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10060145 CITY OF CUPERTINO B UILDING PERMIT BUILDING ADDRESS: 22069 MC CLELLAN RD CONTRACTOR:CUSTOM EXTERIORS INC. PERMIT NO: 10060145 OWNER'S NAME: XINGMING TANG 440 BOULDER CT STE 400 DATE ISSUED:06/22/2010 1ER'S PHONE: 4087779692 PLEE.SANTON,CA 94566 PHONE NO:(925)249-2280 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r- PLUMB r License Class C I Lic.# -3 _ F MECH RESIDENTIAL COMMERCIAL Contractor Date l0 Z Z �J JOB DESCRIPTION: REPLACE 7 WINDOWS,3 SLIDING PATIO DOORS I hereby affi m that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions NO C OFIT NO C 3ANGES TO EXISTING OPENINGS 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 Section 3700 of the Labor Code,for the performance of the work for which t iq Sq.Ft Floor Area: Valuation:$5800 permit is issued. APPLICANT CERTIFICATIONAPN Number:35713027.00 Occupancy Type: I certify that I have read this application and state that the above informatiZisl— 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 ]HERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit A ditionally,the applicant understands and will comply :180 DAYS FROM LAST CALLED INSPECTION. with all non-p o rc regulations per the Cupertino Municipal Code,Section 9.18. Issu:d b -� Date: _l U Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: insta led without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspt ction. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Sign tture of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to — consttuct 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 Compensation,as provided for by Section 3700 of the Labor Code,for the I ha+e read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by com Aiance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Hea th&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I j /� /�/ become subject to the Worker's Compensation provisions of the Labor Code,I must Owner th tzed agent: /vim(/ // CJ forthwith comply with such provisions or this permit shall be deemed revoked. - Date: 71 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hei eby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save '-mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,and expenses which may accrue against said City in consequence of the gwriting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I un ierstand my plans shall be used as public records. Signature Date Lia+nsed Professional CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: I,ot: APN . . . . . . . . : 35713027 .00 DATE ISSUED. . . . . . . : 06/22/2010 RECEIPT #. . . . . . • • • : BS000010691 REFERENCE ID # . . . : 10060_.45 SITE ADDRESS . . . . . : 22069 MC CLELLAN RD SUBDIVISION . . . . . . . CITY CUPER-INO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : XINGM::NG TANG ADDRESS . . . . . . . . . . : 22069 MC CLELLAN RD CITY/STATE/ZIP . . . : CUPER-INO, CA 95014 RECEIVED FROM . . : CUSTOM EXTERIORS, IN CONTRACTOR . . . . . . . : KEVIN GUNDRY LIC # 23679 COMPANY . . . . . . . . . . : CUSTOIR EXTERIORS INC. ADDRESS . . . . . . . . . . : 440 BOULDER CT STE 400 CITY/STATE/ZIP . . . : PLEASANTON, CA 94566 TELEPHONE (925) :249-2280 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 5, 800 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 5, 800. 00 0 .60 0 . 00 0 . 60 0 . 00 1STPLNCK HOURS 1 . 00 L26 . 00 0 . 00 126 . 00 0 . 00 1WINREP EACH 8 1 . 00 380 . 00 0 . 00 380 . 00 0 . 00 ---- ------ ---------- ---------- ---------- TOTAL PERMIT 507 .60 0 . 00 507. 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ------------------- CHECK 1, 015 .40 #5069 --------------- TOTAL RECEIPT 1, 015 .40 an . CITY OF CU:PERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: TZ- Building ZBuilding Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Owner's Name: Phone#: Contractor: Phone: Fax: -? U Z 'i Contractor License#: Cupertino Business License#: o Contact: Phone: _ -�5e.w Fax: 11 J `" D Residential Commercial ❑ Job Description: G L �, i ,► Oe,�r Building Permit Info: Bldg Lr" Elect ❑ Plur.ib ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [}— P Valuation: Square Footage: Project Size: Express M,,S�andard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of tLe Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.<or Revised 07/14/09 M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Iiealth pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/14ealth pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/1 iealth 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 6 IAQ/iealth pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/iealth pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/-lealth. pts y=yes 0 8.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 1 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 8 Reso irce pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Reso irce pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Reso irce pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Iiealth pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Reso irce pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Reso irce pts y=yes 0 1 1 1 Total Points Available: 1 1401 130 57 Total Points Project Received: 1 — 01 01 0 l- Z 2- / 0 /:dat/pr,ogs/greenbu11o:fin Iguidelines/remodelers/greenpointsfinal2.12.04proteoted.xls .Moor Plan Drawir:g (tor Permits only) �X g�oroF� r c r r � � sPDM 1 o -� T;? n 'OR[)AW'twww HE CI _1 TINO GODES AND ARD NANO S ATE__ SIGN fications MU ��O�et ofilan5 a17ti spec ,pes and it iept on the Iah at il ;chan tes or alt nff ns5�ul to make a y rti oy�JV\ me without ��ittenrmof Cupeoa't '`''' i icati nsilding Dof tt, tildi spec LThe mNO1 bF°hei t r errnit or`o beo s �{05ov,�Lfnp �C c�oval of the r `t,ite Law p Of any Gity ir,.i�.�r, rn CE �� - 5 . 14� '- Last Name s v►� ° �—. Address 2 20 C!e (( 04 ___....N. . A City :._...__.....__�.._�_ c* t J � r 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: "7,Zv6 c7 76c, c a "x + PERMIT# OWNER'S NAME: PHONE# 4A GENERAL CONTRACTOR: �.�fi0� �2r��S �.'�t� BUSINESS LICENSE # ADDRESS: LHo (3v�( A.- CITY/ZIPCODE: 'P(�I� r u k 5 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS PECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRAC'ORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. , .� ZZ /'/v I am not using any subcontractors: ;�—/ Signat�ire 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 / Owner/Contractor Signature Date