10090196CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21330 VAI AVE
OWNER'S NAME: CAROL MARIDON
JER'S PHONE: 4082466413
LICENSED CONTRACTOR'S lDErC1LARAATTION
-icense ClassLic. #
contractor A L -e V .1/V tPr
[ 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.
[ hereby affirm under penalty of perjury one of the following two declarations:
[ 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.
[ 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
eermit 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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accnre 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
9.18.
Signature � DateJA �4u
LA OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
permit is issued.
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
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
forthwith comply with such provisions or this permit shall be deemed revoked.
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
nnify and keep harmless the City of Cupertino against liabilities, judgments,
, 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
9.18.
Signature Date
CONTRACTOR: ROBERT LOUTH CO.
PERMIT NO: 10090196
1520 CAROL AVE
DATE ISSUED: 09/21/2010
BURLINGAME, CA 94010
PHONE NO: (650) 438-4637
BUILDING PERMIT INFO: BLDG F
ELECT I— PLUMB
MECH F RESIDENTIAL F COMMERCIAL F
JOB DESCRIPTION: BATH REMODEL(54SQ);NON-STRUCTURAL
Sq. Ft Floor Area: I Valuation: $12500
APN Number: 36205030.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by `" — '- -- Date:
RE -ROOFS:
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
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owne77 aut or' age �� /� ������ Z
n.,(i(�t _ ate 1 U
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constriction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
3 ITEMS OF 3
CITY OF CUPERTINO
PERMI`C RECEIPT
Sec: Twp: Rng: Sub: Bl:{: Lot:
APN ........: 36205030.00
DATE ISSUED.......: 09/21/2010
RECEIPT #......... BS)00011514
REFERENCE ID # ...: 10)90196
SITE ADDRESS 21330 VAI AVE
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER CAROL MARIDON
ADDRESS ..........: 21330 VAI AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: ROBERT LOUTH CO
CONTRACTOR .......: RCBERT LOUTH CO. LIC # 30030
COMPANY ..........: RCBERT LOUTH CO.
ADDRESS ..........: 1520 CAROL AVE
CITY/STATE/ZIP ...: BURLINGAME, CA 94010
TELEPHONE ........: (650) 438-4637
FEE ID UNIT
QUANTITY
AMOUNT PD -TO -DT
THIS REC
----------
NEW BAL
-----
-----------------------
1BCBSC VALUATION
--------------------
12,500.00
----------
1.00
0.00
1.00
0.00
1BSEISMICR VALUATION
12,500.00
1.30
0.00
1.30
0.00
1REMRESBAT SQ FEET
1.00
570.00
0.00
570.00
----------
0.00
----------
TOTAL PERMIT
---------- ----------
572.30
0.00
572.30
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
--------------------
NUMBER
----------------- ---------------
CHECK
572.30
#1393
---------------
TOTAL RECEIPT
572.30
CITY OF CUPERTINO
1 ll�l FFF. F4TIMATOR -- BUILDING DIVISION
_ L __-a .. .L /:... ..� nfin�s nvniln/�/o mtd aro aptly an e.0imate. Contact the Dent for addn'l into.
lVulG: l nese CCs are Uascu Vi[ use i.....4 sw.
FEE ITEMS (Fee Resolution 09-05I Ef . T"1%10)
ADDRESS:
DATE:
REVIEWED BY:
wc'�� 1"-rmil Fc"'
APN:
BP#:
*VALUATION: $12,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: p
It1i,t.
1°I Ck3R f f tT,�:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
$0.00
SCOPE
_ L __-a .. .L /:... ..� nfin�s nvniln/�/o mtd aro aptly an e.0imate. Contact the Dent for addn'l into.
lVulG: l nese CCs are Uascu Vi[ use i.....4 sw.
FEE ITEMS (Fee Resolution 09-05I Ef . T"1%10)
FEI:
_T_F
---- ----
MISC ITEMS
wc'�� 1"-rmil Fc"'
Plan Check Fee:
f % f "i` :' Zi:'t . ,j l'I 3.
f )1 ±,. i- 1} t " t;7 tYt,�,? >
E3
Wo {l. 11=.41 Pcc,
11/7:i!1 b7 %...:jl. %'[,c'-
0.0 1
_ L __-a .. .L /:... ..� nfin�s nvniln/�/o mtd aro aptly an e.0imate. Contact the Dent for addn'l into.
lVulG: l nese CCs are Uascu Vi[ use i.....4 sw.
FEE ITEMS (Fee Resolution 09-05I Ef . T"1%10)
FEI:
- - ----
QTY/FEE
---- ----
MISC ITEMS
Plan Check Fee:
$0.00
L_L4_j s.f.
