10090080 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10307 DENISON AVE CONTRACTOR:CUPERTINO PLUMBINGPERMIT NO: 10090080
OWNER'S NAME: IDE ITSURO AND KAY A 1300 DELL AVE STE C DATE ISSUED:09/13/2010
/NER'S PHONE: 4089968318 CAMPBELL,CA 95008 PHONE NO:(408)253-0618
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r
License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL r
Contractor Date
JOB DESCRIPTION: COPPER REPIPE
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:
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:0 Valuation:$4000
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:31629056.00 Occupancy Type:
permit is issued.
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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
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:
LJ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one o1 inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&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 Owner or authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I mu:t
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state laws relatir g
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upje the above mentioned property for inspection purposes.(We)agree to save
rr. •aify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
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: ,v PERMIT#
OWNER'S NAME: p PHONE# O d
GENERAL CONTRACTOR: USINESS LICENSE#
ADDRESS: �/ I / CODE:
*Our municipal code requires all businesses working in t e city to have a City of Cupertino bu9sse.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR ANDA CONT't ACTORS HAVE OBTAINED A CITU OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINE SS 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 ontractor Signature Date
CITY OF 2UPERTINO
4 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31628022 . 00
DATE ISSUED. . . . . . . : 09/01/2010
RECEIPT #. . . . . . . . . BS000011345
REFERENCE ID # 10090001
SITE ADDRESS 10197 DENISON AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER PHILIP BOHANNON & EMILY UNDER
ADDRESS . . . . . . . . . . : 10197 DENISON AVE
CITY/STATE/ZIP CUPERTINO, CA 95014-2426
RECEIVED FROM ROGER B STEWART
CONTRACTOR TBI) - TO BE DETERMINED LIC # 00096
COMPANY TBI) - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- - --------- ---------- -
1BCBSC VALUATION 1, 500. 00 1.00 0 . 00 1. 00 0 .00
1EPERMITFE FLAT RATE 1. 00 42 .00 0 .00 42 . 00 0 .00
1ERT<200 UNITS 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 127.00 0. 00 127 .00 0 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-
-------- ----------------------------
------- ----------------------------
402 TEMPORARY POWER
.Indoor Air Quality and Firilshes
1.1 , 1 IAQ/Health pts y--yes; 0
2.Use Low VOC,Water-Based Wood Finishes. 2 IACJHsWth pts y--yea 0
, ixa4 31AQ/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 Plywoodbr Interior Uses 1 IAQ/Health pts y=yes 0
- 0
41AQ1Health. pts y=yes
B.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 I0
' 1 i 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
X Yoe-GO er+ejMvq00=111. s.. 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Hsalth 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
Total Points Available.] 140 130F 57
Total Points Project Received. � 01 0 0
l
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�_-- CITY OF C'UPERTINO
CUPEKTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# s, r Date:
Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No
HOA: (Exterior work only) Yes ❑ No If yes,provide letter from HOA
Owner's Phone#
Contra Phone:
Fax: �f
Contractor License#:
Cu ertino Business License#:
Contact. Phone:
Fax:
Residential Commercial
Job Description:
Building Permit Info:
' Bld ❑ Elect �rY Plumb [IMech ❑
g e:T
Occupancy Type:
Type of Construction (Usage Class): Occupan �3
IIMI/V-A II/III B, IV-HT, V-B
1-A, 1-B ❑ ❑
Valuation: Square Footage:
Project Size: Express ❑ Standard 'Lar e ❑ Major ❑
Green Building: Please complete relevant portion of the Green B ding/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
'oints Achieved:
r'or help, contact Build it Green at www.builditgreen.oriZ
Revised 07/14/09
3