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10020012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7586 KIRWIN LN CONTRACTOR:UNITED CHIMNEY PERMIT NO: 10020012 '',ERVICE INC .^"VNER'S NAME: HALL ENIS E AND JOHN R ';79 EL CAMINO DATE ISSUED:02/01/2010 ° +THERTON,CA 94027 PHONE NO:(650)321-9125 NER'S PHONE: 6504834093 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL r Contractor Date JOB DESCRIPTION:REPLACE 2 WINDOWS(BEDROOM&BATHROOM)& I hereby affirm that I am licensed under the provisions of Chapter 9 REPAIR (commencing with Section 7000)of Division 3 of the Business&Professions CHIMNEY&REPLACE DAMPER ASSEMBLY 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 Valuation:$3000 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: permit is issued. APPLICANT CERTIFICATION APN Number:35922023.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED 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 granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued - Date: Sip-nature Date [� OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Date: Business&Professions Code) Signature of Applicant: 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 performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 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 I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I Owner r author zed a ent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relatin€ for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name ur--the above mentioned property for inspection purposes.(We)agree to save nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c�__,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. Signatu Date_1 I 0 Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35922023 . 00 DATE ISSUED. . . . . . . : 02/01/2010 RECEIPT #. . . . . . . . . BS000009664 REFERENCE ID # 10020012 SITE ADDRESS . . . . . : 75E6 KIRWIN LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HALL ENIS E AND JOHN R ADDRESS . . . . . . . . . . : 10E)7 DARTMOUTH LN CITY/STATE/ZIP . . . : LOS ALTOS, CA, CA 94024-5511 RECEIVED FROM • • . . JOHN R HALL CONTRACTOR . . . . . . . : DENISE SANCHEZ LIC # 22931 COMPANY UNCTED CHIMNEY SERVICE INC ADDRESS 57 ) EL CAMINO CITY/STATE/ZIP AT:3ERTON, CA 94027 TELEPHONE (650) 321-9125 FEE ID UNIT QUANTITY kMOUNT PD-TO-DT THIS REC NEW BAL ___ ---- - ---------- 1BCBSC VALUATION 3, 000 . 00 1. 00 0 .00 1. 00 0. 00 1BSEISMICR VALUATION 3, 000 . 00 0 .50 0 . 00 0 .50 0 . 00 lINSPCRT HOURS 1.00 253 . 00 0 .00 253 . 00 0 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1.00 1WINREP EACH 8 1.00 380 . 00 0 .00 380 . 00 0_00 ---------- ---------- ---------- ------ TOTAL PERMIT 676 .50 0 .00 676 . 50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------ -- ----------------- CREDIT CARD 676 .50 VISA --------------- TOTAL RECEIPT 676 .50 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: '12 ©2;z Name of owner Z�+ L� Project address. Contact person � Phone. lax. G SU—46 �ZS Z Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? N Is privacy protection planting required for the project? r1-Y�I�T Build it Green Total Points On what floor(s) is work being done? Brief description of work. PF201= � ffj;?6 e- 2�S l S l�v >G C�4 cwt *�� - Code editions:2007 CBC E)N)2007CFC 6(�N)2007 CMC (Y-N) 2007 CPC (Y-N)2007 NEC (Y-N) Effective rtr� �� .,F>tRi{ VFD IN ALCOROA* t .KITH I HE CITY OF CUPFRTINO C")DE AND ORDINANCES 3 rR DATA.