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10050156 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21810 RIFREDI CT CON'FRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10050156 OWNER'S NAME: ASH ROBIN T AND CHERYL G DATE ISSUED:05/19/2010 VER'S PHONE: 6502076935 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG[_ ELECT r— PLUMB License Class Lic.# MECH F RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SIDING EAST SIDE OF HOUSE,LESS THAN (commencing with Section 7000)of Division 3 of the Business&Professions 800SOFT 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.F:Floor Area: Valuation:$800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35716121.00 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 DLFROM L T CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ' 9.18. Issued by: �� C�!J Date: Signature Date 169 OWNER-BUILDER DECLARATION RE-ROOFS: All r(ofs 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: inspe;tion. 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, Signs ture of Applicant: Date: Business&Professions Code) 1,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 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 haN a 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 Safely 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 cont:minants 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 Heal 1&Safety Code,Sections 25505,25533,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 ODxn r or aut. zed age /� become subject to the Worker's Compensation provisions of the Labor Code,I must _ ,�, prize age Date:_ 4 10 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I herr by 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 Len(er'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 Len(er's Address 7nify 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.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as publig records. 9.18. ,.� � ;? Lice rsed Professional Signature/ Yr Date f O CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35716121. 00 DATE ISSUED. . . . . . . : 05/19/2010 RECEIPT #. . . . . . . . . BS000010445 REFERENCE ID # . . . : 10050156 SITE ADDRESS . . . . . : 21810 RIFREDI CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ASH RCBIN T AND CHERYL G ADDRESS 21810 RIFREDI CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2852 RECEIVED FROM . . . . : ROBIN T ASH CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOLNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----- ----- ---------- ---------- ---------- 1BCBSC VALUATION 800 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 800 .00 0 . 50 0 . 00 0 .50 0. 00 1SIDEOTHER SQ FEET 1 . 00 _ 80 . 00 0 .00 380 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT 423 . 50 0 .00 423 . 50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 423 .50 #"087 --------------- TOTAL RECEIPT 423 . 50 CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# �� ,1 � t r ` Date: Building Address: 1C9 10 F4EFO C-T- Mailing Address (if different from building address): c �l1 E Are Hazardous Materials being used as part of this project? Yes No HOA: Exterior w�onYes ❑ No If es, provide letter from HOA Owner's Name: i Phone#: Contractor: Phone: IT-13 P Fax: Contractor License#: Cupertino Business License#: -7 Lt �y Phone: leo f �C_-3 Contact: Fax: c) z Z?, �,Z Residential Commercial Job Description: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [] Valuation: . Square Footage: i 41 Project Size: Ex ress Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, in dude in plan set& the sheet index. Points Achieved: - For help, contact Build it Green at www.builditgreen.-mg Revised 07/14/09 CITY OF CUP-ERTINO CITY ofGENERAL BUILDING APPLICATION CUPEf�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM PARTITION WALLS 1 PARTICOMM Partition Interior Commercial B 1PARTICOMM 1PARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1 RETSTN Standard (up to 5 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B 1RETSPI0 Special Design, over 10' high (up to B 50') 1RETCRB< Gravity/Crib Wall, 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 , 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>1 OSF Skylight greater tlian 10 sf or B structural 1STAIRS Stairs-first flight/ca addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 04' high (up to 100 sf) B 1 SRACKS>8 Storage Racks over 8' high (up to 100 B st) 4 of 5 M. Ener Indoor Air Quality and Finishes ' 1,)9se howdl+io-lD d 1 IAQ/HE alth pts y=yes 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/HE alth pts y=yes 0 3.Use LOY^VOQ1 es 3 IAQ/HE alth pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resou ce pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/HE:alth pts y=yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Ht:alth pts y=yes 0 4IAQ/Hoalth. pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resou-ce pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resou ce pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/F-ealth pts y=yesl I0 1 1 1 N.Flooring _1.Select-FSC Certified-Wood-Flooring-------- - - -- 8 Resour;e-pts-- y=yes —-- — _0_____ - -- 2.Use Rapidly flariewable Flooring Materials 4 Resour.e pts y=yes 0 8.Use Recycled Content Ceramic Tiles 4 Resour;e pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/HE alth pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resour;e pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resour,.e pts y-yes 0 1 1 1 Total Points Available: 1 1401 130 57 Total Points Project Received: 01 O= G:data/progs/greenbuildingg sidelines/remodelerslgreenpointsfinal2.12.04protectedxls Lrj Permit AppItcationM � k Permit Information -mit Type" 1GENRES-RESIDENTIAL GENERAL BUILDING leOK Usage Class' 111111 B,-111111 B,IV-HT,V-B NE1+V -- Back Square ft _ 0 Applied Value" 800 Insert Row Calculated Value Delete Sgft Livable =0 Bedrooms Total Fees423.50 - _ _ _ k � Fees 3 Reviews 9 Inspections Contractors ------------- ! Fee ID Units Quantity Fee Amount 1 B CBS C VALUATION 800.00 1.00' 113SEISMICR VALUATION 800.00 0.50' j 1SIDE0THER SQ FEET 400.00 380.00 1MPERMITFE FLAT RATE 1.00 0.00' 1 PPERMITFE FLAT RATE 1.00 0.00 I ; _ 1TRAVD0C FLAT RATE 1.00, a j 3 i i VR,