10080022 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10352 PALO VISTA RD CONTRACTOR: PERMIT NO: 10080022
OWNER'S NAME: ALLISON SCHWANDA Cf, C J67(fln Wi Ali)J ATE ISSUED:08/03/2010
NER'S PHONE: 4082573820 , PHONE NO:
LICENSED CONTRACTOR'S DECLARATION r F
/^� �j^ �- BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class � 1 ( Lic.# �j 21 7�
MECH r- RESIDENTIAL r- COMMERCIAL r
Contractor Date � -� '��
I hereby of rrm that am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 29 WINDOWS&1 DOOR
(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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft F nor Area: Valuation:$30000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35702052.00 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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 181) DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the appli ant understands and will comply
with all non-point source relation er the pertino Municipal Code,Section
9.18. M 7 IssuedJVY.�_ � Date:
Signature Date
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspectic n.
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, Signatur;of Applicant: Date:
Business&Professions Code)
1,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
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have r,-ad the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Califon is Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. complia rice with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety(ode,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintai:i compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health 4k Safety Code,Sections 25505,25533,and 25534.
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 O !r thoriz gnt, -7
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for whic 1 this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
un-the above mentioned property for inspection purposes.(We)agree to save Lender's Address
lify and keep harmless the City of Cupertino against liabilities,judgments,
c. and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I unders and my plans shall be used as public records.
9.18.
License,I Professional
Signature Date
CITY OF CUPE:ZTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lo:.
APN . . . . . . . . : 35702052 . 00
DATE ISSUED. . . . . . . : 08/03/2)10
RECEIPT #. . . . . . . . . : BS000011065
REFERENCE ID # . . . : 10080022
SITE ADDRESS . . . . . : 10352 PALO VISTA RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTIVO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALLISON SCHWANDA
ADDRESS . . . . . . . . . . : 10352 PALO VISTA RD
CITY/STATE/ZIP . . . : CUPERTI\1O, CA 95014
RECEIVED FROM . . . . : EDWARD A MARKS
CONTRACTOR . . . . . . . : TBD - TD BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TD BE DETERMINED
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 30, 000. 00 2 .00 0. 00 2 . 00 0 .00
1BSEISMICR VALUATION 30, 000. 00 3 .00 0. 00 3 . 00 0 .00
1WINREP EACH 8 30 . 00 758 . 00 0.00 758. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 763 . 00 0 .00 763 . 00 0 . 00
CITY OF CUPERTINO
CUPEI�T1NO GENERAL BUILDING
PERMIT APPLICArCION FORM
APN # r - r.j `"1 ?✓_`` Date:
Building Address: i 0 1 S- PA r 'V 14c_-
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes LJ No
HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's Name: Phone#:
IWC,u\ StAwatJ& qdB — -)-S7-M 10
Contractor: Phone:
1Pq,eNt zu- Cvs+ta k, t am Drjo'- Fax: Vbe a 3 4 3---VJ-q
Contractor License#: -"1-14 .l—
Cu ertino Business License#:
Contact-
r/ k t 1��vLn Fax:
Residential Commercial
Job Description:
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
II/III/V-A I EIB
1-A, 1-B ❑ ❑ , IV-HT, V-B
Valuation: 00 Square Footage:
Project Size: Express Standard ❑ Large ❑ l�Za'or ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, inclu 3e in plan set & the sheet index.
'oints Achieved: U`
I For help, contact Build it Green at www.builditgreen.orQ
Revised 07/14/09
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7DATE: REVIEWED BY:
2'1 APN: BP#: *VALUATION: $30,000
4z PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex OVER THE TA-PPLICATION
USE: COUNTER? Q Yes No TYPE: 1GENRES
ME2HA CAL Q Yes
�® Y: ' Q Y,es (• ', 'f E '� AL Q Yds ie'N.o
xW
O O
3U
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s .ft.
TOTALS: 0 $0.00 $0.00
T71r;
NOTE: These fees are based on the Preliminary information availabh-and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS(Fee Resolution 09-051 FT f 7:7 '09) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 30 # Window/Sliding Glass Door
Suppl. PC Fee: (E) Reg. OT 0.0 �hrs $0.00 $758.00 IWINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: Q Yes Q No $0.00 O
Work Without Permit? Q Yes 0 No $0.00 0
Planning $0.00 Select a Non-Residential Q
Building or Structure
A
Strong Motion Fee: IBSEISMICR $3.00 Select an Administrative Item
B1d�4 Stds Commission Fee: IBCBSC $2.00
WBUTALS $5.00 :6758.00 TOTAL`FEE:' $763.00
Revised: 7/27/2010
M.Indoor Air Quality and Finishes
1.UseL1DWNo-V(5C'Paint 1 IA(IHealth pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAa Health pts y--yes 0
3.Use Low/.flo VOC Adhesives 3 IAa Health pts y--yes 0
4.Use Salvaged Materials for Interior Finishes 3 Res)urce pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQIHealth pts y--yes p
6.Use Exterior Grade Plywood for Interior Uses 1 IA(lHealth pts y--yes 0
7.SaW411 [FaluMmaidor� _ __ . _ 4 IAa Healtli is - es p
B.Use FSC Certified Materials for Interior Finish 4 Res)urce pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Res)urce pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ'Health pts y--yes p
t o
N.Flooring
1.Select FSC Certified Wood Flooring 8 Reso irce pts y--yes 0
2.Use f3apidlyFlenewaWe f=looring Materials 4 Re D irce pts y=Yes 0
3.Use Recycled Content Ceramic Tiles 4 Reso'trce pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQA isalth 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 Resol lrce pts y--yes 0
t 1 t
Total Points Available: 1401 1301 57
Total Points Project Received:1 01 01 0
-7
G:data/progs/greenbui1c1ngi uidelines/remodslers/greenp6intsfinal212D4protectebds
C �
o � 1
p
o
rb r
41 \ Z N T
O tr C?�'
CD m CN
y G
atLpv _
% --1 ;:6 Ln Zn
+� O nI, w 7 N ' I Z�
O > > O N
(!� (P ,
a f o
QA0
L,
S" )
P
F
tb
a
�o
i 60`(c) (1
o �,; '• - � Koko �
�.J
c orl
o
d �
S r
(� 9hrrc 91oh
� G
Q �\
`^7
r
C�
-C
a
s
a
e��
P
k
r
Building Department
City Of Cupertino
10300 Torre Avenue
ELI Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: f 6355 Z AINO V(-9-APERMIT# I/,20
OWNER'S NAME: O" PHONE# ' d f- Q3r
GENERAL CONTRACTOR: LOOLOOV BUSINESS LICENSE#
ADDRESS:/s" : 6
'Our municipal code requires all businesses working in the(ity to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSI'ECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU C C�N TRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
S gnatu re Date
Please check applicable subcontractors and complete tI a following information:
V SUBCONTRACTOR BUSINESS N XVIE 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