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10090078 CITY OF CUPERTI vO BUILDING PERMIT BUILDING ADDRESS: 22617 ROYAL OAK WAY CONTRACTOR:JAMES DUNAWAY PERMIT NO: 10090078 OWNER'S NAME: JAMES DUNAWAY 22617 ROYAL OAK WAY DATE ISSUED:09/13/2010 NER'S PHONE: 4082559244 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION (� r— r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH r RESIDENTIAL[_ COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL(IOOSQ),KITCHEN CABINETS,SOME (commencing with Section 7000)of Division 3 of the Business&Professions APPLIANCES; Code and that my license is in full force and effect. NO RE-ROOF&NO STRUCTURAL 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. 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 Sq.Ft Floor Area: Valuation:$8000 permit is issued. APPLICANT CERTIFICATION APN Number:34232009.00 Occupancy Type: 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 constriction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES 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 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: Signature Date Ln OWNER-BUILDER DECLARATION RE-ROOFS: I 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,I 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 c2oUkctors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following ee declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I 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. I 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(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I 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 fety Code,Sections 25505,25533,and 25534. Compensation laws of Califomia. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I m! ner suthQ forthwith comply with such provisions or this permit shall be deemed revoked. QTR C ION LENDING AGENCY APPLICANT CERTIFICATION / I certify that I 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 relatin€ 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 -mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,and expenses which may accrue against said City in consequence of the granting of this p9pa.. dditionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all no n�mt sou regulations er the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Sign ture Date Gr/�j� Licensed Professional l' - CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$8,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex R)I��li- PENTAMATION 1GENRES USE: p hZ t,t) 1`t t PERMIT TYPE: WORK SCOPE a,',ch. 1'1�°rr t lrc,h' 'htlltb Pz'crrt C/rc°c, (_7Uc Picli�CIIC(k lv h P.q'w t F">c: Ph";m' f�o"llit Fcc: I:f(c Po mi;h:< F-1 -t- Li 011wr Ah i In"l, O ,c,r.Phirrrh Irr , o;ilc r l!cc.fcslz. NOTE. Theseees are based on the preliminary into rmation available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-051 Ef. 711%10) FEE QTY/FEE MISC ITEMS Plan Check Fee: 110.00 1 s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: 0 Reg. 0 OT 0.0 1 hrs 90.00 $570.00 1REMRESKIT PME Plan Check: 10.00 Permit Fee: 10.00 Suppl. Insp.Fee10 Reg. 0 OT Fo.0 hrs l0.00 PME Unit Fee: 1.0.00 PME Permit Fee: 10.00 Coilso'lrciion T"L Acoustical Fee: 0 Yes (F) No 90.00 0 Work Without Permit? 0 Yes E) No 90.00 e) Planning Fee: 90.00 Select a Non-Residential E) Building or Structure 0 ll-'Ivu(Doctrlactifolit'ri Fees: Strong Motion Fee: IBSEISMICR 50.80 Select an Administrative Item Bldj4 Stds Commission Fee: 1BCBSC ;;1.00 SUBTOTALS: 9;1.80 $570.00 TOTAL FEE: $571.80 Revised: 9/01/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34232009 .00 DATE ISSUED. . . . . . . : 09/13/2010 RECEIPT #. . . . . . . . . BE000011440 REFERENCE ID # . . . : 10090078 SITE ADDRESS . . . . . : 22617 ROYAL OAK WAY SUBDIVISION . . . . . . CITY CLPERTINO IMPACT AREA . . . . . . OWNER JFMES DUNAWAY ADDRESS . . . . . . . . . . : 22617 ROYAL OAK WAY CITY/STATE/ZIP . . . : CLPERTINO, CA 95014 RECEIVED FROM . . . . : JFMES E DUNAWAY CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : JFMES DUNAWAY ADDRESS . . . . . . . . . . : 22617 ROYAL OAK WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 000 . 00 1 .00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 8, 000 . 00 0 .80 0 .00 0. 80 0 .00 1REMRESKIT SQ FEET 1. 00 570 . 00 0. 00 570 . 00 0 . 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 571 .80 0 .00 571. 