10090197 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10329 MC KLINTOCK LN CONTRACTOR:SANDIUM PERMIT NO: 10090197
OWNER'S NAME: GAI BING CHEN 4223 VERDIGRIS CIR DATE ISSUED:09/21/2010
ER'S PHONE: 4082559421 SAN JOSE,CA 95134 PHONE NO:(408)894-9072
❑ LICENSED CONTRACTOR'S DECLARATIONr— r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C"c-', Lic.# �-kk f
c � — (�+ ~-� MECH RESIDENTIAL COMMERCIAL
Contractor �7y\� Date '?//- �O
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: FURNACE&A/C INSTALLATION
(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:$10254
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 is issued. �V. __ APN Number:34215044.00 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 c�
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by,- `� "" °' '"- Date:
9.18.
SignatureDate J
RE-ROOFS:
L 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 of 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)
I,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&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,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 contaminants 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
Health&Safety Code,Sections 25505,25533,and 25534.
1 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 Own r authorized agent:
Compensation laws of California. If,after making this certificate of exemption,) ,___— Date:
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 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 relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
i nify and keep harmless the City of Cupertino against liabilities,judgments,
L and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
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
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34215044 . 00
DATE ISSUED. . . . . . . : 0:/21/2010
RECEIPT #. . . . . . . . . : BE000011516
REFERENCE ID # . . . : 1C090197
SITE ADDRESS . . . . . : 10329 MC KLINTOCK LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GAI BING CHEN
ADDRESS 10329 MCKLINTOCK LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ARTHUR L NORINS
CONTRACTOR . . . . . . . : MICHAEL LEE LIC # 28867
COMPANY . . . . . . . . . . . SANDIUM
ADDRESS 4223 VERDIGRIS CIR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95134
TELEPHONE . . . . . . . . : (408) 894-9072
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 254 . 00 1. 00 0. 00 1.00 0 .00
1BREMAIRHA NO.UNITS 1. 00 63 . 00 0. 00 63 . 00 0 .00
1BSEISMICR VALUATION 10, 254 . 00 1 .10 0 .00 1. 10 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 275 .10 0 . 00 275. 10 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 275.10 VISA
---------------
TOTAL RECEIPT 275 .10
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OFCUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: "VALUATION: 1$10,254
*PERMIT TYPE: Mechanical Permit PL kN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY 101'AL PENTAMATION
USE: SFD or Duplex I;I 00A,AQ ,L PERMIT TYPE: 1 RMAP2
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=10K cfm) 1BREMAiR 1 # $63
Furnace, Forced-Air 1MFR=<100 1 # $126
TOTALS: 1 $189.00
Mech.Plan Check0.0 hrs $0.00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $42.00 ,. �, ,:�>;rt.; r,� Li _L_
the r f r'�°c-TsJsr'-
NOTE: Thesefees are based on the prefindnary in ormation zvailable and are on an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 09-051 Elf. %%7.%10) FEE QTY/FEE MISC ITEMS
Plus Chce A Fcc.
Supp/. 1'('r`"Ce
PME Plan Check: $0.00
Permil it l'ec
Supp/. 111'y Fee
PME Unit Fee: $189.00
PME Permit Fee: $42.00
Constriwnon 7_4ix F
ICIM,sfic:c.cl Rcviciv
Work Without Permit? 0 Yes E) No $0.00
/'lcrrtrtirr�> f�c��°: :
Travel Documentation Fee: ITRAVDOC $42.00
Strong Motion Fee: $'1.03 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC
SUBTOTALS: $275.03 $0.00 TOTAL FEE: $275.03
Revised: 9/14/2010
. n oR"MWn Pas
1.Use lx+wA�o-�fl)E 3'ai
2.Use Low VOC,Water Sased tVood Finishes 1 IAQ/Health pts y_yes
21AQ/Health is e 0
3.Use� V1]C Adt�res p Y=Y s 0 .
4.Use Salvaged Materials for Interior Finishes 3 IAQ/Health pts Y--yes
5.Use Engineered Sheet 3 Resource is Y—Yes 0
Goods with no added Urea p 0
Formaldehyde
S.Use Exterior Grade Plywood for Interior Uses S IAQ/Health pts y-yes
0
7..Seal1IAQ/Health is� 4r�4DtF p Y=Yes o
S.Use FSC Certified Materials for Interior Finish _ 4 IAQ/Health. s _ es
01
9.Use Finger-Jointed or Recycled-Content Trim 4 Resource pts y=yes 0
10.Install Whole House Vacuum System 1 Resource pts y--yes 0
3 IAQ/Health pts y--yes
N.Flooring 1 1 1
1.Select FSC Certified Wood Flooring
2.Use B Resource pts y-yes D
��F7oou�Og.f�at�a�s
3.Use Recycled Content Ceramic 4 Resource is Tiles p Y=Ye 0
4.Install Natural Linoleum in Place of Vinyl . 4 Resource pts y-yes 0
5.Use Exposed Concrete as Finished Floor 5 IAQ/Health pts y=yes
4 Resourceis 0
S.Install Recycled Content Carpet with Low VOCs p Y=Yes 0
4 Resource pts y=yes 0
Total Points AVallal)e:
1401 1301 57
Total Points Project Received: 0 0
0
G:data/progsrgree:nbuildfngguidelines/remoderers/greenpointsfinal212o4prof eetedAs
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST 1)4
JOB ADDRESS: 1ndc x I`l. PERMIT# U
OWNER'S NAME: Y' A,' PHONE# s-9 c�=
GENERAL CONTRACTOR: BUSINESS LICENSE# S Y (
ADDRESS: T N CITY/ZIPCODE: N VA r-
*Our municipal code requires all bus nesses wo 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: Date
Signature
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSII`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
FUIRNACEAC
I 1%10 F
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
q
Building Address:
2 7
1cA 1i ^k A
3, e- V
Owner's Name: P) one#:
Contractor: Phone N
Fax
Contractor License Cupertino Business License#:
Contact: Phone#: (j,
/ I 1.L
Fax #:
Building Permit Info:
Elect F-1 Plumb ❑ Mech
Residential EJ Commercial F-1
Job Description:
For Residential Installations:
Attic El I" floor 2nd floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight F-1 Additional weight(structural calcs) F-1
Structural Calculations required for new installation ❑
New installation Planning Approval RequiredEl
Cost of Project: Type of Construction (Usage Class):
C,
LA)
Strapped On Platform Bonc.ed ' New Loca6an Replacement
Project Size: Exprens El StandardD`- Large :] Major 0 C
Valuation:
Green Building: Please complete relevant portio a of the Green Building Checklist & attach it to the
application or if applicable, include in plan set& the sheet index.
Revised 01/07/09