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10080094 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10839 BROOKWELL DR CONTRACTOR:PETER'S CONSTRUCTION PERMIT NO: 10080094 OWNER'S NAME. DAN YE 100 C,:)NCORD CIR DATE ISSUED:08/13/2010 JER'S PHONE: 4082191575 MOU VTAIN VIEW,CA 94040 PHONE NO:(650)906-8788 ❑ LICENSED CONTRACTOR'S DEECCLjARATION BUILDING PERMIT INFO: BLDG r- ELECT F PLUMB� License Class Lic.# �Q % r r r / MECH RESIDENTIAL COMMERCIAL n Contractor [✓�-�'Z _Date � '' I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE ONE 6'3"WINDOW WITH 6'4"WINDOW (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.F1 Floor Area: Valuation:$1000 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 whic ��) permit is issued. rAPN Vumber:36921031.00 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 p ERMIT 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 with all non-point source regulations per the Cupertino Municipal Code,Section Issuedpy!�-7� Dater� 9.18. Signature - Date dp�� J RE-ROOFS: �. OWNER-BUILDER DECLARATION All re ofs shall be inspected prior to any roofing material being installed.If a roof is instal ed 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 inspe,:tion. 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 stricture 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 Calif)rnia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the coml liance 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 conts minants 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 p Heal h&Safety Code,Sections 25505,25533,and 25534. 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 Own!r or Hathor' Compensation laws of California. If,after making this certificate of exemption,I 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 herby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for%hich this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lenc er'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 Len(er's Address upon the above mentioned property for inspection purposes.(We)agree to save i­' -unify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION gi .icing 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. Liceased Professional Signature Date CITY OF CUEERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Iot: APN 36921( 31 .00 DATE ISSUED. . . . . . . : 08/13/ 2010 RECEIPT #. . . . . . . . . : BS000011181 REFERENCE ID # . . . : 10080094 SITE ADDRESS . . . . . : 10839 BROOKWELL DR SUBDIVISION . . . . . . . CITY CUPER-INO IMPACT AREA . . . . . . OWNER DAN YE ADDRESS 10839 BROOKWELL DR CITY/STATE/ZIP . . . : CUPER-INO, CA 95014 RECEIVED FROM . . . . : PETER S CONSTRUCTIO CONTRACTOR PETER WANG LIC # 25511 COMPANY . . . . . . . . . . : PETER S CONSTRUCTION ADDRESS 100 CONCORD CIR CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94040 TELEPHONE . . . . . . . . : (650) '306-8788 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 1, 000. 00 1. 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 1, 000 . 00 0 . 50 0.00 0.50 0 . 00 1WINREP EACH 8 1. 00 380 .00 0. 00 380. 00 0 .00 ---- ------ ---------- ---------- ---------- TOTAL PERMIT 381 .50 0. 00 381.50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ------------------- CASH 381.50 --------------- TOTAL RECEIPT 381 .50 1 ' INO CITY OF CUPERT CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM :te APN # Da r/ Cl Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes 0 No HOA: Exterior work only) Yes ❑ No If es, )rovide letter from HOA Owner's Name: Ph e: 2 PA-A/ z r� j Contractor: Phone:/ Q .P�, Gltic Fax: V ,l"6l l o (, ''� �'� Contractor License#: b Cupertino Business License#: t Contact: Phone: Fax: Residential Commercial ❑ Job Description: r p� Uyl e, �3 '' !^, �rda�.J T v (� j�(� Gv 4,%G-LO AJ v Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type:2_ 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [l Valuation: Square Footage: O-51D I Project Size: Expressdard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of tlLe Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: .�. For help, contact Build it Green at www.builditgreen.ur Revised 07/14/09 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex OVER THE APPLICATION 1 R3SFDW USE: COUNTER? 0 Yes 0 No TYPE: WORK SCOPE TYPE OF FLR AREA OCCUPANCY TYPE: CONSTR. s.f. PC FEES', PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00 TOTALS-0 $0.06 ` , °3�' Yr1, $0.00 " 7�4R`#:W" tti* � 3. �a"`rdi'. � x s *• �r, t a SY4r k ,v�.x y �,r rr 1/',4L 91y" p�Q t rw a _1 r ,.�'�,- e f}111,1 '1( W,�.! N/• ,b frau C'hrct / Plc,rz Cho-k FIT,In p 01 Phlmtj Iw LDpUJI!c'P l;lcr lia.ti��. I I jch [Pi"imb bj,p. I.e., NOTE: Thesefees are based on the prelindnary information avail able and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 09-05/ Eff. 7.11111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. © OT 0.0 1 hrs $0.00 $380.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. © OT FO.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 l !i11�rrrri rion 1,r.� _7F Acoustical Fee: 0 Yes (D No $0.00 Work Without Permit? 0 Yes E) No $0.00 0 Planning Fee: $0.00 Select a Non-Residential Q 7 lo s,I 1 enc Mih 1� nruliot! CVS. Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $1.00 b,4g � 4. 4rwB "UTALS` $1.50 $380.00 x1� f,st $381.50 - a •._... '� .k, '— ...a -7.tr.. .• Revised: 8/12/2010 INPUT Resourres EnergyAD M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAC/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAC/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAC/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Re::ource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61ACIHealth pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAC JHealth. pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IACIHealth pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Re source pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Re source pts y=yes 0 10.Install Whole House Vacuum System 3 IAOJHealth pts y--yes 0 1 1 D N.Flooring 1.Select FSC Certified Wood Flooring B Res)urce pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Res wrce pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Res)urce pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAC/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Res)urce pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Res wrce pts y=yes 0 1 1 1 Total Points Available: 1 1401 130T----5-71 Total Points Project Recelved: ' 1 01 0 0 -2,,6 f � G:data/progs/greenbuildi igguidelines/remodelers/greenpointsfinal212.04protected.xls w p o r. T G 1 v !^ V)iN 6N, i APPROVE D IN AC(-OHDANF;�-E dVI1N CNE CIT OF � CUPEHI!NO CUD S AND()FIDINAf jGES F \ DATE_ --------� - V ~" SIGN – -- This set of p ans and specit.icabons US be kept on the lob at all time,,;and it is N unlawful to make any changes or alt ration s i on same without written pern-lisfA01 I on the Budding ia De{ rtment,City of C c'do is Q I The stamping of this Ulan and speci 1, SUAI I NOT b,,hell to permit ort a I approval of the violation Or XV—r" or s rFt.any Ordinance or w *a 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: Llv_e�P ✓ PERMIT# OWNER'S NAME: , PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# Z ADDRESS: (/1) 4!�ZYt 6 rd e_t ��t CI Y/ IPC DE: 0 0 *Our municipal code requires all businesses working in the .ity to h e a Ci y of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS1'ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. _ 1 am not using any subcontractors: � Signature Date Please check applicable subcontractors and complete the following information: j/ 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