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10040171 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11607 CEDAR SPRING CT CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10040171 DATE ISSUED:04/29/2010 OWNER'S NAME: ALEX LYZSHEVSKY PHONE NO: 1ER'S PHONE: 4082651594 � ❑ LICENSED CONTRACTOR'S DECLARATION gUILDING PERMIT INFO: BLDG� ELECT� PLUMB� License Class Lic.# ��Z �v MECH� RESIDENTIAL� COMMERCIAL� �l� ��°�� ' �� 2��/�� Contractor T 2 '�" �'�f' Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD AIR CONDITIONING (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 hvo 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.Ft Floor Area: Valuation:$4200 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,far the performance of the work for which this APN Number:36654067.00 Occupancy Type: permit is issued. 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 pE�IT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilit�es,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply _ with all non-point source re latiof�s per the Cupertino Municipal Code,Section Issued b�� Date:� 2�—�10 9.18. � / f��__ ��/ `�� S ignature Date � �' RE-ROOFS: OWNER-BUILDER DECLARATION All roofs 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the propeRy,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the fol►owing three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's Califbrnia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by 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 contaminants as def►ned by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety��os}¢,Sections 25505,25533,and 25534. 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 Owner or a ' d agent: �1� ��lG�' Compensation laws of Califomia. If,after making this certificate of exemption,I Date: � become subject to the Worker's Compensation provisions of the Labor Code,I must G� forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address uqon[he above mentioned property for inspection purposes.(We)agree to save nnify and keep harmless[he City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION .,,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulyitions per the Cupertino Municipal Code,Section 9.18. (�. r Licensed Professional l'---�'��/ ,y;'�'� Date �� GD Signature � � CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36654067 . 00 DATE ISSUED. . . . . . . : 04/29/2010 RECEIPT #• • • • • • • • • � BS000010286 REFERENCE ID # . . . : 10040171 SITE ADDRESS . . . . . : 11607 CEDAR SPRING CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ALEX LYZSHEVSKY ADDRESS . . . . . . . . . . : 11607 CEDAR SPRING CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5139 RECEIUED FROM . . . . : AIR & PLUMBING SYST CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ----- 1BCBSC VALUATION 4, 200 .00 1. 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 4, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 lEPERMITFE FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1MRRAA UNITS 1 . 00 63 . 00 0 .00 63 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 190 . 50 0 . 00 190 . 50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL � ��L>�-{ �� 1 � I CITY OF CUPERTINO FURNACE/AC CUPEI�TINO PERMIT APPLICATION FORM APN # Date: 1�(.Q ��7 6U v�/z v/�a Building Address: /��0 � �-� �� S��.; �.. c� � - Owner's Name: � �� Phone#: � /�S � �' /.f'�, O��--� ��-�'-� � =>.. l� Contractor: � R _ Phone#: �j��y j 3� .- 2 �t;�f� � c �i � �� w�� ^ � �4 �'�"� S / ) �S `) � C��+' �� '�2 � �v Fax#: ( �' / � T Contractor License#: `��'o � � � � Cupertino Business License#: Contact: �� Phone#: Sr�% e'� � D Fax #: Building Permit Info: Elect� Plumb ❑ Mech � Residential Commercial ❑ Job Description: � r . � � C�p,v�� „� � For Residential Installations: Attic ❑ 1 S` floor 2°d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight(structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): �lZ�(� _ . Strapped ❑ On Platform Bonded New Location ❑ Replacement - Project Size: Express �tandard ❑ Large ❑ Major❑ Valuation: �(Z �� Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set& the sheet index. Revised O1/07/09 CITY OF CUPERTINO ' '� �� FURNACE/AC CUPE(�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou 1 MRAPPVNT Residential for the install/relocate/or M replacement of ea appliance vent install & not incl in an appl permit. FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outlet. C 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismic B 1 MECPLNCK Mechanical Plan Check M � � � 1MFR=<100 Furnace Syst<=100k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1 MFRN>100 Furnace Syst> l 00k BTU install or M relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h � 1 EPERMITFEE Electric Permit Fee E r 1 MPERMITFEE Mechanical Permit Fee N1 - 1PPERMITFEE Plumbing Permit P r 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B /� - � M.Indoor Air uality and Fin�shes 1.Use Low�o-V�Pait� 1 IAQIHealth pts y=yes 0 2.Use Low VOC,Water-Based Wo�d Finishes 2 IAQ/Health pts y=yes 0 3.Use Lowl�io VOC AdF�esives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials f�r Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Piywood for lnterior Uses 1 IAQ/Health pts y=yes 0 7.Seal all E�Pe�tide�Caard or AIIDtF 4 IAQ/Health pts y=yes � 8.Use FSC Certified Materials for Interi�r Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y—yes 0 10.Install 1Nhole House Vacuum System 3 IAQ/Health pts y=yes 0 1 1 ! N.Ffooring 1.5elect FSC Certified Wood Flooring 8 Resource pts y=yes 0 2.Use Rapi�y Renewabls Flooring Materials 4 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 1 1 ! Total Points Available: 140 130 57 Total Points Pro'ect Received: ; 0 0 �--� Y- - � `�'l-Z��o G:data/progs/graenbuildingguidelines/remodelers/greenpoinlsfina12.12.04protected.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUB ONTRACTOR LIST JOB ADDRESS: ��j?J fi PERMIT# f�>� ^� � OWNER'S NAME: ,�� PHONE# `" GENERAL CONTRACTOR: /Z Gx't''<' � � BUSINESS LICENSE# ADDRESS: 5 �J'�6�---�-c (/t� �'`' " � CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCSUBCON Y I CTORS IHAVE OBTAINED AHCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL 7 BUSINESS LICENSE. / �Y�� I am not using any subcontractors: "` Date f Signature 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