Loading...
10070090 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20685 ACADIA CT CON'rRACTOR:BROTHERS HOME PERMIT NO: 10070090 IMPROVEMENT 1 'BIER'S NAME: TOM&IVY POTHEN 2510 DOUGLAS BLVD DATE ISSUED:07/13/2010 ,,yNER'S PHONE: 4088367182 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680 lyd LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class E -! Lic.# �r, MECH r RESIDENTIAL COMMERCIAL Contractor �— Date 7 ;/w I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 16 WINDOWS&2 PATIO DOORS,LIKE FOR LIKE RETRO (commencing with Section 7000)of Division 3 of the Business&Professions FIT 11[STALL 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 Floor Area: Valuation:$12000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. /� APN Number:32656022.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 80 DAYS FROM LAST CALLED INSPECTION. 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. .1-, Issue d by: Date: Date � OWNER-BUILDER DECLARATION RE-ROOFS: All rc ofs 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 instal ed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspe-:tion. 1,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, Signature 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 declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the Calif rrnia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance 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 Code,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 Addi ionally,should I use equipment or devices which emit hazardous air conta 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 I certify that in the performance of the work for which this permit is issued,I shall Heah h&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 Owner or a orized.egent: 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 here by 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 w rich 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 s above mentioned property for inspection purposes.(We)agree to save Lender's Address i ify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the mg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION wt[h all non-point source regulations per the Cupertino Municipal Code,Section I und,;rstand my plans shall be used as public records. 9.18. Licer sed Professional Signature Date / V CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32656022 .00 DATE ISSUED. . . . . . . : 07/13/2010 RECEIPT #. . . . . . . . . BS000010851 REFERENCE ID # • • • 10070090 SITE ADDRESS . . . . . : 20685 ACADIA CT SUBDIVISION . . . . . . : CITY CUPERZINO IMPACT AREA . . . . . . OWNER TOM & IVY POTHEN ADDRESS . . . . . . . . . . : 20685 ACADIA CT CITY/STATE/ZIP . . . : CUPERIINO, CA 95014 RECEIVED FROM . . . . : SEAN FERGUSON CONTRACTOR . . . . . . . : GENE ti . CAVANNA LIC # 27964 COMPANY . . . . . . . . . . : BROTHERS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 2510 LOUGLAS BLVD CITY/STATE/ZIP . . . : ROSEVILLE, CA 95661 TELEPHONE . . . . . . . . : (408) 295-0680 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 12, 000 . 00 1 . 00 0 .00 1 . 00 0 . 00 1WINREP EACH 8 12 . 00 _` 06 . 00 0 .00 506 . 00 0 . 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT E07 .00 0. 00 507. 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CREDIT CARD 507 . 00 MC --------------- TOTAL RECEIPT 507. 00 CITY OF CU PERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: 1$12,000 -PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex I OVER THE APPLICATION 1 R3SFDADD/REM USE: COUNTER. Q Yes ® No TYPE: MECHANICAL Q Yes Q No I PLUMBING © Yes Q No I ELECTRICAL ©Yes O No � al C' 3 �I OCCUPANCY TYPE: TYPE OF FLR ARE.k PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. (sq.ft.) R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00 TOTALS: I 0 $0.00 I ( $0.00 I I I I I I I nI n n NOTE: These Fees are based on the preliminary information availaole and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resoltuion 09-051 Eff. % 1:09) FEE QTYIFEE I MISC ITEMS 12 Plan Check Fee: $0.00 # Window/Sliding Glass Door Suppl. PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 $506.001 I WINREP I Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:E) Reg. ®OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 n i Acoustical Fee: ® Yes Q No $0.00 Work Without Permit? ® Yes (F) No $0.00 I I E) Planning Fee: $0.00 Select a Non-Residential E) Building or Structure Strom Motion Fee: IBSEISMICR I $1.20 Select an Administrative Item Bldc-= Stds Commission Fee: 1BCBSC I $1.00 I SUBTOTALS: $2.20 $506.001 TOTAL FEE: I $508.20 Revised: 6/30/2010 CITY OF CUPERTINO CU CITY O]NO GENERAL BUILDING PERMIT APPLICATION FORM APN # I Date: l / Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No 2 HOA: (Exterior work only) Yes ❑ No [ If yes,provide letter from HOA Owner's Name' Phone#: _ Contractor: � ` ' Phone: Fax: Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential lLd Commercial ❑ _k Job Description: 6 ; L0 14- Building Permit Info: ' Bldg n" Elect ❑ Plurr.b ❑ Mech ❑ Type of Construction (Usage Class): Occupancy TType:�--� 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B 0—' \�� _ Wall Valuation: / Square Footage: Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of thi: Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet in x. Points Achieved: .-... For help, contact Build it Green at www.builditmen.o:-g Revised 07/14/09 M.Indoor Air Quality and Finishes 1.Use Lo*Na-VOC Nni 1 1AO]Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IA,)/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 RE source pts y=yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61A,)/Health pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAO/Health pts yeses 0 7 Seal all Exposed PArticlaboard or MDF 4 IA,)./Health. pts y=yes D S.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[AQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 RIDE ource pts yeses 0 3.Use Recycled Content Ceramic Tiles 4 Res ource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IACdHealth pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Res ource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCE; 4 Res ource pts y=yes 0 Total Points Available: (A, 1 1401 1301 571 Total Points Project Received:1 01 01 01 G:datalprogs/greenbuild'i rgguidelines/remodelersl greenpointsfinal2l2.04proteoted.xis 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: (P YS 14 c c. �I v C 1 PERMIT# OWNER'S NAME: j(je-7 � L��` co-f hlo PHONE# GENERAL CONTRACTOR y j/� I,�� �(.�,��� wj(1rc,rw,w�1 BUSINESS LICENSE# ADDRESS: =SS ` /-��'Sjcas; (�i a CITY/ZIPCODE: *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 111 I am not using any subcontractors: i Signature Date Please check applicable subcontractors and complete the following information: IV SUBCONTRACTOR BUSINESS 1\AME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation l Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal A Sheet Rock Tile J —� -- Owner�Corf#ractor Signature Date Z ,..� t� iiZ 1a • UA f� �b r M