80 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 571 .80 MC --------------- TOTAL RECEIPT 571.80 .Indoor Air Quality and Finishes 1 IAO/Health pts y--yes; 0 2.Use Low VOC,Water-Based Wood Fnishes 2 IAQ/Health pts y=yes 0 3.Aalot 3IAQ/Health Pts Y=Y es 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQIHealth pts y=yes 0 6.Use Exterior Grade Plywood.for Interior Uses 1 IAQ/Health pts y--yes 0 - 4IAQ/Health. pts Y--yes; 0 B.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; 01 1 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0 N.Fiaoring 1.Select FSC Certified Wood Flooring 6 Resource pts y--yes; 0 2-we fig aernewabo;F_loorii�lait.is'.. 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 Total Points Availabi 140r 1301 57 Total Points Pro'ect Received: r v ~) 01 01 0 GAORIprogsdi ireenbuild'iingguiderinestremodelerslgreenpointsfinat21204pmWad.x1s RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number:`� c2 - .32 —00 -- Name of owner. , 1 -� ,� /S� Z)oyr'9'y y Project address. =22 1 214 C ems, 1s 1,6/,4 1!� Contact person. �,� i4S LVAIII-zvit-�' P lone. EX F ix. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces i.iside the garage?rte.`-�l_. Is privacy protection planting required for the project? Build it Green Total Points On what floor(s) is work being done? Brief description of work. ag CGS ` vr� c Code editions:2007 CBC -N)2007 CFCN)2007 CMC N) 2007 CPC '6-N)2007 NECN) Effective 1/1/08 APPROVE[) IN A(-(.<)HDAWl �NITI! THE("ITY CUPS Rl INO CODE t,AND ORDINANCES'" i.)A I-EAa �� 51G this set of plions MUS' 13 be kept all times and it-s inlawful make any changes c7r altr.-ration on sm ae without wntten I,ermission from the Building Department,Cit of Cupertino. The stamping of this Irl Af') -�n(1 specifications be an SHALT NOT be held��pe)fmit ory pprovions approval of the wolation�� a City fate I aw Plan Review Process Work Book Page-8-Revised 8/05/08 c4c o aff u VA C-I if Al ,,� fie C�° � . . z U 47,-F' K E F C- 1 3616 if \Ai 12 ------------------- 24.Dl-%E'P-1 K.31-2BOWL . :;IJ,,/-'-,,I'I, to co Lu 13 z qp c ji E Cu C-Q U) 0 LO2:JXGtI'0617ZCC c E LO 0 9 DCHI2JAA XG I Z 0 c Q '77 75 ........... IM < S.- Y Flour* Sc00%f lye W Two e0walerp OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINC,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building(a)cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS � I� /?j � / ,�� APN BP# OWNFER NAME, (/ OWNER ADDRESS c 0,4v ave_- vN,�v,¢-� 2 6 / �- L DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the pormitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- uilder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully actinll as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my proparty. I understand building permits are not required to be signed by property owners unless they are responsible for th construction and are not hiring a licensed Contracor to assume this responsibility. 3. 1 understand as an "Owner-Builder" I am the rE!sponsible party of record on the permit. I understand that I may rotect myself from potential financial risk by hiring a I censed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law t)be licensed and bonded in California and to list their license numbers on permits and contracts. (� 5. I understand if I employ or otherwise engage a ny persons, other than California licensed Contractors, and the y taI value of my construction is at least five hundred dollars ($500), including labor and materials, I may be / considered an "employer" under state and federal law - 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and ?'federal government, withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I e Iso understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors' Sta:e License Law, an Owner-Builder who builds single-family osidricensed ential structures cannot legally build them with th s intent to offer them for sale, unless all work is performed by subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. g8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for nyinancial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 �9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service,the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB)at 1-800-321-CSLB (2752)or www cslb.ca.gov for more information about licensed contractors. G;information 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that II am the party legally and financially responsible for propos ad construction activity at the site address listed above. 