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10090209 CITY OF CUPERTI140 BUILDING PERMIT BUILDING ADDRESS: 20613 SCOFIELD DR CONTRACTOR:KRAMER CONSTRUCTION PERMIT NO: 10090209 OWNER'S NAME: ORLANDO LARSON 20667 CRAIG CT DATE ISSUED:09/22/2010 WNER'S PHONE: 4082530957 CUPERTINO,CA 95014 PHONE NO:(408)255-6976 ❑ LICENSED CONTRACTOR'S DECLARATIONr r �� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# T ��1� MECH r RESIDENTIAL COMMERCIAL Contractor. Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL ONE NEW WINDOW IN EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions IS 36"X 36"IN E Code and that my license is in full force and effect. IS 36"X 36"IN GARAGE 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:$800 permit is issued. APPLICANT CERTIFICATION APN Number:35909007.00 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 construction,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 aicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per a Cupertino Municipal Code,Section 9.18. All J G- q2 //- Issued�. _—�"2-..._. Z-- Date: Signature Date / �)V OWN R-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 1,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 contractors 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 three 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&Safety Code,Seed s 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow or an nt: Date: forthwith comply with such provision or this permit shall be deemed revoked. CONSTRUCTION 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 relating 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 `4emnify 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 b.anting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35909007.00 DATE ISSUED. . . . . . . : 09/22/2010 RECEIPT #. . . . . . • • • : BS000011533 REFERENCE ID # . . . : 10090209 SITE ADDRESS . . . . . : 20613 SCOFIELD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ORLANDO LARSON ADDRESS . . . . . . . . . . : 20613 SCOFIELD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2945 RECEIVED FROM OFLAND J LARSON CONTRACTOR STAN KRAMER LIC # 23187 COMPANY KFAMER CONSTRUCTION ADDRESS 2C667 CRAIG CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (908) 255-6976 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ------- 1BCBSC VALUATION 800. 00 1 . 00 0. 00 1.00 0 . 00 1BSEISMICR VALUATION 800 .00 0 .50 0 .00 0.50 0 .00 1BUSLIC FLAT RATE 1. 00 114 .00 0. 00 114 . 00 0 . 00 1SUPINSFEE HOURS 1.00 126 . 00 0 .00 126 . 00 0 .00 - --------- ---------- ---------- ---------- TOTAL PERMIT 241.50 0 .00 241.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 241 .50 VISA --------------- TOTAL RECEIPT 241 .50 CITY OF CUPERTINO FEE ESTIMATOR--BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: *VALUATION: $800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY 101,1/; PENTAMATION USE: SFD or Duplex 11=1.00,, 'lt PERMIT TYPE: WORK SCOPE r „ , f f r Li -E]F-L- NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS 09-051 a. 7%1i70j FEIN QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: ISUPINSFEE $0.00 Suppl. Insp. Feer Reg. 0 OT 1.0 hrs $126.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr uc fion T i Acoustical Fee: 0 Yes No 10.00 Work Without Permit? 0 Yes E) No 10.00 Planning Fee: 0.00 Select a Non-Residential Building or Structure 'lr'crrc�� C:�oc trrr«-frtatir,rt f`rc.�: Strom Motion Fee: 1BSEISMICR ` 0.50 Select an Administrative Item BldP_Stds Commission Fee: 1BCBSC ;>1.00 SUBTOTALS: $1 9'7.501 $0.00 TOTAL FEE: $127.50 Revised: 9/14/2010 Minoor A r Quality an finis es - • 1.Use Low/fJo-VO C Paint 2.Use Low Voc,Neater Based Wood Finishes 1 IAQ/Hsalth pts y=Yes 2IAQ/Health t5 3.Use Lflw/No VOC Adhesives p y--yes DD 4.Use Salvaged Materials for Interior Finishes 3 IAQ/Health pts y=yes D 5.Use Engineered Sh3 Resource pts y=yeseet Goods with no added Urfa D Formaldehyde 6.Use Exterior Grade Plywood for Interior Uses 11AQ/Health pts y=yes IAQ/Health Pts y=yes y D 7.Seal!all Exposed P�loleboard pr MDF es 0 B.Use FSC Certified Materials for Interior Finish — 4 IA— AQ eaJ`h Dts v= as D 9.Use Finger-Jointed orRecycled-Conte4 Resource pts y=yesnt Trim D --- 10.Install Whole House Vacuum System 1 Resource pts y=yes 0 3 IAQ/Health pts y=yes D N.Flooring 1.Select FSC Certified Wood Flooring 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 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 D B.Install Recycled Content Carpet with Low VOResource pts y=yes Cs D 4 Resource pts r=yes D Total Points Available: 14D 130 57 E====70i'll Points Proiect Received: t7>. 0 0 p t progslgree�6 dngguidelines/raMDdelers/greenpointsfina1212D4prDinted.xis I sim CITY OF CUPERTINO CITY6F CUPS TING GENERAL BUILDING PERIYIIT APPI.jICATION FORM APN#.. c Date. Build' Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of th.is project? Yes No HOA: (Exterior work only) Ye-s ❑ No [ If' es, provide letter from HOA Owner's N e: Phone#: Contractor/" �y Phone: fL Fax: Contractor License Cupertino Business License#: Contact: Phone: Fax: Residential Commercial Job Description: Building Permit Info: Bldg ❑ Elect ❑ _ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 0 1-A, 1-13 ❑ II/III/V-A ❑ II/VI B, IV-HT, V-B Valuation: Square Footage: "". 041 Project Size: Express []om-Stindard ❑ Large ❑ Major ❑ 61 11 Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicabl!, include in plan set & the sheet index. Points Achieved: - e - For help, contact Build it Green at www.buildit!Zr!en.or Revised 07/14/09 z