$570.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee{') Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$ 0.00
PME Permit Fee:
$ 0.00
Acoustical Fee: 0 Yes 0 No
$ 0.00
0
0
Work Without Permit? 0 Yes 0 No
$ 0.00
Planning, Fee:
90.00
Select a Non -Residential
Building or Structure
0
0
/
�hc(b'E'j L)(X"�lftic'11�L7iitil"1 1`E'E',S':
Strong Motion Fee: 1BSEISMICR
91.20
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
;>1.00
SUBTOTALS:
1;2.20
$570.00
TOTAL FEE:
$572.20
Revised: 9/14/2010
1. UseLown4o-VOC.Ptint
2. Use Low VOC, Water -Based Wood Finishes
3. Use Lvwft4q VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
7. SBal.altE�ose®Iaei+d�r�►1DF
B. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
I D. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
2- Use Rapidly Renewable Flooring lyiatera*
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl .
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
Total Points Available:
Total Points Project Received:
1 IAQ/Health pts
y --yes
21AQ/Health pts
y=yes
31AQ/Health pts
y=yes
3 Resource pts
y=yes
61AQMealth pts
y=yes
1 IAQ/Health pts
y=yes
4IAQ/Health pts
y=yes
4 Resource pts
y=yes
1 Resource pts
y --yes
3 IAQMealth pts
y --yes
B Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y --yes
5 IAQ/Health pts
y=yes
4 Resource pts
y --yes
4 Resource pts
y=yes
1401-730 5-11 57
01 01 0
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SIGNED
This set of plans and specifications MW
he kept on the job at all 11!,jes and it 'i
,mlawful to make any than (es or -,jterati6ns
-)n ,ante Without ,,tte, Vern)jsc,,Ion frorn
ti�eH�AdingD )artn1e?)t,G'tY0fCuPer1j(1()
lc
plin and spoctficatv.on,
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AAAi NOT be h0d 1ki Pdr!"t'M L
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'77
CUPERTINO
V"NTR ACTOR / SL BCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: d,
PERMIT #
CJ Ol 076
—4 6
OWNER'S NAME:
PHONE #
NSE # 3
GENERAL CONTRACTOR: f`l/t
BUSINESS LIC
ADDRESS: Z C vu V
CITY/ZIPCODE:
_ rs_.
hncinncc IirPnsP_
*Our municipal code requirts all businesses worxung in Mu Lgty u•1"•� - - ..7 — ----r-- _____ ._ _-
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: 77
Date
Signature
,.t. 1, �.,"IwahlP ciihenntractors and complete the following information:
�/
-- --rr---
SUBCONTRACTOR
BUSINESS 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
ADDITION /REMODEL
FEE SCHEDULE
APN#� � � � � �
Date: q
Is a 2n unit being added? Yes ❑ No If yes, 13
lease fill out the permit application
for 2° unit.
Building Address:
30
Mailing Address (if different from building address):
Owner's Name: _
Phone # :
L) 5(
- J3
Phone #:
S�
It6�7
�3�-
Contractor:
Fax #:
y
Cu ertino Business License:
State Cont�rLic #:Phone
#:
K --
Contact: �7 J
l( 0 �f ✓ 4� a �-'
Fax #:
Landscape Ordinance compliance:
Landscape area in sq. ft. (includes all irrigated areas): ("
If 2,500 sq. ft. or less, compliance with the LandscfLpe Water -Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
)fiance Method: U Plant
Water Bu
Building Permit Info: Mech. 0 Hillside El
Bld [ Elect. Q Plumb. [��
Job Description:
Addition -What is being added?(Be Specific):
1111A
What is being remodeled (not including addition)?
13 u. Ik r Y W-0,- 4>, t — s t r,.v% w.vuA
Remodel Includes Re -Roof: Yes ❑ No Dr If yes list number of squares
Remodel Includes Structural: Yes F-1No
Do you have the pre -application planning approval?
If yes, please provide a copy of yourplanning appro
Square Footage:
Addition: Porch
Remodel: Kitchen
Deck:
Bath S� Other.
Yes ❑ No ❑
I 1pffpr_ Planners name:
Garage: Detached Attached
Type of Construction (Usage Class): Occupancy Type:i-' a
1-A, 1-B ❑
IUIII/V-A ❑ II/III B, IV -HT, V Valuation:
Please check this box if the project is a
Pro'ect Size: Express ❑i. _,ard ❑ Large [IJda'or ❑ second-storyEladdition
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved`
include in lan set & the sheet index.
Revised 05/18/10