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10090244 CITY OF CUPERTITIO BUILDING PERMIT BUILDING ADDRESS: 10842 WILKINSON AVE CONTRACTOR:' PERMIT NO: 10090244 OWNER'S NAME: BANGERT STEVEN N AND BETH G �!/. 7✓54, bD. DATE ISSUED:09/27/2010 .PER'S PHONE: 4082558014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT F PLUMB r License Class 25 Lic.# 5 ZK' r F MECH RESIDENTIAL COMMERCIAL /L ContractorG�/ - j F}A/ ate I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL 2 BATHROOMS(127SQ),NON-STRUCTURAL& (commencing with Section 7000)of Division 3 of the Business&Professions WILL INCLUDE LIGHTING&PLUMBING ONLY;NO RE-ROOF&NO Code and that my license is in full force and effect. 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 hrsurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which permit is issued. Sq.Ft Floor Area: Valuation:$39686 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35613035.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. - , Signature -1 t ' Date Issued by' Date: e ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I musl F Owner or nt: forthwith comply with such provisions or this permit shall be deemed revoked. - � � Date:142Z/1- APPLICANT 2 /1 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 relatin€ I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) ,,^^*r the above mentioned property for inspection purposes.(We)agree to save Lender's Name inify and keep harmless the City of Cupertino against liabilities,judgments, ..,.s,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 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: Bl{: Lot: APN . . . . . . . . : 35513035. 00 DATE ISSUED. . . . . . . : 09/27/2010 RECEIPT #. • • . . • • • • : BS000011565 REFERENCE ID # . . . : 10090244 SITE ADDRESS . . . . . : 10842 WILKINSON AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BANGERT STEVEN N AND BETH G ADDRESS . . . . . . . . . . : 10842 WILKSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4732 RECEIVED FROM . . . . : WCRLEY'S HOME DESIG CONTRACTOR . . . . . . . : TPD - TO BE DETERMINED LIC # 00096 COMPANY TPD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 39, 686 . 00 2 .00 0 .00 2 . 00 0 .00 1BSEISMICR VALUATION 39, 686. 00 4 . 00 0. 00 4 .00 0 .00 1BUSLIC FLAT RATE 1. 00 114 .00 0 .00 114 . 00 0 .00 1REMRESBAT SQ FEET 127 . 00 570 . 00 0. 00 570 .00 0 .00 - --------- ---------- ---------- ---------- TOTAL PERMIT 690 . 00 0.00 690 .00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 690 .00 #3769 --------------- TOTAL RECEIPT 690 .00 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $39,686 *PERMIT TYPE: Building Permit PLY LN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex I t Yl,,i L PENTAMATION 1 GENRES USE: PERMIT TYPE: WORK SCOPE F-7- . F7t`oni(l 'c' LiI;r<_ . LiItz7c l M'I". /'CC, P''ttt�tz�. h, VC, NOTE. Thesefees are based on the preliminary information a vailable and are only an estimate. Contact the De t or addn 7 info. FEE ITEMS (Fee Resolution 09-051 El 7`1,10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $C.00 A27 s.f. Remodel,Bath(<=300 sfl Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $C.00 $570.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 10.701 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cfm} Irlwfi")f7 ]'Cn F71 Acoustical Fee: 0 Yes (F) No $0,00 0 Work Without Permit? Q Yes E) No $000 0 Plannin I'ee: $000 Select a Non-Residential Q 7i-ctrE>l[�t>crt711�rafuJ,c>,7 f s:�,g: Building or Structure 0 Strong Motion Fee: IBSEISMICR $397 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $200 SUBTOTALS: $597 $570.00 TOTAL FEE: $575.97 Revised: 9/22/2010 M.Indoor Air Quallity and Finishes 1.Use LDwMo-VbG 1 IAQ/Health pts yryes D 2,Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes D 3.Use Loyno'Ves 3 IAQ/Health pts yryes D 4,Use Salvaged Materials for Interior Finishes 3 Resource pts yeses 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQMealth pts y--yes D S.