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10120091 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19947 BEEKMAN PL CONTRACTOR:RC'S MECHANICAL PERMIT NO: 10120091 SERVICES OWNER'S NAME: SHIRLEY EITREIM 4161 INGOT ST DATE ISSUED: 12/15/2010 NER'S PHONE: 6502226841 FREMONT,CA 94538 PHONE NO:(510)438-8806 ❑ LICENSED CONTRACTOR'S DECLARATION r r r C�^ � BUILDING PERMIT INFO: BLDG ELECT PLUMB C2 License Clas !-V -J Lic.# f�,(�/� MECH RESIDENTIAL COMMERCIAL Contractor ll(..)1 D• - V� I hereby affirm that I am licensed under the provisions of C 9 JOB DESCRIPTION: REPLACE FURNACE IN SAME LOCATION (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 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. Sq.Ft Floor Area: Valuation:$2735 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 APN Number:31630139.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date` Z-1 `0 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. u OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cu s ertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se ' 2'.1 3,and 25534. t r Section 3700 of the Labor Code,for the performance of the work for which this g ��+ 7J�� l/ permit is issued. Owner or authorized a ent: tl� Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 unon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION mnify and keep harmless the City of Cupertino against liabilities,judgments, s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO . . % e FEE ESTIMATOR—BUILDING DIVISION IVADDRESS: 19947 beekman place. 1 DATE: 12/15/2010 REVIEWED BY: bob s. -,.., APN: i BP#: *VALUATION: 1$2,735 1 *PERMIT TYPE: Mechanical Permit I PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION FURN/AC SFD or Duplex I 1 , ;..i h': ;;;; , USE: PERMIT TYPE: A WORK I SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Furnace, Forced-Air 1MFR=<100 1 # $126 -1 TOTALS: 1 I I $126.001 Mech.Plan Check I 0.0 I hrs $0.00 l'I.,,,,,' P!,-, ( ',,' 1 Mech.Permit Fee: IMPERMIT Other Mech.Insp. Fl hrs $42.00 oth - ,', ,,,' : , r--1 r);,/,, i .,,, ,„,„ F-1 NOTE: These fees are based on the preliminary information available and are onl an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 09-051 EY 7'140) FEE QTY/FEE MISC ITEMS I I 4 PME Plan Check: $0.00 Pciniii F, t . Suppl, Ilia, [cc' I I PME Unit Fee: $126.00 PME Permit Fee: $42.00 I I Work Without Permit? 0 Yes 0 No $0.00 Planning FaaN. Travel Documentation Fee: 1TRAVDOC $42.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 I SUBTOTALS: $211.50 $0.00 TOTAL . FEE: 1 . $211 50 ) , Revise&1210712011--3 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN • 31630139. 00 DATE ISSUED • 12/15/2010 RECEIPT # • BS000012243 REFERENCE ID # . . . : 10120091 SITE ADDRESS • 19947 BEEKMAN PL SUBDIVISION CITY • CUPERTINO IMPACT AREA OWNER • SHIRLEY EITREIM ADDRESS • 19947 BEEKMAN PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM • RUBEN CORTEZ CONTRACTOR • RUBEN CORTEZ LIC # 31745 COMPANY • RC'S MECHANICAL SERVICES ADDRESS • 4161 INGOT ST CITY/STATE/ZIP . . . : FREMONT, CA 94538 TELEPHONE • (510) 438-8806 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL 1BCBSC VALUATION 2, 735 .00 1 . 00 0 .00 1 .00 0 .00 1BSEISMICR VALUATION 2, 735 .00 0 .50 0 . 00 0 .50 0 .00 1MFR=<100 UNITS 1 .00 126 . 00 0 . 00 126 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 .00 0 .00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0 .00 TOTAL PERMIT : 211 .50 0 . 00 211.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CREDIT CARD 211 .50 VISA TOTAL RECEIPT : 211.