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10050109 1{nilriints ��Pnarrmvm CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22116 LINDA VISTA PL CONTRACTOR:AMERICAN VISION PERMIT NO: 10050109 WINDOWS INC WNER'S NAME: DAVID GOORVITCH 1050 E DUANE AVE STE H DATE ISSUED:05/11/2010 OWNER'S PHONE: 4082579041 SUNN)VALE,CA 94085 PHONE NO:(408)617-0901 LICENSED CONTRACTOR'S DECLARATION JOB U ESCRIPTION: RESIDENTIAL COMMERCIAL -7 7 q 5�C, (1 )RETROFIT GARDEN WINDOW NON-STRUCTURAL License Class Lic.# / 0 Contractor &LK(CA-J 1 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 performance of the work for which this permit is issued. Sq.F1 Floor Area: Valuation:$2446 1 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 APN slumber:35608010.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 DAYS FROM LAST CALLED INSPECTION. indemnify and kleep harmless the City of Cupertino against liabilities,judgments, costs,and expees ' ich may accrue against said City in consequence of the Issuc d by: Date: granting of this per . Additionally,the applicant understands and will comply with all non-point rce reg lations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: =natur�7 Date All rc ofs 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 inspe.tion. ❑ OWNER-BUILDER DECLARATION Date: Signature of Applicant: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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, Business&Professions Code) I,as owner of the roe y g HAZARDOUS MATERIALS DISCLOSURE property,rty,am exclusive) contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I hale read the hazardous materials requirements under Chapter 6.95 of the Calibrnia Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maii.tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&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 equi ent 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 ea Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cu ti unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Sections 5 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 I hei eby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. wor;s for which this permit is issued(Sec.3097,Civ C.) Lender'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 +^building construction,and hereby authorize representatives of this city to enter n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION ...,iemnify 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 Liccrised Professional 9.18. Signature Date CITY OF CU PERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM C)b5v( b cl APN# � UDate: Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes D No HOA: (Exterior work only) Yes ❑ No If es, provide letter from HOA Owner's Name: Phone#: T)406 a v rz N -/Cary Contractor: Phone: - re bd Fax: Contractor License#: Cupertino Business License#: Contact: Phone: �v - i-7-c sic �) C 0 C— w�,WI N Fax: LIi-6- G 17-6y Residential Commercial ❑ Job Description: mvcr_V4/fl_� Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B Efl_,--- (2- Valuation: Square Footage: . q y Project Size: Express �andard ❑ 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: For help, contact Build it Green at www.builditgreen.c r Revised 07/14/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Descripti.)n Fee Permit Type Group 1GENRES or 1GENCOM ISTUCOAP Stucco Applications (up to 400 sf) B additional stucco application f 1 WINREP Replacement windows/sliding glass B / door (ea 8 windows) 1 WINMEWSTR New Window-,,tructural shear B wall/masonry(ncludes plan ck fee) IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Zheck(when no E/M/P) B when not over counter) hourly-stand a]one 1 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residi,ntial B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 M.{ndoor Arruality and Finishes 0 1.Use LoW NO-VOC Paint 1 IAQ/Hea th pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Hee Ith pts y=yes 0 3.Use LowNO VOC Adhesives 3 IAQ/Hee Ith pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resourc a pts y=yes 5.Use Engineered Sheet Goods with no added Urea 0 Formaldehyde 61AQ/Heltlth pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Heilth pts y=yes 0 7 Seal all Exposed Part{ciaboard or MDF 4 IAQ/He filth pts y=yes 8.Use FSC Certified Materials for Interior Finish 4 Resour; 0e pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resowr e pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/H;alth pts y=yes M I - ` ( ` N.Flooring B Resource pts y=yes 0 1.Select FSC Certified Wood Flooring 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 4 Resoun;e pts y=yes 0 3.Use Recycled Content Ceramic Tiles 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/HE alth pts y=yes 4 Resour;e is es 0 5.Use Exposed Concrete as Finished Floor p Y=y 0 6.Install Recycled Content Carpet with Low VOCs 4 Resour-,e pts y=yes Total Points Available: 140E-1 30 57 01 01 0 Total Points Project Received: G:daWprogs/greenbuilding 3uidelinestremodelers/greenpointsfinal2.12.04protected.xls CITY OF CUPERTINO BL ILDING PERMIT BUILDING ADDRESS: 22028 LINDY LN CONTRACTOR:JOHNSTON ELECTRICAL PERMIT NO: 10050183 CONTRACTOR ""VNER'S NAME: TONY THOMAS 1302 LI VCOLN AVE STE 204 DATE ISSUED:05/25/2010 u YVNER'S PHONE: 4086859573 SAN JOSE,CA 95125 PHONE NO:(408)266-0236 ❑ LICENSED CONTRACTOR'S DECLARATION BUILT;ING PERMIT INFO: BLDG ELECT F PLUMB � �; v License Class Lic.