10060003 CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR:WESTHILL PERMIT NO: 10060003
BUILDING ADDRESS: 10012 N FOOTHILL BLVD CONSTRUCTION CO
VNER'S NAME:
LOS GATOS,CA 95032 PHONE NO:(408)395-4361
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
❑ LICENSED CONTRACTOR'S DECLARATION
0RE MOVE AND REPLACE EXTERIOR SIDING WITH NEW T
License Class Lic.# I ocx) I-1 l
Contractor �, SIDING
Date — (
I hereby affirm that I am licensed under the provisions of Chapter 9
(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 [AP
Ft Floor Area: Valuation:$7600
performance of the work for which this permit is issued.
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 which this N Number:32650051.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION ve information is PERMIT EXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the aboWITHIN 180 DAYS OF PERMIT ISSUANCE OR
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
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYJS FROM LAST CALLED INSPECTION.
indemnify and keep harmles City of Cupertino against liabilities,judgments, —I 10
costs,and expenses which ay a' i ity in consequence of the Is!ued by: Date: I
granting of this pe dditi all he lic understands and will comply
with all non-
in;tailed without first obtaining an inspection,I agree to remove all new materials for
in;pection.
❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
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,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
(alifornia Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: 1 ealth&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay A AiV54.
agement District I
v,ill maintain compliance with the p tin i ,Chapter 9.12 and
performance of the work for which this permit is issued. t ne Health&Safety Code,Seed s 05, 5 ,a
I have and will maintain Worker's Compensation Insurance,as provided for by /' _f �b
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:V
permit is issued.
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must v hereby
affirm
t at t permit is issued(S c.309re is a construction 7,Cing gveC.�for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. vender's Name
APPLICANT CERTIFICATION Lender's Address
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
the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
._mnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # ' Q l// Date:
E�
Building Address: /40Z) t 2 � \
Mailing Address (if different from building address): 4,-7
Anvt
Are Hazardous Materials being used as part of this project? Yes No
HOA: (Exterior work on
Yes ❑ No (` If es, rovide letter from HOA
Owner's Name: �es5Phone#: q t
CS$�� ��
Phone: s�
Contractor: W 1F S�, �f Coe-
l Fax:
Contractor License#: F�, -1 bO C)+0
Cupertino Business License#:
Contact: � - Phone:
S �d! S Fax:
Residential Commercial
Job Description:
L
I/V CAC
Building Permit Info:
Bldg Elect ❑ Pl-nnb ❑ Mech ❑
Type of Construction (Usage Class): rp;
Ccy Type:
❑ II/111III B, IVH- T V-B c G tQi
1-A, 1-B ❑ IUIIUV-A --
Valuation: Square Footage:
Project Size: Express ❑ Standard ❑ Large [ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
IFor help, contact Build it Green at www.builditgree:i.or
Revised 07/14/09
CITY OF CUPERTINO
CUPEf�F GENERAL BUILDING APPLICATION
FEE SCHE13ULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
1 PARTICOMM Partition Interior Commercial B 1PARTICOMM
1 PARTIR Partition Interior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1 RETSP 10 Special Design, over 10' high (up to B
50')
1RETCRB< Gravity/Crib Wal(, 0-10'high (up to B
50 ft)
1 RETCRB> � Gravity/Crib Wal l over 10' high (up to B
50 ft)
SIDING
1 SIDEST/BK Siding, Stone & Erick Veneer B
(interior/exterior)
1 SIDEOTHER Siding all other B
SKYLIGHTS y
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>l 0SF Skylight greater tr an 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0--8-' high (up to 100 sf) B
1 RAACKS>8 Storage Racks over 8' high (up to 100 B
st)
4 of 5
CITY OF CU:PERTINO
Cin OF GENERAL BUILDING APPLICATION
CUPEkTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1WINREP Replacement,windows/sliding glass B
door (ea 8 wi zdows)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
IEPERMITFEE Electrical Pernit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Peimit Fee P
lELCPLNCK Stand Alone Electric Pln Ck(hourly) j::E:1MECPLNCK Stand Alone Mechanical Pln Ck (hrlyM
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BCBSC Cal Bldg Stzndards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
IBSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 cf5
M.indoor Air Quality and Finishes
1.Use LowMaVOC Paint 1 IAQ/H' P Y=Y
,alth is es 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/H;alth pts y=yes 0
3.Use LowMo VOC Adhesives 3 IAQ/Hi;alth 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/H;alth pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/H;alth pts y=yes
7.Seal all Exposed Particleboard or MDF 4 IAQ/H;alth. pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resou rce 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 B Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resour(:e pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resoume 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 ReSDurl:e pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resoume pts y=yes 0
1 1 i
Total Points Available: E 1401 1301 57
Total Points Project Received:1 1 01 01 01
G:data/progs/greenbuildinggu felines/remodelers/greenpointsfinal2.12.04protected.xls