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Building Department City Of Cupertino 10300 Torre Avenue � 9ss Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACT R/ SUBCONTRACTOR LIST JOB ADDRESS: f"p.49- � 1-4 013Q RMIT# OWNER'S NAME:5M ‘T2 EPHONE#04:fi3) �GC� SOSn GENERAL CONTRACTOR:9)( S\i (- BUSINESS`LICENSE# 3 4� ADDRESS:4Ua\ 't ' O1 S7 R t CA CITY/ZIPCODE: ok4 *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 SUBCONTR• 1 RS HAVE OBTAINED A CITY OF C PERTINO BUSINESS LICENSE. V2— \4 0 I am not using any subcontractors: Sig r Date Please check applicable subcontractors and complete the following information: i/ 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 4i Owner/Co ri�y o Signature Date UJPIJT urs Energy IAD/Health n.oor Air Quality an. mis es 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=yes0 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 6IAQfHealth pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Sealalifxposeti Partioleboad or MDF 4 IAQ/Health pts y=yes 0 B.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 0 0 0 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use RapidlyRenewable 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 0 0 0 • I Total Points Available:I ( 1401 1301 571 I Total Points Project Received: 6-101 01 01 G:data/progs/greenbuiidngguidelines/remodelers/greenpointsfina12.12.04protectedxls �.)'" CITY OF CUPERTINO FURNACE/AC CITY CUPERJINO PERMIT APPLICATION FORM APN # fQ (!` ��Date:6 ((4, r� ��_' l 5 b_ 2_ rtO Building Address: V`,1 (A q)eglait pJ ac\t Cu ; )1 NO °1a) id Owner's Name: SNS c �-1 \I-2 E t Phone#: Contractor: Phone#:(650) 222, vc_n1.., sWNkCjeS Fax#: &O) 2_13S3 Contractor License#: Cupertino Business License#: Z Contact: Phone : ru._ be 4UPiOQ 1 Co12:11-=-% Fax #: W 2_65 Building Permit Info: Elect ❑ Plumb ❑ Mech Residential Commercial ❑ Job Description: SerME LCA/A-11 o l.3 Fv2-1-1\eroE For Residential Installations: Attic ❑ 1st floor [2i 2nd floor ❑ Adhere to minimum setback requirement ❑ For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of ConstructioA(Usage Class): tc2--935.59—Q (,) rapped ❑ On Platform ❑ Bonded ©r New Location ❑ Replacement [14 Project Size: Express ff r- Standard ❑ Large ❑ Major❑ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Revised 01/07/09 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21834 BENETTI CT CONTRACTOR:S&B CONSTRUCTION PERMIT NO: 10120035 OWNER'S NAME: PARUAT CHITALE 1294 CALDWELL CT DATE ISSUED: 12/06/2010 O'WNER'S PHONE: 4083093620 SUNNYVALE,CA 94087 PHONE NO:(408)529-1818 411 LICENSED CONTRACTOR'S DECLARATION Q r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# ` l / MECH RESIDENTIAL COMMERCIAL Contractor �jiy'' __ CIA,!.� Date i1. `OC• ( I hereby affirm that I am Hcensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL KITCHEN(120SQ)NEW CABINETS,COUNTER (commencing with Section 7000)of Division 3 of the Business&Professions TOPS,NEW FLUORESCENT LIGHT,2 SEPARATE LINES FOR Code and that my license is in full force and effect. DISH WASHER&DISPOSAL&2 DEDICATES LINES FOR 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:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:32649028.00 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,t applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations r the Cupertino Municipal Code,Section 9.18. t2'b fA �.