-- St 3' This set o plat s and specifications MUST "ta be kept on tl^a lob at all times and it is y rtfE SFr unlawful to mak',any changes or alterations on same withe ut writter,permission from the Building De-)artrrmeni, C Ay of Cu rtmo. �AW The stamping o' this alar;and specikahons } SNAL L NOT b'held to permit or to be an approval of thf violaiion got any'pn:vistons of any City )rd1n,".'e 'r "t,ite t_aw. Plan Review Process Work Book Page-8-Revised 8/05.'08 O O N LO N � Q � � U � Q v l U:3 r M TL 3 cc s N t o o N N N O OCA M f6 m N I,.J ti D . ' N i 4—� ---►I d 2) o Q I� cu U oo 00 L 3v N tl o w CL M o � rn F . j 0 ' CITY OF CUPERTINO OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM _ Date: APN # Building Address: Fr ess (if different from building address): ous Materials being used as part ofthis project? Yes Norior work onl ) Yes ❑ No [✓] ;des, rovide letter from HOA Phone#: me: Cf Y o r� �,,, , Phone: Contractor: P�� �� �' Contractor License#: V1 Y .� 2—4 31 Cu ertino Business License#: phone: iS Contact: u� ! L Fax: C3 S :l S Residential Commercial 2-) Job Description: Building Permit Info: Bldg d" Elect ❑ Plumb ❑ pan cy T yp Mech ❑ occupancy Type of Construction(Usage Class): Ty 1-A, 1-B ❑ IUIII/V-A ❑ II/III B. IV-HT,N-B Q- Square Footage: Valuation: J Project Size: Express❑ Standard ❑ Larg�❑ Major ❑ Green Building: Please complete relevant portion of the Green Banlden g/LEED the sheet indeChecklxt& attach it to the application or if applicable,include m p Points Achieved: IFor help, contact Build it Green at www.buildit;Yreen.or Revised 07/14/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPE(�TINO FEE SCEIEDULE 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 F windows) IW s4ME MSTR New Window-structural shear B wall/masonry(includes plan ck fee) 1EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE =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-sl and alone 1BCBSC Cal Bldg; Standards Commission Fee B ALL EERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1 BUSLIC Business License B l ��hS�Cr i 5 of 5 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -,UPEkTINO Buildin De artment JOB ADDRESS: -75�� w.P W N ''-�`' PERMIT # OWNER'S NAME: PHONt # G -`-t S3 3 GENERAL CONTRACTOR: 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 P3 L�,(, C s Heating Insulation Landscaping Lathing Masonry v Vi';MCP c Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile - t t� caner/Contractor Signature Date �p SANITq� � f DISTRICT MANAGER-ENGINEEIR a� �r 9 BOARD ORS MARK THOMAS&COMPANY,INC. � RICHARD K.TANAKA WILLIAM A.1BOSWORTH JOHN M,GA 1`TO DISTRICT COUNSE i, � �o CUR'TIS B.HARRISON ATKINSON•FARASYN,LLP. l'4B1 A.4 HEO � WENDELL H.KKIRR,JR. HAROLD S.TOPPEL CHRISTOPHER C.LEE 20033 STEVENS CREE C BOULEVARD,SUITE 104 CUPERTINO,CAL FORNIA9501x.2154 V/ (408)2$3.7071 PHONE • (408)2ES-5173 FAX WWW.CUP ertinosanitarydistriet.Com February 8, 2010 Approved For Issuin ile: CSD —MOP Muil.ding Dept. —Cupertino City of Cupertino Building/ Plumbing Permits Attn: Building Department 10300 Torre Ave. Cupertino, CA 9501.4-3202 Subject: Residential. .A.ddition/Renvd.el —Misc. Submittal.No. 1./APPROVED Name: Hall Residence Address: 7586 Kirwin Lane, Cupertino APN: 359-22-023 Permit No.: 1.0020012 The Cupertino Sanitary District has reviewed,the plans for the subject project: a No additional conditions/requirenn.ents by the District. All conditions,requirements and recommendf.tions are to be completed at the (Owner./Developer)'s expense. Storm water from surface or roof drains, other gerleral surface runoff water or condensate from any residential HVAC equipment shall not be dis-,hanged to the sanitary sewer. You-rs very truly, MARK T140MAS & COMPANY, INC. District Manager-Eri.gineer for Richard K. Tanaka If you have any questions or need additional inFormation, please call Ch en Vu at 405-253- 7071.. S;1Wc_:'>l:l)ti1C'11_571)SURCc"iI'wrn I.,1�1_llSluf.dh)(NC7I�I:if'f' 'lul'I,RS1Rl SfUFiN'I'1'�I,Ai,>I)1"!I)NIS 21i1\401:)Fi1.,lAddiliois 2010\1002lNi12 R sideni4ifAddn1tcnindclI - - , oc - SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND SURROUNDING UNINCC RPORATED AREAS