10070149 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10534 MERRIMAN RD CONTRACTOR:ROYAL SERVICES PERMIT NO: 10070149
'OWNER'S NAME: DONALD F MORRISON JR 4398 NICKER CT DATE ISSUED:07/21/2010
NER'S PHONE: 4159310332 SOQUEL,CA 95073 PHONE NO:(408)972-2452
G LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class Lic.# _ 7 66 f-f
MECH r— RESIDENTIAL r— COMMERCIAL r
Contractor )(. Date 2t /0
I hereby affirm that I am licensed under the rovisions of Cha ter 9 JOB DESCRIPTION: DUPLEX-REBUILD CHIMNEY ROOF AREA UP
(commencing with Section 7000)of Division 3 of the Business&Professions **SEE NOTES**
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:$2900
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
q)J APN Number:34216094.00 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 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulation r the Cupertino Municipal Code,Section
9.18. Issued byr Date:
Signature Date 2f (D
❑ 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: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
I,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
1 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 read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California 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 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. 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 Health&Safety Code,Se ' us 255051 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 authorized ent: �v
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 which 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
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
.nify 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
granting of this permit.Additionall ,the applicant understands and will comply
with all non-point source regula ns er the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature / Date �
CITY OF CUPERTINO
3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blc: Lot:
APN 34216094 . 00
DATE ISSUED. . . . . . . : 07/21/2010
RECEIPT #. . . . . . . . . BS300010932
REFERENCE ID # . . . 10070149
SITE ADDRESS . . . . . : 10534 MERRIMAN RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DOVALD F MORRISON JR
ADDRESS 10532 MERRIMAN RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ANTHONY XAVIEL
CONTRACTOR TONY XAVIEL LIC # 22767
COMPANY ROYAL SERVICES
ADDRESS . . . . . . . . . . : 4398 NICKER CT
CITY/STATE/ZIP . . . : SOQUEL, CA 95073
TELEPHONE (408) 972-2452
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 2, 900 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 2, 900. 00 0 . 50 0 .00 0 . 50 0 . 00
1CHIMNEYRE EACH 1. 00 507 .00 0. 00 507. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 508 .50 0 .00 508 . 50 0 . 00
CITY OF CUPERTINO
RECEIPT NUMBER: BS000010932
RECEIVED BY: PAT PAYOR: ANTHONY XAVIEL
TODAY'S DATE: 07/21/10 REGISTER DATE: 07/21/10
TIME: 15: 16
4
1BCBSC 10070149 $1 .00
1BSEISMICR 10070149 $.50
1CHIMNEYRE 10070149 $507. 00
BUSINESS LICENSE TAX RNEW #22767 $114 . 00
----------------
TOTAL DUE: $622 . 50
CHECK $622 .50 REF NUM: #20560
TENDERED CHANGE
$622 .50 $. 00
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Its ADDRESS: DATE: REVIEWED BY:
APN: BP#. *VALUATION: 1$2,900
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Chimney/ Chimney Repair
PRIMARY SFD or Duplex ' APPLICATION 1R3SFDADD/REM
USE: TYPE:
xw
tx a
00
APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES
Chimney Repair 1CHIMNEYR 1 $507
TOTALS:
- 7 ,77 - ;
NOTA. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS jl✓ee Resohtiion 29-051 1:091 FEE QTY/FEE MISC ITEMS
Permit Fee: $507.00
Work Without Permit? Q Yes No $).00
Strong Motion F-ee: 1BSEISMICR $).50 Select an Administrative Item
E31d�g Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS; $503.50 $0.00 TOTAL FEE: $508.50
Revised: 6/30/2010
CITY OF CXPERTINO
CITY OF
CUPEkTiNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
Building Address: f
105.3L[ merrimA, p d
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of thi3 project? Yes No
HOA: (Exterior work only) Yes ❑ No ❑ If yes,provWe letter from HOA
Owner's Name: Phone#:
'aaA $I 6g4(S6W Wr OT ( 0,?3.
Contractor: Phone: t fog c?7d_ ;2 y5-
AL 5trUICE5 Fax:
Contractor License#: -7q/&4
Cupertino Business License#: 1
Contact: Phone:
Fax:
Residential Commercial El
Job Description: p I fid ;
D6F2 (ti t2 E/4 'v n
Building Permit Info:
' Bld *ln— Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A7 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-13
Valuation: n4 0 10 lb Square Footage:
Project Size: Express ❑ Standard ❑ Large [] Maj or ❑
Green Building: Please complete relevant portion ,)f the Green Bu' ding/LEED Checklist& attach it
to the application or if applicable, include in plan set & the sheet index.
'oints Achieved:
For help, contact Build it Green at www.builditpre en.or
Revised 07/14/09
s
M.Indoor Air Quality and Finishes
11116 1 IAQ/Health pts yeses p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Heaith pts y=yes. p
3.Lisa Lo VM 3 IAQ/Health pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAQ/HeaJth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes p
7.W of0111111111111140?tom" 41AQ/Health. pts y=yes p
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; p
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
Use t3apidye>roen9 Matedals4 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 130 57
Total Points Project Received: 0 0 0
2-1-16
G:data/pmgsJgre 3nbuildngguidelines/remodelers/greenpointsfina12.12.D4protected.xis
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CUPERTINO
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: �3 m e.(f(a� � �L PERMIT# a �
OWNER'S NAME: 0 Lf
&U OCL tj C(- I/1 PHONE # LICENSE#�
GENERAL CONTRACTOR: o C 'rU 4fE) BUSINESS LIC 1 ^�
ADDRESS: Veaf�� CITY/ZIPCODE: o
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S)HAVE OBTAINED AHCITY OF CUPERTINO
UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS
BUSINESS LICENSE. / Z r ;2 b rU
1 am not using any subcontractors: Signature Date
Please check applicable subcontractors and complete the following information:
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
Date
wner/Contractor Signature