flooring 3 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 3 IAQ/Health pts y=yes
5.Use Exposed Concrete as Finished Floor 0
Resource pts yges 0
6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0
1 i 1
Total Points Available:
1401 1301 57
Total Points Project Received:
0 0
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CIT1f OF
,UPE�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT #
1 U �-u Rl) 0����l �
OWNER'S NAME: ) v) � )tti,(1�� �i� PHONE # WO ;21S 3 z GS
GENERAL CONTRACTOR A3LZ C-=L4)S S FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com Clete 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
v
Owner/Contractor Signature Date