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10040083 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7546 DE FOE DR CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10040083 OWNER'S NAME: HAKIM M AND RASHIDA H MESIWALA DATE ISSUED:04/13/2010 PHONE NO: :,R'S PHONE: 4088368028 ❑ LICENSED CONTRACTOR'S DECCLLA�RATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB License Class 1/ / Lic.# X77-1 MECH F_ RESIDENTIAL r- COMMERCIAL Contractor K e I (7 PO Date /3 O I hereby affirm that I am licensed under the provisions of Chapter 9 TOB DESCRIPTION:KITCHEN REMODEL,REPLACE CABINET&COUNTER TOP, (commencing with Section 7000)of Division 3 of the Business&Professions SINK;NO ELECTRICAL,NO LIGHT FIXTURES,NO Code and that my license is in full force and effect. MECHANICAL.REPLACE 2 WINDOWS,I IN KITCHEN&I IN 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 this Valuation:$6000 permit is issued. Sq.Ft Floor Area: APPLICANT CERTIFICATION ane Occu Type: I certify that I have read this application and state that the above information is APN Number:35924028.00 Occupancy YP 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Date: Y,X1�' Signature Date Issued by: ; Cj OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: I,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 declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Healt Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or aut r' nt: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby a correct.I agree to comply with all city and county ordinances and state laws relating affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name nify 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 granting of this permit.Additionally,the applicant understands and will comply with allnon- ur egulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signatu Date 3 Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35924028 . 00 DATE ISSUED. . . . . . . : 04/13/2010 RECEIPT #. . . . . . . . . BS000010172 REFERENCE ID # 10040083 SITE ADDRESS 7546 DE FOE DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER HAKIM M AND RASHIDA H MESIWALA ADDRESS 7546 DE FOE DR CITY/STATE/ZIP CUPERTINO CA, CA 95014-4307 RECEIVED FROM KEN GEE 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 ---------- ------------- ---------- ---------- ---------- - 00 1BCBSC VALUATION 6, 000 . 00 1. 00 0 .00 1 . 00 0 • 1BPFIXTURE NO OF FIXTURE 1 . 00 8 . 00 0 . 00 8 . 00 0 . 00 1BSEISMICR VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 1WINREP EACH 8 1 . 00 380 . 00 0 .00 380 . 00 0 . 00 ---------- ---------- ---------- --- TOTAL PERMIT 473 . 60 0 .00 473 . 60 0 . 00 To whom it may concern: A,� My name is °"�R k i I V` f Wet IQ property owner at De ro e �✓ �' _�VI vCA -TY-0fd I authorize Ken Gee construction and his agent to obtain all permits for my kitchen remodel project. Sincerely Property owner April 12, 2010 ��4 ! r ;f CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM Date.ate:�C •� 3 Building Address: Mailing Address (if different from bui ding address): Are Hazardous Materials being used as part of this project? Yes LJ No HOA: (Exterior work only) Yes rovide letter from HOA Owner's Name: Phone#: M..I*RZ&A, -- Contractor: nFax: one: Contractor License#: o�� Cupertino Business License#: Contact: Phone: Fax: Residential Commercial Job Description: . W�noCdKl Building Permit Info: BI d Elect ❑ Plumb Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-13 ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B ©� V ti n: Square Footage: Project Size: Express ©/Standard ❑ Large ❑ Ma'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.buflditgreen.org Revised 07/14/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEt�TiNO 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 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M / 1 PPERMITFEE 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 alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B / 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B fs'pt=zX r vrz 5 of 5 n oor rr ualdy an rots es 1.wiLewwwe P--&t 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Loyd"VOGA&ASWes 3 IAQ/Health 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/Health pts y=yes 0 6.Use Exterior Grade Plywood for Intertor Uses 1 IAQ/Health pts y=yes 0 IADF.. 4IAQ/Health. 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 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes I 1 0 i i 1 N.Flooring _1.Select-FSC Certified Wood Flooring---- ----.--- -- --- 8-Resource-pts - y=yes -- -- -- -0 -- — — - 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 13.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 1WEI Total Points Available: 1401 130 57 Total Points Project Received: 0 01 - 0 G:data/progs/greenbuildingguidelines/remodelars/greenpointsfinal2.12.04protected.xls Community Development 10300 Torre Avenue z Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 :UPEkTINO Buildin De artment JO ADDRESS: PERMIT # < OWNER'S NAME: PHONE # �3 -- GENERAL CONTRA OR FAX # I am not using any subcontractors: Signature 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock er/Contractor Signature Date