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10110107 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22861 STONEBRIDGE ST CONTRACTOR:LOEWEN&FRECH INC PERMIT NO: 10110107 OWNER'S NAME: SAIFU ANGTO 245M MT HERMON RD DATE ISSUED: 11/17/2010 OWNER'S PHONE: 6505300001 SCOTTS VALLEY,CA 95066 PHONE NO:8313354632 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ �� REPLACEMENT OF EXISTING 82 GALLON SOLAR ELECTRIC License Class Lic.# q WATER IN GARAGE. � ContractoZ)a 1��✓ap � �•Date C!v / 1 U 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. I hereby affirm under penalty of perjury one of the following two declarations: Sq.Ft Floor Area: Valuation:$2500 1. 1 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 APN Number:34213035.00 Occupancy Type: performance of the work for which this permit is issued. 2. 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. eo PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECTION. 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 —� //�/�J� upon the above mentioned property for inspection purposes. (We)agree to save Issued by: Date: indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may a against said City inconsequence of the granting of2RP y the applicant understands and will comply with RE-ROOFS: all non-poia Cupertino Municipal Code,Section 9.18. /\/c) "� All roofs shall be inspected prior to any roofing material being installed.If a roof is Signature Date V 2! &J U installed without first obtaining an inspection,I agree to remove all new materials for inspection. r OWNER-BUILDER DECLARATION Signature of Applicant: Date: i..creby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 1. 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 HAZARDOUS MATERIALS DISCLOSURE sale(Sec.7044,Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance wi the Cupertino Municipal Code,Chapter 9.12 and the performance of the work for which this permit is issued. Health&Safety Code, a tions 25505,25533,and 25534. 2. I have and will maintain Worker's Compensation Insurance,as provided for by OwneWrqri�. ent: F / l 7�� Section 3700 of the Labor Code,for the performance of the work for which this Date: Xhio CEJ permit is issued. 3. I certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY 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 [hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.) Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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, costs,and expenses which may a e against said City inconsequence of the ;ng of this permit.Addition II ,the applicant understands and will comply with ,n-point sourAe regulations a the Cupertino Municipal �"�ut/Code,Section �9..1118./\ Signature_ Date A /71 &/0 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34213035. 00 DATE ISSUED. . . . . . . : 11/17/2010 RECEIPT #. . . . . . . . . : BS000012025 REFERENCE ID # . . . : 10110107 SITE ADDRESS . . . . . : 22861 STONEBRIDGE ST SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SAIFU ANGTO ADDRESS . . . . . . . . . . : 22861 STONEBRIDGE ST CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : LOEWEN & FRECH INC CONTRACTOR . . . . . . . : LOEWEN, DEBRA LIC # 21212 COMPANY . . . . . . . . . . : LOEWEN & FRECH INC ADDRESS . . . . . . . . . . : 245M MT HERMON RD CITY/STATE/ZIP . . . : SCOTTS VALLEY, CA 95066 TELEPHONE . . . . . . . . : 8313354632 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 500 .00 1. 00 0 .00 1. 00 0.00 1BSEISMICR VALUATION 2, 500 .00 0.50 0 .00 0 .50 0 . 00 1PPERMITFE FLAT RATE 1.00 42 . 00 0 .00 42 . 00 0. 00 1PRWHEATR UNITS 1. 00 25. 00 0 .00 25. 00 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 110 .50 0 .00 110 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 110.50 1177 --------------- TOTAL RECEIPT 110.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER M.Indoor Air Quality dhd Finfalm - _ 1 IAQ/Health pts y=yes p 2.Use Low VOC,Water-Basad Wood Finishes 2 IAQ/Health pts y--yeap WIN -- 31AQ/Health pts y-yes p 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes p 5.Use Engineered Sheet Goods with no added Urea Formaldehyde B IAQ/Health pts y--yes p B.Use Exterior Grade PlywoodforInferior Uses 1 IAQ/Health pts y--yes p 41AQMealth pts y--yes p 8.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes 0 9.Use Fnger-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 D N.Flooring 1.Select FSC Certified Wood Fooring _ B Resource pts yryes 0 -71- ° 4 Resource pts y--yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts yeses 0 4.Install Natural Linoleum In Place of Vinyl .5 IAQ/Health pts y--yes 0 5.Use Exposed Concrete as Finished FiOor 4 Resource pts Y--yes 0 B.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes 0 ! ! ! Total Points Avatla-ble: 140 - 130 57 Total Points Project Recelved:i 01 01 0 Adv �7 lC� G:data/prDWgreenbufld'mogWdeMes/remodelamfDreenpointdna1212D4proteDfedxls Building Department City 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: PERMIT# -7 OWNER'S NAME: PHONE O- 000 / GENERAL CONTRACTOR: ltff . BUSINES LICENSE# Z,121 ADDRESS: 12c/-5,(q ZL/Z CITY/ZIPCODE: 5cofrs *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 SUBCONT CT HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. / I am not using any subcontractors: 17 y� )1 Signature Date Please check applicable subcontractors and complete the following information: V 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 Owner/Contractor Signature Date CITY OF CUPERTINO WATER HEATER CUPEt�T1NO PERMIT APPLICATION FORM APN# 2 � ` 13 � � �� Date: n J I J `f �.I kv 7 ZD o Building Address: 2-s& / Owner's Name: Phone #: 6-Av&i-o c}—mol Contractor: `` Phone #� �� 3 Fax Cupertino Business License #: Contractor State License #: 2121Z C-&G-3 y/ Contact: Phone 1P660 ��) Fax h(93/j 33 75�-0 Building Permit Info: Bldgo Elect Plumb 0� Mech ❑ Residential 5f Commercial ❑ Job Description: 20-er�� , 14jgl,�-� Ott. Strapped On Platform [D�Bonded New Location ❑ Replacement Valuation (cost of project): Project Size: Express Standard ❑ Large ❑ Major ❑ 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. Green Building Points achieved: Revised 03/10/10