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10110111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21530 ADDINGTON CT CONTRACTOR:HAUER DANIEL S AND PERMIT NO: 10110111 SUE C TRUST OWNER'S NAME: HAUER DANIEL S AND SUE C TRUST 21530 ADDINGTON CT DATE ISSUED: 11/17/2010 'NER'S PHONE: 4089730563 CUPERTINO,CA 95014-4847 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REPLACE SLIDING PATIO DOOR 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. Sq.Ft Floor Area: Valuation:$2088 I hereby affirm under penalty of perjury one of the following two declarations: t. I have and will maintain a certificate of consent to self-insure for Worker's APN Number:35622034.00 Occupancy Type: Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 2. 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 PERMIT EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 DAYS FRO LAST CALLED INSPE�CfTI/ON. 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 Z I to building construction,and hereby authorize representatives of this city to enter Issued by: C Date: 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 RE-ROOFS: all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 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 Signature Date inspection. /, Signature of Applicant: Date: OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r 1,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation,will do the work,and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 2. I,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will i. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety Code,Sections 25505,25533,and 25534. performance of the work for which this permit is issued. O err authorized/7� 2. I have and will maintain Worker's Compensation Insurance,as provided for by , Date: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. CONSTRUCTION LENDING AGENCY 3. 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 I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If,after making this certificate of exemption,I for which this permit is issued(Sec:3097,Civ C.) become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I understand my plans shall be used as public records. 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 Licensed Professional upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ing of this permit.Additionally,the applicant understands and will comply with an non-point source regulations per e C ertino Municipal Code,Section 9.18. SiaatntE / Date — 7—�O k-2 CITY OF CUPERTINO c1rr Of cUPEKTINO GENERAL BUILDING PERIYQT APPLICATION FORM 0 APN # `-� J R,-� 03 Date: Building Address: Z(S �>o Nom-T245 C L)X -' vP FZ�- k � Mailing Address (if different from building address): ` Are Hazardous Materials being used as part of this project? Yes ❑ No 0� HOA: (Exterior work only) Yes ❑ No [Q�if yes, provide letter from HOA Owner's Name: i Phone#: Co tractor: Vt� 1 Phone: �°�1 (�i 2t r,4 N 10 W(0i 70 a-y� Fax: 4*)6 47Z Contractor License#:CSLB 7 7 j Z-e e 0//3 Cupertino Business License#: (0 ;�44 `7 Contact: Phone: Fax: ���'— <4 7 Z� S�5 � �esidenti al� Commercial ❑ Job Description: �� TJ� c� �AT'b ��� Building Permit Info: ' Bldg [a Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ EIMN-A ❑ II/III B, IV-H'-r, V-B C, l�� $� Waluation: C) �F` Square Footage: Project Size: Express Fq----S-tandard ❑ 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: �;or help, contact Build it Green at www.builditzreen.om � Revised 07/14/09 2 M.Indoor Air Quaft and Finishes 1.Use LowNo-VOC Paint 1 IAQ/Health pts Y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQiHealth 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 vuith no added Urea Formaldehyde 6IAQ/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes 0 7.Seal.allfag bsed'Partiolelioard or MDF 4 IAQ/HeaJth pts y=yes 0 S.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 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y--yes 0 2.Use RapidifyRenewahle Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pis yeses 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Heaith 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 Available: 1401 1301 571 Total Points Project Received:1 1 01 01 01 G;data/progslgreenbuRcEnggi idelines/ra modelers/greenpointstrna1212.04prolected xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CO ITRACTO R SUBCONTRACTOR LIST JOB ADDRESS: 7/ 53� j�p�iVG�U,�I c�2T PERMIT# / 0/ADZ// OWNER'S NAME: )"q/V P,q[J 2 _ PHONE# 4CF CJ' 73--©S—/—,- GENERAL CONTRACTOR: /� BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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: Signature Date Please check applicable subcontractors and complete the following information: j/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood ��� V- Glass/Glazing Am e 2�G4• ) ��5le)V 1/f/t*/?/J 46)3 C 5U3 # 7 7F' 3 Z 6 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 BUILDING PERMIT BUILDING ADDRESS: 850 ALDERBROOK LN CONTRACTOR:GREEN�EAF SOLAR& PERMIT NO: 10110143 ELECTRIC OWNER'S NAME: QIAN BAIXIN 667 N 12TH ST DATE ISSUED: 11/22/2010 OWNER'S PHONE: 4085288425 +SAN JOSE,CA 95112 PHONE NO:(408)691-4743 :W. LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r- PLUMB Q License Class �r �© Lic.# v �S�t7 7 Contractor ate nQ�V L �-f2e�t} MECH t— T_RESIDENTIAL COMMERCIAL� 1 hereby affirm that I am licensed under the v s or(syChapter 9 JOB DESCRIPTION: INSTALL 2.8KW SOLAR SYSTEM ON A SINGLE STORY (commencing with Section 7000)of Division 3 of the Business&Professions ROOF. Code and that my license is in full force and effect. ARRAY PITCH IS SAME AS ROOF PITCHE 4:12 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. 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:$11800 pennit is issued. APPLICANT CERTIFICATION APN Number:36917023.00 Occupancy Type: 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,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPD2ES 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,the applicant understands and will comply 180 D YS FROM ST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature (0 Issued by: O Date: ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 1 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,1 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 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 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(ia)should I store or handle hazardous material. permit is issued. Additionally,should 1 use e4uipment or devices which emit hazardous air contaminants as defined by;the Bay Area Air Quality Management District I will 1 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,1 become subject to the Worker's Compensation provisions of the Labor Code,I must 2WRIN thorized agents_ forthwith comply with such provisions or this permit shall be deemed revoked. Date: e, 7iU I u APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY, I certify that 1 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 costs,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. 1 understand my plans shall be used as public records. Signature Date Licensed Professional