10030032 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10286 VIRGINIA SWAN PL CONTRACTOR:BENCHMARK GENERAL PERMIT NO: 10030032
BUILDING
"vNER'S NAME: DOLORES MARIK&HARRY MUTTART 1463 MARTIN AVE DATE ISSUED:03/04/2010
.,,,NER'S PHONE: 4082578956
SAN JOSE,CA 95126 PHONE NO:(408)294-7775
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB
License Class Lic.#q 4a C MECH f— RESIDENTIAL r— COMMERCIAL r
Contractor_ t44 JZV Date 1bFe d
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION:NEW ELECTRICAL;OUTLETS,11;SWITCHES-21;LIGHTS 25
(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.Ft Floor Area: Valuation:$5000
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 anc Type:
occupancy
permit is issued. APN Number:31646004.00 P Y YP
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,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 lo
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date:l—— /G1`
9.18.
--- OIO
SirtnatureL2 Date 03
r
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:
1,as owner of the property,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
1,as owner of the property,am exclusively contracting with licensed contractors to
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 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 California 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
contaminants as defined by the Bay Area Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,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 autho iz
Compensation laws of California. If,after making this certificate of exemption,I Date: U 3 O
become subject to the Worker's Compensation provisions of the Labor Code,I must
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
the above mentioned property for inspection purposes.(We)agree to save
mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
MAS,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 regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature o Dated d� «
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31646004 . 00
DATE ISSUED. . . . . . . : 03/04/2010
RECEIPT #. . . . . . . . . BS000009875
REFERENCE ID # 10030032
SITE ADDRESS 10286 VIRGINIA SWAN PL
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DOLORES MARIK & HARRY MUTTART
ADDRESS 10286 VIRGINIA SWAN PL
CITY/STATE/ZIP CUPERTINO CA, CA 95014-2025
RECEIVED FROM WM AARON VAN ROO
CONTRACTOR AARON VAN ROO LIC # 31562
COMPANY BENCHMARK GENERAL BUILDING
ADDRESS . . . . . . . . . . : 1463 MARTIN AVE
CITY/STATE/ZIP SAN JOSE, CA 95126
TELEPHONE (408) 294-7775
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ----------
---------- ---
1BCBSC VALUATION 5, 000 .00 1 . 00 0 .00 1 . 00 0•
1BREMFIXT NO. FIXTURES 25 .00 78 . 00 0 .00 78 . 00 0. 00
1BREMRECEP NO. OUTLETS 32 .00 66 . 00 0 .00 66 . 00 0 . 00
1BSEISMICR VALUATION 5, 000 .00 0 . 50 0 .00 0 . 50 0 . 00
1EPERMITFE 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
---------- ---------- ---------- --
TOTAL PERMIT 229 . 50 0 . 00 229 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-----------------
--------------- - ------
CREDIT CARD 229 . 50 MC
---------------
TOTAL RECEIPT 229 . 50
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner. � � Vit nv�
Project address. 107_2�0 � t h V 0z
Contact person. A ayyy\ V wn E09 Phone. (.-Itr6�) 'H� —
Fax. C'40i 124-4
Net square footage of lot. iJ A-
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the ga N
Is privacy protection planting required for the_pr ' 9 Y
t
Build it Green Total Points ~
On what floor(s) is work being done?
Brie description of work.
Code edition •420P(QTP-
-N 2007 CF (Y -1)2007 CMC (Y-N)
AP N)2007 NEC (Y -N)
-- - -T l+ 2 ZDb
L4
Effective 1/1/08 e7NA�6 `� ST
APPRwE-n
IN ACCOROANt:L WI1H THE CITY OF
CUPERTINO CODLS ANL ORDINANCES
DATE
This set of plans and specifications MUST
be kept on the lob at tii times and it is
unlawful to make any changes or alterations
on same without wntten permission from
the Building De panin )t. City of Cupertino.
The stamping of�trn,,t;i.u,and specifications
SHALL NOT be to permit or to be an -
approval of the oolafi-,of ar-,y i,rovrs,ons
30 of any City titate,t_aw
SA
Plan Review Process Work Book Page-8-Revised 8/05/08
iy:. y,. a r: ♦tee x,: v- rt ` s'as >.-_'"4 I `.?'i' s, ! .: 'ry � :_ K✓
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4.r,r�.n.,-x' >w Ffrk�" f< i. � *"! L..a �,:,s7..} b 1 qq
trr ,e^ +#�P ",c. `..an"n4 .a �`15�Fil
Bedroom(s) YES N/A NO
All light fixtures are high efficacy. ❑ ❑
Incandescent fixtures are switched with manual-on/automatic-off occupancy
sensors OR dimmer switch. ® ❑ ❑
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
ASTM E283 or equivalent. Installation is airtight(caulking, gaskets). ® ❑ ❑
High-efficacy and low-efficacy fixtures are switched separately. ❑ ® ❑
R1 Living Room / Dining Room YES N/A NO
All light fixtures are high efficacy. ❑ ❑
Incandescent fixtures are switched with manual-on/automatic-off occupancy
sensors OR dimmer switch. ® ❑ ❑
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
ASTM E283 or equivalent. Installation is airtight(caulking, gaskets). ® ❑ ❑
High-efficacy and low-efficacy fixtures are switched separately. ❑ ® ❑
Hallway(s) YES N/A NO
All light fixtures are high efficacy. ❑ ❑
Incandescent fixtures are switched with manual-on/automatic-off occupancy
sensors OR dimmer switch. ® ❑ ❑
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
ASTM E283 or equivalent. Installation is airtight(caulking, gaskets). ® ❑ ❑
High-efficacy and low-efficacy fixtures are switched separately. ❑ ® ❑
Gd Entry Area / Foyer YES N/A NO
All light fixtures are high efficacy. ❑ ® ❑
Incandescent fixtures are switched with manual-on/automatic-off occupancy
sensors OR dimmer switch. ❑ ® ❑ r-
(o
Recessed fixtures installed in insulated ceilings are rated ICAT and certified
ASTM E283 or equivalent. Installation is airtight(caulking, gaskets). ❑ ® ❑
High-efficacy and low-efficacy fixtures are switched separately. ❑ ® ❑ o
LA.
LO
Ed Outdoor. Space(s) YES N/A NO
All light fixtures are high efficacy. CL
Q Q
Incandescent fixtures are controlled by motion sensor with a manual-on/off switch
r�
AND photocontrol.
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CITY OF CUPERTINO
CITY Of
CUPEI,TINO GENERAL BUILDING
PERMIT APPLICATION FORM
noDate:
+ �
Building Address:
("(1 �, , 't 1`l IG i C
Mailing Address cif different from building addres ):
Are Hazardous Materials being used as part of this project? Yes No
HOA: Exterior work only) Yes ❑ No El/ If yes, provide letter from HOA
Owner's Nam Phone#:
Contractor: Phone: (�{(A,) _ _7 -1_S7-
1 Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone: ( ) L� _ -`l (c
�k�.;
L'Y1 1TA �'f Fax: C� G
Residential Commercial
Job Description: ,-) I
771
Via _7S
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
V luation: Square Footage:
Project Size: Express E2/ Standard ❑ 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.buflditgreen.org
Revised 07/14/09
slttu� CITY OF CUPERTINO
CITY of GENERAL BUILDING APPLICATION
CUPEI�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)
I WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
r
I MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
I PLMBLNCK 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
IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
IBSEISMICR Seismic Residential B'
IBSEISMICO Seismic Commercial B
t 1 TRAVD0C Travel &Documentation B
1 1BUSLIC Business License B
2�-tom'Z-E-C_ 5 of 5