# rS f / _ ,,�,�/� MECH RESIDENTIAL COMMERCIAL r Contractor : H4.5, r-4 e I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ELECTRICAL SERVICE UPGRADE TO 200 AMP,60AMP AC DISCOI,NECT (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft I loor Area: Valuation:$700 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN N ember:35627007.22028 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 acctue against said City in consequence of the 1F,O DAYS FROM LAST CALLED INSPECTION. granting of this permit. AdditionallyAhe applicant understands and will omply with all non-point source regula' s the Cupertino Municipal Cod Secti �2 J, 9.18. Issued Date: c`-nature Date J_ New, /D ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roo Fs 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 installer without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspect.on. 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, Signatr.re of Applicant: Date: 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 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 Califo•nia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compl ance 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. 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 contai Anants as defined bye the Bay Area Air Quality Management District I will permit is issued. maintain compliance with<t a Cupertino Municipal Co e,Cha ter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Heald &Safety Cote, ctions 25505,25533,and 255 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 Owne or au r' gent: 1,9�� It a become subject to the Worker's Compensation provisions of the Labor Code,I must Date: i forthwith comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I beret-y 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 wl�ich this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lend(r's Name to building construction,and hereby authorize representatives of this city to enter -i the above mentioned property for inspection purposes.(We)agree to save Lend(r's Address unify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Add4ignail he applicant understands and wiy comply with all non-point sou ce ul ns per the Cupertino Municipal Co e,S Ition I undo rstand my plans shall be used as public records. 9.18. Signature Date d Y v Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35627007 .22028 DATE ISSUED. . . . . . . : 05/25/::010 RECEIPT #. . . . . . . . . BS0000:_0479 REFERENCE ID # . . . : 10050183 SITE ADDRESS 22028 ]CINDY LN SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERT:_NO IMPACT AREA . . . . . . OWNER TONY THOMAS ADDRESS 22028 :CINDY LN CITY/STATE/ZIP . . . : CUPERTCNO, CA 95014 RECEIVED FROM BRIAN JOHNSTON CONTRACTOR . . . . . . . : BRIAN JOHNSTON LIC # 23411 COMPANY JOHNSTON ELECTRICAL CONTRACTOR ADDRESS 1302 LINCOLN AVE STE 204 CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE (408) 256-0236 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 700. 00 1 . 00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 700 . 00 0 .50 0. 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 .00 1ERT<200 UNITS 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 127 .50 0 . 00 127 .50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127 .50 AMEX --------------- TOTAL RECEIPT 127 .50 CITY OF Lai CITY OF CUPERTINO GENERAL BU]=LDING CUPERTINO PERMIT APPLICArCION FORM APN # - Date: 2 '16 Building Address: 2Zo2� L��n MailingAddress(if different from building add ess): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: Exterior work only) Yes ❑ No Ifes, novide letter from HOA Owner's Name: Phone#: To J4 og- Contractor: Phone: Fax: or— Contractor License#: ':j q S I tp F Cupertino Business License#: Contact: Phone: `�` Z(ob.d23.� & Fax:VL �� Residential Commercial Job Description: �,�G�t C*L �g6o—v6Ca- vt04;Ae "&9a4- 7-�> Zoo '1////' Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1�1 1-A, 1-B ❑ II/III/V-A ❑ II/VI B,IV-HT, V-B E�J-- '- Valuation- Square Footage: 7-,IjQ -- Project Size: Ex ress❑ Standard ❑ Lar e ❑ Na or ❑ 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: For help,contact Build it Green at www.builditgreen.or I Revised 07/14/09 CITY OF CU.PERTINO C U CITY OF O GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ISTUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1WINMEWSTR New Window-structural shear B wall/masonry ;includes plan ck fee) I EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 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 2lone / 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B ' 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 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:? 1 LiiG PERMIT# Sd l OWNER'S NAME: 7- _ PHONE# l� GENERAL CONTRACTOR: ) Is .{ lG�G h2c,r BUSINESS ICENSE# ADDRESS: 11d..) CITY/ZIPCODE: S --,ZoSe GA 1 *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) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACT+ HAVE OBTAINED A CITY OF U ERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: I/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing lectrical 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 Ower/Cot4tactor Signature Date