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10100107 I - CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20308 SILVERADO AVE COT TRACTOR: PERMIT NO: 10100107 OWNER'S NAME: DISTEL LP >(W_1: O�"ri U 4n DATE ISSUED: 10/14/2010 s NER'S PHONE: 6508686078 k Q-- PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.#_ y/ ! r MECH r RESIDENTIAL COMMERCIAL r Contractor Date � � G I hereby affirm that I am licensed under the provisions of Chapter 9 JOf DESCRIPTION:KITCHEN REMODEL(I I OSQ);NON-STRUCTURAL (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.14 Floor Area: Valuation:$15000 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 t 's permit is issued. APr Number:36938013.00 Occupancy Type: APPLICANT CERTIFICATION 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 -PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 all non-point source regulations per the Cupertino Municipal Code,Section Issued by' Date. ^� 9.18. Signature Date RE-ROOFS: L OWNER-BUILDER DECLARATION All i oofs shall be inspected prior to any roofing material being installed.If a roof is inti lied without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of insp xtion. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Sigr ature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, _ Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's Cal fornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the con pliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safi•ty Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Aduitionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this con:aminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the p Hea Ith&Safety Code,Sections 25505,25533,and 25534. 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 Ow mer or autho ' d agen Compensation laws of California. If,after making this certificate of exemption,I _ Date:—��"�" r` become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I he, affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for vhich this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Ler der's Name 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 Ler der's Address upon the above mentioned property for inspection purposes.(We)agree to save in'' � ify and keep harmless the City of Cupertino against liabilities,judgments, ,d expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION gi.....ing of this permit.Additionally,the applicant understands and will comply I ur derstand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Lic!nsed Professional Signature Date .Indoor Air Quality and Finishes 1 IAQ Health pts y-yes 0 2.Use Low VOC,Water-Based Wood Finishes. 2 IAQ'Health pts y--yea 0 31AQ'Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Ree ource pts y--yes 0 5.Use Engineered Sheet Goods with}no added Urea Formaldehyde 6IAQ'Health pts y--yes 0 5.Use Exterior Grade Plywood for Interior Uses 1 IAQMealth pts y--yes 0 0 4IAC"ealth. pts yeses B.Use FSC Certified Materials for Interior Finish 4 Re:ource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Re;ource pts y=yes 0 10.Install Whole House Vacuum System 3 IA(VHealth pts y=yes 0 1 ! 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 jflea�ewab1gBovg s 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 Total Points Available: 1401. 1301 57 Total Points Project Received: 0 0 0 G:daWprops/greenbuild igguidelines/remode)erslgreenpointsfine1212.D4protected.xis A TC H ' FE MODEL 2 0 3 t ,l VERA..D o VE, C.-,UPeRT 1 0, APPROVI i N ACt.O(�DAN(-•E vV{T T is t:ITY i . DPFRT!NO CD O/E�.`,AND((())RC)INANGE',; SIGNE:C) s rt�cat�on This yet of Plans ►,�rcept on the Ir,i,at narxle� �,r alteration` javefly «rda`N ljrIt vtithout wi�tt«,n�E'rrn s; X.1TcHEN' REMOTEL ---------- S qF I V Y i Y N 2f Y 30 pro �05 sup,T�Utt� I CITY OF CL PERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: )ATE: REVIEWED BY: APN: BP#: *VALUATION: 1$15,000 q;�PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex ' '` _. PENTAMATION 1 GENRES USE: •- fPERMIT TYPE: WORK SCOPE F771 Vo olh't t,rdC li'tbj. + _ la.tis 1 'e T r <. 1.t'E Its� fie NOTE. Thesefees are based on the preliminary information avaiGible and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 Fff 7i1%101 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 110 J s.f. Remodel,Kitchen(<=300 sf) Suppl. PC Fee: E) Reg. 0 OT 1 0.0 1 hrs $0.00 $570.00 IREMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Uoh";IPIW[ion Tax F 71 Acoustical Fee: 0 Yes (D No $0.00 Work Without Permit? 0 Yes E) No $0.00 E) Planning Free: $0.00 Select a Non-Residential 0 Building or Structure 0 frttrea f_)oc�rlrl�rttc�tit>tr f`erc'.S: I Stromn,Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.5C $570.00 TOTAL FEE: $572.50 Revised: 9/29/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY ## 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36938013 . 00 DATE ISSUED. . . . . . . : 10/14/2010 RECEIPT #. . . . . . . . . : BS000011746 REFERENCE ID # . . . : 10100107 SITE ADDRESS . . . . . : 20308 SILVERADO AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DISTEL LP ADDRESS . . . . . . . . . . : 20308 SILVERADO AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GLADYS W KWOK CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 15, 000 . 00 1 .00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 15, 000 . 00 1 .50 0.00 1. 50 0 . 00 1REMRESKIT SQ FEET 110 . 00 570 . 00 0 . 00 570 . 00 0 .00 ---- ------ ---------- ---------- ---------- TOTAL PERMIT 572 .50 0 .00 572 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ------------------- CREDIT CARD 572 .50 VISA --------------- TOTAL RECEIPT 572 . 50 CITY OF CUPERTINO cl) ADDITION/REMODEL CUPERTINO FEE SCI-IFiDULE APN# Date:--") b q �)g d Is a 2n unit bein added? Yes ❑ No [}�f es, lease fill out the permit application for 2 unit. Building Address: G Mailing Address (if different from building address): A(1e. G�c-►�''-`� I E. , `J CA +[? Owner's Name: Phone# : A 31B Contractor: , Phone#: Fax#: Cupertino Business License: State Contractor License#: Contact: �� Phone#: rl 7 ? ; �j Fax#: Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): 41_� 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 Proje-A Submittal is required. Com fiance Method: ❑ Plant Type ❑ l Vater Budget Building Permit Info: / Bld . 9 Elect. Plumb. Mech. Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? (� Remodel Includes Re-Roof. Yes ❑ No ❑ T yes list number of squares Remodel Includes Structural: Yes ❑ No ❑ Do you have the pre-application planning approv 31? Yes ❑ No ❑ If yes, please provide a copy of your plannig a roval letter. Planners name: Square Footage: Addition: Porch: Deck: _ Garage: Detached Attached Remodel: Kitchen Bath Oth:r Type of Construction (Usage Class): Occupancy Type: R- 1-A, 1-B ❑ IUIII/V-A ❑ IVIII B, IV-HT, V-B Valuation: pyo Please check this box if the project is a Project Size: Express ❑3--Standard ❑ Lar e ❑ Ma'c r ❑ second-story addition ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicab',e, Green Building Points Achieved:edd include in plan set & the sheet index. Revised 05/18/10