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts yryes D id 7 04 IAQMealth As Y--yesD eldaarlhil@ S.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes D D.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts yryes p 1 D.Install Whole House Vacuum System 3 IAQMealth pts yeses D N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y--yes p 2—,Use 13a_Ma HY 13MMWB flooring M4*als 4 Resource pts y--yesp 3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yessD 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y--yes D 5.Use Exposed Concrete as Finished Floor 4 Resource pts y--yes D 5.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes D 1 1 Total Points Available: 1401 130 57 Total Points Project Received: . 0 0 0 G:data/pmgs/gree ibuDrUnggi iderineshemodelers/greenpointsfinal212D4proiaoledxls t RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: " 3 —fir Name of owner. 1 Project address. /D� Contact person. P-lone. %' E��= 'f (SLI i`-t/ F ix. Net square footage of lot. Existinp, Proposed Square footage: First floor: Second floor: Garage: ;5 TOTAL: , . Are there at least two 10 foot by 20 foot clear spaces i:iside the garage? �I'} Is privacy protection planting required for the project? Build it Green Total Points On what floor(s) is work being done? --- Brief description of wo�� 771/ d' Code editions: 2007 CBC -N)2007 CFC < N)2007 CMC (Y-N) 2007 CPC N)2007 NEC (T)-N) Effective 1/1/08 1 � IN ACCORDANCE` CUPERTINO COCl S ANDD ORDINP NCE: <'�f DATE._- il�a�,M, This set of Plans and spec he kept on the fob at all times ar J it i` unlawful to make any changesor s.it nrhorns on same withoua�n eet City of C Ipertino. the Building Depths plan and spEx i 1caticns The stamping o SHALL NOT be held to permit or o be an approval of the v1olat;on of,any P' of any City Or+:mance qr ;tate !aw Plan Review Process Work Book Page-8-Revised 8/05/08 I Lo -C lo 00 PIC tl Ur ---------- ICKI T7- 7e ;J-4 I t ��t� �— „e ��; � � � � ��. ■ �� . �� • ■�� ■ �. ��` �.. � �� , .� � �� i�� `� c� � � �r� ■ '.rte'-�!� :��ii�� H �� /� �� , ■ �� s � H s ,d, rear ,.,.� ��r _ i ■� � i� _ � 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: PERMIT# " OWNER'S NAME:0-47-��E -= PHONE# 204- GENERAL CONTRACTOR BUSINESS LICENSE# ADDRESS: /' jly CITY/ZIPCODE: i- *Our municipal code requires all businesses workinj in the city to have a City of Cupertin usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTF:ACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. - I am not using y an subcontractors: Si;nature Date Please check applicable subcontractors and complete the following information: V 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 beet Rock e Owner/Contractor Signature Date CITY OF C'UPERTINO ADDITION/REMODEL CUPERTINO FEE SCREDULE - Date: � � 0 2 /L Is a 2n unit being added? Yes ❑ No,&If Yes, please fill out the permit application for 2" unit. Building Address: AVIV Mailing Address (if different from building address): Owner's Name: Phone# : Coi}tractor: Phone#: _ Fax#: Cupertino 8usmess License: r- State Contractor License Contact: Phone#: .�5',o'Za Fax M Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated ar gas): IV � 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: Bldg. Elect. [Z-` Plumb. Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition;? 61-v y`". �_Vf�j.' ,ry4�ti /i/ems�7.�"�er � 7 /✓Lf�i,s'(i� GJ/- //s�G c/.�- /' �' ' Remodel Includes Re-Roof: Yes Lj No t- `If ye list number of squares / Remodel Includes Structural: Yes ❑ No [�— Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your plannin approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath_ 'Oahe Type of Construction (Usage Class): Occupancy Type: -� 1-A, 1-B ❑ II/In/V-A ❑ II/III B, IV-HT, V-B 9--- Valuation: J� Please check this box if the project is a Project Size: Express L;,Standard ❑ Large ❑ T4a'or ❑ second-story addition ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieved: 774�:5_ include in plan set& the sheet index. Revised )5/18/10