11010031 r CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10244 DANUBE DR CONTRACTOR:AMERICAN HOME PERMIT NO: 11010031
RENEWAL INC
OWNER'S NAME: PATRICIA LUGHEZZANI 310 SHAW RD STE A DATE ISSUED:01/05/2011
ER'S PHONE: 4082554274 S SAN FRANCISCO,CA 94080 PHONE NO:(650)553-9054
I$� LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r—
License Class 3 G I Li..# 7-(O 54�,
ilil ;-�� MECH r— r—RESIDENTIAL COMMERCIAL r
Contractor 41A4xw� 7100E t'-C . Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL TWO FIBERGLASS ENTRY DOORS.NO CHANGE
(commencing with Section 7000)of Division 3 of the Business&Professions IN
Code and that my license is in full force and effect. OPENING SIZE
I 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:$4400
permit is issued.
APPLICANT CERTIFICATION APN Number:36948006.00 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. Ad ' ' ally,the applicant un tands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with allnon-point so re tions per the rtino Municipal Code,Section
9.18.
Signatu Date/n/l� Issued by Date:
U OWNER-BUILDER DECLARATION
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.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall 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 o or ed agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
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
upon 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
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
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
Building Department
ILgiCity Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 1�►2 PERMIT#
OWNER'S NAME: -2 PHONE# °'ZS5 ` WZ2
GENERAL CONTRACTOR: Avja' k,/, J BUSINESS LICENSE#
ADDRESS: 310 ;A} CITY/ZIPCODE: ,q-„J '?e10
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
ignatur Date
Please check applicable subcontractors and comple a 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
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Iz-7
Zpiner/ ontractor Signature Date
• Y
ResourcesINPUT 1IAQIHealth-
1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No 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 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed Particleboard or MDF 4 IAQ/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
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
I I 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 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 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 Availablel 1 1401 130 57
Total Points Project Received:1 1 01 01 0
G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls
CITY OF CUPERTINO
3 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36948006 .00
DATE ISSUED. . . . . . . : 01/05/2011
RECEIPT #. . . . . . . . . : BS000012404
REFERENCE ID # . . . : 11010031
SITE ADDRESS . . . . . : 10244 DANUBE DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PATRICIA LUGHEZZANI
ADDRESS . . . . . . . . . . : 10244 DANUBE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JEFF RAINEY
CONTRACTOR . . . . . . . : MARC STELZER LIC # 22705
COMPANY . . . . . . . . . . : AMERICAN HOME RENEWAL INC
ADDRESS . . . . . . . . . . : 310 SHAW RD STE A
CITY/STATE/ZIP . . . : S SAN FRANCISCO, CA 94080
TELEPHONE . . . . . . . . : (650) 553-9054
4 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 4,400 . 00 1 .00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 4,400 . 00 0.50 0 .00 0 .50 0 .00
1WINREP EACH 8 2 . 00 380 . 00 0 .00 380 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 381 .50 0 .00 381.50 0 .00
1