� Issued b T '` Date: - G-t Signature S7 Date 240(� 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: HAZARDOUS MATERIALS DISCLOSURE 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 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. I 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 t e 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,Se' ions 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 Owne or :uthorized _ent: I Z,6 forthwith comply with such provisions or this permit shall be deemed revoked. 1 'a ,, - Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 indemnify 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 ;f;of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION ', nit 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 RESIDENTIAL PROJECT COVER SHEET. Assessor's Parcel Number: '1_69- Y q- Name of owner. ?ftiçM1 _ C/i / ( 7i-1--/ Project address. '72 1 g EN / C j------ Contact person. 370Vi 370V kCJ %TJC- Phone. 4icf: . c2 (? / a Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: ,-'. Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y I '.vacy protection planting required for the project? __— Build it Green Total Points — On what floor(s) is work being done? Brief description of work. �%I�%C'h�� e t- a Ei" Vo � �� ,frtok- ' e)---&-C7-27 25" /`N #ZZ Fe-A-a 6'14-'5 i9-V.9 f071 w8 Code editions: 2007 CBC N)2007 CFC N)2007 CMC 'N) T> 2007 CPC -N)2007 NEC -N) inn r'F'f�CiVEt 0 IN ACt c)FtUHN( E "' ,tar: CITY G Effective 1/1/08 JPE-I�'IN()` �;.)E SAND()PDi�lANi'- UUAFE 12 . '14_ G'"!. rn sIGNtt) J��i`w' �1'"ee-- • ; CI this set of plans ar�ds ' (---le....,_, - y specifications t i s� \.7-10 '"'kept on the;oh at all times and it is inlawfu!to make any changes or alteration: C.) on same without written permission from `� 20104.13 the Pudding Department, City of Cupertino e The stamping of this s plan and E pecificatrons :;iiAt NOT be helm to permit or to be„+ approval of the violation or.,r, ;,,,visions .' City Orden in,,, . , , ,,A. Plan Review Process Work Book Page-8- Revised 06-15-10 / 132" 0wNE�+ / 24" 15" 77" 16" • P�1�.I '] 1-1 1 C X11 T,4 L C-- / / 42'oil 3f .r ' O 7"7 t+ f curE, r irvo cA cila il N 1542L c -sr 1 W1842R 4 4 v- 0 0 5e f- cA Al ES- D cutlacl 01rN •24L 24.DISHW SB36 3DBEPO- cv X W z. mL'NE-S c D Ux/ri- I in N M W N N N a .. • .� AD V Tvi 1A/ CASIN • Li 6 -� CU) �Gua2E�c:� a . . - -0" _ - - ., . .. r ..____ _ C t , N T • O� , o -•1 9524 B27 0-GI ASI RI ANGEL R77 P3O8924 636-2 "' N o� N W362424 r-nr-1 �_ \� W2742 PIRQID@41 MW274212 W2436-GL ,tt, . ` °"=� ..• 3,.„ y., 27., 31,, 27" / 30" / 36" / 19 " 1, .12" 108" / t. iIf 36" f 27" 30" 27" 30" / 24" / 12"—/ 2 189" / All dimensions_size designations 20 vsia This is an original design and must Designed: 12/5/2010 given are subject to verification on TECHNO OGi s fa not be released or copied unless Printed: 12/6/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. SABRI C. KUCEVIC (PARJAT) All -awing#: 1 / r--< /v/ 1 Y .,."a CD 4 ♦ r leaill T-NFICE COPY ..„... „..... , \_. r1 41.4 r � [ 1 ,► 3# 000-1 r_ ___ ______-\ 4 ,77.--- 6_, 1 DD cm a^ _ --- -- ,,,,,i NNNNNNN / ,, Note: This drawing is an artistic 20 204Designed: 12/6/2010 interpretation of the general TECHNOLOGIES j Printed: 12/6/2010 appearance of the design. It is not meant to be an exact rendition. r ignl All awing#: 1 V \ , , ...:0ea. .... ..iiii 'sb rb•- II , n n 11 s____ 11 �� 1, 1 fT111III ii....,s _ . ,,,, : 111 1 11 CO j '-- HE 11 ' 0 R 1a aII 0 it5 If =,_IFS L _= ' 4 ' , ® ® ® ® ® ,, -7 r ' ` ' r r/ \ / \ / \ ✓ , / .