10070175 CITY OF CUPERTIr O BUILDING PERMIT
BUILDING ADDRESS: 22330 HOMESTEAD RD APT 228 CONTRACTOR:CONTROLLED SYSTEMS PERMIT NO: 10070175
OF CALIF.
NER'S NAME: STEPHEN O HYATT 1098 B INDEPENDENCE AVE DATE ISSUED:07/27/2010
OWNER'S PHONE: 4088575415 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)268-8674
❑ LICENSED CONTRACTOR'S DECLARATIONr-
-7) � BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Clas Lic.# `
MECH r RESIDENTIAL f— COMMERCIAL �
Contractor UDate 3
I hereby of rm that I am 'ce ed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE EXISTING AIR CONDITIONING SYSTEM
(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.Ft Floor Area: Valuation:$4200
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 'ch this Q
permit is issued. APN Number:32659999. v U Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above in ation is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned perty for ins ection purposes. (We)agree to save WITHIN 180 DA 1'S OF PERMIT ISSUANCE OR
indemnify and keep ha css he City pertino against liabilities,judgments, 180 DAYS FROM I A.ST CALLED INSPECTION.
costs,and expen whic ma accrue ga st said City in consequence of the
granting of this a it. mat nally,t e licant understands and will comply
with all non-po nt ourc re at' ns p t Cupertino Municipal ode,Section Issued Date /'2��
9.18.
S` �ture Date 7 1 (�
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
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 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 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance 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 contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with th Cupertino Municipal Code,Chapter 9.12 and the
Health 7. a
afety Code,Sectio s 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 O n u horized ent:
Compensation laws of California. If,after making this certificate of exemption,I Date: ` 'v
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. ONSTR TION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender'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 Lender's Address
V he above mentioned property for inspection purposes.(We)agree to save
it. nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting 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. Licensed Professional
Signature Date
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl.c: Lot:
APN . . . . . . . . : 32559999 . 09
DATE ISSUED. . . . . . . : 07 /27/2010
RECEIPT #. . . . . . . . . : BS)00010975
REFERENCE ID # . . . : 10 )70175
SITE ADDRESS . . . . . : 22330 HOMESTEAD RD APT 228
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . =lERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : STEEPHEN O HYATT
ADDRESS . . . . . . . . . . : 22330 HOMESTEAD RD APT 228
CITY/STATE/ZIP . . . : CU?ERTINO, CA 95014
RECEIVED FROM . . . . : JO'iN E DOHERTY
CONTRACTOR . . . . . . . : DOAERTY, JOHN LIC # 19098
COMPANY . . . . . . . . . . : CO:JTROLLED SYSTEMS OF CALIF.
ADDRESS . . . . . . . . . . : 10 )8 B INDEPENDENCE AVE
CITY/STATE/ZIP . . . : MOJNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (4 )8) 268-8674
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 4, 200. 00 1 . 00 0. 00 1. 00 0 . 00
1BREMAIRHA NO.UNITS 1. 00 63 . 00 0. 00 63 . 00 0 . 00
1MPERMITFE FLAT RATE 1. 00 42 .00 0. 00 42 . 00 0 .00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 148 . 00 0 . 00 148. 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 148 . 00 MC
---------------
TOTAL RECEIPT 148 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL. MECHANICAL
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$4,200
R�PERMITTYPE: Mechanical Permit PLA v CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du lex APPLICATION 1RMAP2
USE: p TYPE:
� W
as
C)
3 �
APPLIANCE/EQUIP TYPE CAPACITY FE):ID QTY BP FEES
A/C Units (<=10K cfm) 1BREMAiR 1 $63
TOTALS: F $63.00
Mech.Plan Check0.0 hrs7$0-00
Mech.Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $42.00 ' F-1
NOTE. Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Yee Resolution 29-05I Eff %-/:'09) FEE QTY/FEE MISC ITEMS
r j (
PME Plan Check: $0.00
PME Unit Fee: $62.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes (D No $C.00
Travel Documentation Fee: ITRA VDOC $4'e.00
,_ .I, t ,E CSelect an Administrative Item
Bld�4 Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $14x:.00 $0.00 TOTAL FEE: $148.00
Revised: 7/22/2010
CITY OI CUPERTINO
FtWTACE/AC
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
) &
Buildi Addr45 Lo ri 0019—S-6r�
Own N P ne#
Contractor: Phone#: (40$)02 b*--SCo 74;
,
nro tr eA Fax#: (40A :2 b'Q ! ?71)
Contractor License#: Cupertino Business License#:
C—Z0
Contact. Phone#: 5-0 zZZ 4 7
DO Fax #:
Building Permit Info:
Elect M--- . Plumb Mech
Residential Commercial
Job Description:
' �s - � s
For Residential Installations:
Attic ❑ 1St floor E 2nd floor
Adhere to minimum setback requirement EJ--
For Commercial Installations:
Replacement same weight ❑ Additional weight(structural calcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project: Type of Geon (Usage Class):
0 -
Strapped 0 On Platform Bonded New Locatkun ❑ Replacement
Project Size: Express Standard ❑ Large [] Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 01/07/09
M.indDDr Air Quality and Finishes
a•llseLi iilVb- � 1 IAQ/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0
3 IAQ/Health pts y--yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes D
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes
7.W141tPaF 41AQ/Health. pts y=yes 0
S.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring a Resource pts y=yes 0
Use Rapkly Renelti+able Fbo*q Mduials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health 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 Resource pts y—yes 0
Total Points Available: 1 1401 1301 57
Total Points Project Received:1 01 01 0
G:data/pmgs/gre enbuildingguidelines/remodelers/greenpoin 212.04pr ed.xis
Building Department
City Of Cupertino
LIJI 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: Z Z 3�'o 0VK�b � �.' PERMIT#
OWNER'S NAME: eAA civ- PHONE # qfA �FG 7- 5 15
GENERAL CONTRACTOR: .t BUSINESS LICENSE#
ADDRESS: .Q 4103 ' CITY/ZIPCODE: Sq,vt
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUP4NCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND 7ALLYSPNTILMACTHAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. _7 J
1 am not using any subcontractors: !
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINE SS 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
'le
caner ontractor Sig ature Date