10030079 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20888 GREENLEAF DR CONTRACTOR:SEARS HOME PERMIT NO: 10030079
IMPROVEMENT
-`NER'S NAME: YVONNE LA FEVRE 1024 FLORIDA CENTRAL PKWY DATE ISSUED:03/15/2010
u,,NER'S PHONE: 4089739517 LONGWOOD,FL 32750 PHONE NO:(925)245-2000
0 LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB F
License Class 3,C6 C20 Lic.# 7 Z ( ') "/ F f— r-
11
,G i I MECH RESIDENTIAL COMMERCIAL
Contractor Date 1 /0
I hereby afli"withSctio�_n
'at
the provisions of Chapter 9 JOB DESCRIPTION:INSTALLATION OF ONE RETRO FIT VINYL WINDOW IN
(commencin 7000)lbrDivision 3 of the Business&Professions KITCHEN,IN KIND,NO NEW CONSTRUCTION
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 Floor Area: Valuation:$1500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:32630168.00 Occupancy Type:
I certify that 1 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 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-
poin ource regulations per the Cupertino Municipal Code,Section
9.18. Issued by:- Date:�
Si"nature ate 1 /U
ER-BUILDER DECLARATION RE-ROOFS:
All roofs 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:
inspection.
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, Signature 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
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 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 Safety 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
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
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 Health&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 Own or auth i a 1
become subject to the Worker's Compensation provisions of the Labor Code,I must Date.._3 S//0
forthwith comply with such provisions or this permit shall be deemed revoked. 611�11 -
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby 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 Lender's Name
to building construction,and hereby authorize representatives of this city to enter
w -the above mentioned property for inspection purposes.(We)agree to save Lender's Address
nify and keep harmless the City of Cupertino against liabilities,judgments,
cL„,s,and expenses which may accrue against said City in consequence of the
granting 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 I understand my plans shall be used as public records.
9.18.
3 � s//� Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32630168 . 00
DATE ISSUED. . . . . . . : 03/15/2010
RECEIPT # . . . . . . . . . : BS000009933
REFERENCE ID # . . . : 10030079
SITE ADDRESS . . . . . : 20888 GREENLEAF DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER YVONNE LA FEVRE
ADDRESS 20888 GREENLEAF DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JEFF RAINEY
CONTRACTOR . . . . . . . : ALFRED W NYMAN JR - ASST SEC LIC # 23097
COMPANY SEARS HOME IMPROVEMENT
ADDRESS 1024 FLORIDA CENTRAL PKWY
CITY/STATE/ZIP . . . : LONGWOOD, FL 32750
TELEPHONE (925) 245-2000
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 1, 500 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 1, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1WINREP EACH 8 1 . 00 380 . 00 0 . 00 380 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 381 . 50 0 . 00 381 . 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 381.50 VISA
---------------
TOTAL RECEIPT 381 .50
CITY OF
Is CITY OF CUPERTINO
GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Iv
Building Address: 20888 Greenleaf Drive
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No 0
HOA: Exterior work only) Yes ❑ No If yes,provide letter from HOA
Owner's Name: Yvonne LaFever Phone#: 408 973-9517
Contractor: Phone: (916) 830-3423
SEARS HOME IMPROVEMENT PRODUCTS, INC. Fax: (407) 551-3085
Contractor License#: 721379
Cupertino Business License#:
Contact: LIZ & BRENT Phone: 916-830-3423
Fax: (407) 551-3085
Residentialx❑ Commercial ❑
Job Description: INSTALLATION OF ONE RETRO FIT VINYL WINDOW In Kitchen.
In kind. No new construction.
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 L. -f( —7
Valuation: $1,500.00 Square Footage:
Project Size: Ex ress ❑ Standard x❑ 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.builditi!reen.org
Revised 07/14/09
'; CITY OF CUPERTINO
Cin OF GENERAL BUILDING APPLICATION
CUPEf�T1N0
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)
1WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
l EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK 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
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 of 5
. n oor tr ua tty an rrns es _____
1.Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y--yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 XVI-lealth pts y=yes
7.Seal al Wised Pardoleboard or MDF 4 IAQ/Health. pts y=yes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes D
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2 Use Rapidly Renewable 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 1
Total PointMailablel 1 1 401 1301 57
Total Points Project Received: 01 0 0
G:datalprogs/greenbuildingguidelines/remodelers/greenpointsfina121204prDleoted.xis
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�,UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
2-0'M 6 �,�L�. 1 , , ciZ �o Sd l v -7 1-11
OWNER'S NAME: �-Uc xlAlE i, �� PHONE # q0 ZZ 3 9.'5 t 7
GENERAL CONTRACTOR:fq 5 I-��nNo- / - yr r-,�-, FAX # 10 7 SS - 3 e
I am not using any subcontractors:
Signa a Date
Please check applicable subcontracs com lete the followinginformation:
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
Tile
/Contractorature Date