1. 1 agree that, as the party legally and financially rE sponsible for this proposed construction activity, I will abide applicable laws and requirements that govern OWnE r-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the I have provided on this form. Licensed contrai:tors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a re 5ult of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Ccntractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency fc r the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender,5,ddress: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city 'nay be required to be presented when the permit is issued to verify the property owner's si nature. Date: Property Owner's Signature: -N- - --- --- - ---- --- - ---------------------------------------------------------------------------------------------------------------- - ( (5TE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TOA:T ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: - - -� Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property ow ier for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be prE sented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderFonn_2010.doc revised 04/14/10 P. nr)Poor r Qualityan4nnishes 1.Use iDWIND- O-C i"airt 1 IAWsalth pts Y--yes p 2.Use Low VOC,Water Based Wood Finishes 2 IAQ/Health pts y--yes 0 3.Use Low?O VUC Adhesives 3 IAQMealth pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts yryes 0 5.Use Engineered Sheat Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 S.Use Exterior Grade Ply►r000d for Interior Uses 1 IAQ/Heaith pts y--yes 0 7.$B3l p®�ael#i aiebeaqdflfMOF 4lAQ/HEalth is _ e5 -- o B.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/Hsalth pts y--yes 0 1 1 1 N.Flaoring 1.Select FSC Certified Wood Flooring B Resource pts yeses 0 2. a.i3ap4f3mwoe flomug wam4s 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 ResDLlrCe pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource-pts y--yes 0 1 1 t Total Points Availab e:l 140 1301 57 Total Points Project Received:] 0 0 0 G:daldprog:/greenbuiidingguidelinestramodelerstgneenpointsfina1212.Mproieeted.xls CITY OF CUPERTINO WATER HEATER CUPERTINO PERMIT APPLICATION FORM APN # - -, .- Date: ag f l5ha Building Address: i-�0 LL, ( N6 n LLL Owner's Name: Phone #: 94maSwaw,1 Vk`S� a `�"�" y68 - 25�� i71 Uw1Q Contractor: Phone #: Fax #: Cupertino Business License #: Contractor State License #: Contact: Phone #: Fax #: Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Residential t, Commercial ❑ Job Description: :�s 0 I ;,,`� �a Y.V0 e5 s w a.to , k ea-h2,r a,+- "m e p..J n P Y. Strapped ❑ On Platform ❑ Bonded ❑ New Location Replacement ❑ Valuation (cost of project): Cj ( Ck Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant po rtion 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 CITY OF C'UPERTINO ADDITION/REMODEL CUPERTINO FEE SCHEDULE APN# Date: Is a 2nd unit being added? Yes ❑ No If yes, )lease fill out the permit application for 2nd unit. Building Address: Mailing Address (if different from building address): Owner's Name: Phone# •,� Gas yr zs�s- 2 Contractor: Phone#: Fax#: Cupertino Business License: State Contractor License#: Contact: Phone#: �{ L)UAA4A-�1__ Fax#: Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): 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 Project Submittal is required. Compliance Method: ❑ Plant Type ] Water Budget Building Permit Info: Bld Elect. Plumb. Mech. El Hillside El Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition;? l 7N�� (.J�66 OV6 F 5 r 0`q L&A-61W� Remodel Includes Re-Roof: Yes ❑ No �T If yes list number of squares Remodel Includes Structural: Yes ❑ N9CJ Do you have the pre-application planning approval? Yes ❑ No If yes, please provide a copy of your plann!Rg approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Other Other Type of Construction (Usage Class): Occupancyype: 1-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [[ Valuation: Please check this box if the project is a Project Size: Express a Standard ❑ Large ❑ Major ❑ second-story addition ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set& the sheet index. Revised 05/18/10