\ / \ .. / `r _ i r Note: This drawing is an artistic 20 0 iii Designed: 12/5/2010 interpretation of the general TECHNoLoGIES Printed: 12/5/2010 appearance of the design. It is not meant to be an exact rendition. r -ign1 All ' -awing#: 1 0 vi rimj, 11p FFicE Copy 1l1 �I. , � owe,,�� /—// _ r ril 1, , --__ J moi► ,----,... _wLL,* .J ,_.., „,,..A,\_,,„,...74 ,, , N � zi/e>,4wa.,.7.7-7- "1"1.k , INILIIIIIIIIII /. kV �_���� IIIII Lel ,U===l \-\��� 4,"4i I=lief \U\-\\Ili - t. Note: This drawing is an artistic 20 ` '" Designed: 12/5/2010 interpretation of the general recr+No o°ciEs Printed: 12/5/2010 appearance of the design. It is not meant to be an exact rendition. ^'sign 1 All I Drawing#: 1 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 21834 bennetti ct. DATE: 12/06/2010 REVIEWED BY: bob s. APN: BP#: *VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY 7-01PENTAMATION SFD or Duplex 1R3SFDREM USE: 1 1„f 111-4P1 PERMIT TYPE: WORK ct—n cseNrA0cQ-A .,nom _r-fru co--Li—Q/1 SCOPE J • NOTE: These fees are based on the preliminary information available and are on( an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 09-051 Elf 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00120 s.f. Remodel,Kitchen(<=300 sf) Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $570.00 IREMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fees Reg. 0 OT , 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 • Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure ila1 I Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $3.00 $570.00 TOTAL FEE: $573.00 Revised: 11/08/2010 R ' Building Department 1.P/ City Of Cupertino 10300 Torre Avenue �41.I9�� Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Z/gay PiPE-7T/ c 1 PERMIT# /O 12 0(-)OWNER'S NAME: 1 Priz-; �'j ci1I YrL.L- PHONE# �$'• 5Z7• /Q GENERAL CONTRACTOR: y jV C77 BUSINESS LICENSE# ADDRESS: /2,9 GiC 1��-t�c�-�- CA CITY/ZIPCODE: .. 11/i//41/1411-6: 4a' f/ *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: /L. o‘ • ZO/ c7 Sig ture Date Please check applicable subcontractors and comp to the following information: V SUBCONTRACTOR BUSI ESS 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 Owner/Contractor Signature Date / CITY OF CUPERTINO `� `_ _ -' � ADDITION/REM D O EL CUPERTINO FEE SCHEDULE APN# ( L( ( ,^�1 0t Date: /2-/C0O (V Is a 2nd unit being added? Yes ❑ No El If yes, please fill out the permit application for 2nd unit. Building Address: Mailing Address (if different from building address): 11 3 `f 5Ey� ri c 1 Owne sri. 'i n ,_ , �� -----: Phone# t' --- • 3 O Ci y 3,6 2 0 Contractor: Phone#: L f O .. 5 .c . la S 1" 6 Coms-rizu Crrt`D iq Fax#: 4 . .7 33 _ ig. /g- Cupertino Business License: C) _ State Contractor License#: _ - Contact: Phone#: Fax#: Landscape Ordinance Compliance: , • Landscape area in sq. ft. (includes all irrigated areas): X-�,,A If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type El Water Budget 3uilding Permit Info: Bldg. N Elect. 1_- Plumb. 7 Mech. [ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): N E W CRI?iV a.TS' /Co I¼. i 271PS ITF t v fL (40r2-E-iC e*i i L-it G ti-I What is being remodeled (not including addition)? 1) LAW DIw' ke ) D67b ' 2 . W Pei)NSiti fait., coag i moi. Remodel Includes Re-Roof: Yes ❑ No E412. yes list number of squares Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No El If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: i" Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen ' , J Bath Other Type of Construction (Usage Class): Occupancy Type: C ---7 1-A, 1-B ❑ II/I1I/V-A ❑ II/III B, IV-HT, V-B EL Valuation: 2.0i COO (.J Please check this box if the project is a ')roject Size: r ss [tandard ❑ Large ❑ Major ❑ second-story addition ❑ i'lease 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. 0- Revised 05/18/10