10020115 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10286 VIRGINIA SWAN PL (ONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10020115
OWNER'S NAME: DOLORES MARIK&HARRY MUTTART DATE ISSUED:02/22/2010
ER'S PHONE: 4082578956 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATIONr
t,� _ ItUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# 7S� ��
��► MECH r r
RESIDENTIAL COMMERCIAL r
Contractor > r11.0
_Gftkl,) � Date
I hereby affirm that I am licensed under the provisions of Chapter 9 OB DESCRIPTION:REPLACE ELECTRICL PANEL,UPGRADE SUB-PANEL
(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. q,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
permit is issued. E.PN Number:31646004.00 Occupancy Type:
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
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 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
with all non-point source regulations per the Cupertino Municipal Code,Section Issued b �- Date:
9.18. Y
Signature Date—7,,/2aj Lb
IV
RE-ROOFS:
L OWNER-BUILDER DECLARATION 01 roofs shall be inspected prior to any roofing material being installed.If a roof is
i nstalled 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)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: 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. :;afety 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 !ontaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. naintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
p health&Safety Code,Sections 25505,25533,and 25534.
1 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 13 a ithorized gent:
Compensation laws of California. If,after making this certificate of exemption,I A. Date:V�j 14)
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
hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION or 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
upon the above mentioned property for inspection purposes.(We)agree to save
ind -minify and keep harmless the City of Cupertino against liabilities,judgments,
c nd expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
gru...mg of this permit.Additionally,the applicant understands and will comply 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 Date 7-12"
CITY OF <'UPERTINO
OPERATOR: patg
PERMIT RECEIPT COPY # 1
6 ITEMS OF 6
: Rng: Sub: Blk : Lot:
Twp: ; 31(46004 .00
APN . . . . .
02,122/2010
DATE ISSUED. • • ; BS )00009792
RECEIPT # • • • • . . 1OJ20115
REFERENCE ID #
SITE ADDRESS 1C286 VIRGINIA SWAN PL
SUBDIVISION CZJPERTINO
CITY . . . . . . . . . . . .
IMPACT AREA • .
DDLORES MAR
& HARRY MUTTART
OWNER • • • • • . " 10286 VIRGINIA SWAN PL
ADDRESS CUPERTINO CA, CA 95014-2025
CITY/STATE/ZIP
E,ENCHMARKLIC # 00096
RECEIVED FROM l,BD - TO BE DETERMINED
CONTRACTOR • • • • ` 17BD _ TO BE DETERMINED
COMPANY . . . . . .
ADDRESS . . . . . . . . . "
CITY/STATE/ZIP
TELEPHONE • • • "
THIS REC NEW BAL
AMOUNT PD-TO-DT ----- ----------
FEE ID UNIT QUANTITY ---------- ---------- ----- 1 .00 0 .00
--------- - 1. 00 0 .00 050 0 . 00
---------- .
5, 000 .01 0 .00 0 .00
1BCBSC VALUATION 0 . 50
000 .0') 0 .00 114 .00
1BSEISMICR VALUATION 150 � 114 .00 42 .00 0 . 00
FLAT RATE 42 . 00 0 .00 0 . 00
1BUSLIC 1.0) 0 .00 84 .00 0 , 00
1EPERMITFE FLAT RATE 2 .00 84 .00 0 .00 42 .00 --
JERT<200 UNITS 1 .00 42 .00 -------- ---------- ------0 .
00
1TRAVDOC FLAT RATE ---------- 0 .00 283 .50 0 .
283 .50
TOTAL PERMIT
AMOUNT REFERENCE NUMBER
----------------- 283 . 50 #METHOD OF PAYMENT ---________- --- 7539
CHECK -_-_____---- ---
283 . 50
TOTAL RECEIPT :
CITY OF C,UPERTINO
CUPEkTINO GENERAL, BUILDING
PERMIT APPLICATION FORM
APN # Date:
B uilding dress:
Mailing Address (iftdifferent from building addre s):
Are Hazardous Materials being used as part of this project? Yes No
HOA: (Exterior work only) Yes ❑ No If,res, provide letter from HOA
Own is Name: Phone#:
�Z r
Contractor• Phone: (-4' 05 ?"119'
Fax:
Co ractor License#:,�c`O �5
Cupertino Business License#:
Co act: .Phone: (Q pg) b� 1--J-1�
y Fax: q
Residential V Commercial
Job Description:
Building Permit Info:
Bldg ❑ Elect :dumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-Ft ❑ 12*;,Stl2f�1alal-e S
Valuatio Square Footage:
Project Size: Express R( 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.builditgreen.or
Revised 07/14/09
CITY OF (:UPERTINO
CUCITY
TYOF 0 GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacemont windows/sliding glass B
door (ea � windows)
1 WINMEWSTR New Winslow-structural shear B
wall/masonry (includes plan ck fee)
I EPERMITFEE Electrical Permit Fee E
I MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alo;ie Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Flan Check (when no E/M/P) B
when not over counter) hourly-staid alone
' 1BCBSC Cal Bldg standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic R-,sidential B
IBSEISMICO Seismic C)mmercial B
1 TRAVDOC Travel & Documentation B
1BUSLIC Business License B
5 of 5
M.Indoor Air Quality and-Finishes;
1.Use Low/No-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 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 p
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal as Exposed Pariiolebatard or MDF 4 IAQ/Health. pts y=yes 0
B.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 Id 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
Total Points Available: 1 1401- 1301 57
Total Points Project Received: &A 0 0 0
G:datalprogslgr!enbuildingguidelines/ramodelersigreenpointsfinal2.12.D4protected.xls
Community Development
{ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
L OZ4S1P V 1 Y i n ra &wan ( a
OWNER'S NAME. PHONE # ( D , +1 -I-1
GENERAL CONTRACTOR r FAX# p� -
I am not using any subcontractors:
Si mature Date
Please check applicable subcontractors and corn Dlete 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
Tile
Owner/Contractor Signature Date