09090030 CITY OF CUPERTINO BUILDING PERMIT
BUlt DING ADDRLss: 10238 CRESTON DR CONTRACTOR:FLAAGAN JOHN K PERMIT NO:09090030
AND YVONNE H
VN'LR'S NAME: F!•AAGAN JOHN K.AND YVONNE H 10238 CRESTON DR DATE ISSUED:09/04/2009
%_,WNLR'S PHONE: 4086919410 CUPERTINO CA, 95014-1014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH RESIDENT14Z COMMERCIAL
Contractor _ Date
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL 2 SKYLIGHTS NON-STRUCTURAL
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
I havo 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 won) for which this permit is issued. Sq.Ft Floor Area. Valuation:$4000
1 have and will mait.tain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labc:r Code,for the performance of the•:vork for which this APN Number:32637050.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have teal this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
cc.rrect. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representativ.s of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against!!abilities,judgments,
cysts :•.nd expenses vhirh may accrue against said City in consequence of the Q'9
Issued by: Date:
grantir.;of this permit. Additionally,the applicant understands and will comply
with all of
sout%�e regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Date _ All rocfs shall he inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all Jew materials for
inspection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
hereby affirm that I am exempt from the Contractor's License Law for one of
the fallowing two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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,
BUSO;Qss&Professions Code)
1,as owner of the property.am exclusively ecntracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec 7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should i store or handle hazardous
I hav, and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Comptmsation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Managtment District I
perfeanance of the voik for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I Lave and will mairtai..Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25r 3,and 25534, ?
Section 3700 of the La�or Code,for the performance of the••cork for which this
permit:s issued. Owner or authorized agent _Date:_
I c.r.:fy that in the performance of the work for which this permit is issued,1 Shall
not employ any person m any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the?':orker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of
forthv,'th comply with such provisions or this permit shall bi.deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
1 certify that 1 have read this application and state that the above information is
currc::t I agree to comp;y with all city and county ordinances and state laws relating
lc building construction and hereby authorize representatives of this city to enter
i Ole above mentioned propery for inspection purposes.:;We)agre€to save
.unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs.and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with ali non-point source regulations per the Cupertino Municipal Code,Section Licensed Professicrtal
9.18.
Signature s"� Date _�i
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32637050 . 00
DATE ISSUED. . . . . . . : 09/04/2009
RECEIPT #. . . . . . . . . BS000008614
REFERENCE ID # . . . : 09090030
SITE ADDRESS 10238 CRESTON DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER FLAAGAN JOHN K AND YVONNE H
ADDRESS 10238 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014
RECEIVED FROM . . . . : YVONNE FLAAGAN
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY FLAAGAN JOHN K AND YVONNE H
ADDRESS 10238 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 4, 000. 00 1 . 00 0. 00 1 . 00 0 . 00
1BSEISMICR VALUATION 4, 000 . 00 0 .50 0 . 00 0 .50 0 . 00
1SKYL<10SF EACH 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 me
---------------
TOTAL RECEIPT 381 .50
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
0qNW6
APN # 3--) Date: l _ LI — U C)
Building Address: i G Z `)2� C Z7 �S.'1`
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No
HOA: (Exterior work only) Yes ❑ No If es, rovide letter from HOA
Own 's Name: Phone#:
Contractor: Phone:
�_.�� Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
Residential Commercial E]
Job Description: _
Building Permit Info:
Bldg Q Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B R II/III/V-A ❑ IUIII B, IV-HT, V-B [�]� ,73
Valuation;; Square Footage:
'4OLell
�
Project Size: Express 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.org
Revised 07/14/09
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEkTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
PARTITION WALLS
1PARTICOMM Partition Interior Commercial B 1PARTICOMM
1PARTIR Partition Interior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1 RETSP 10 Special Design, over 10' high (up to B
50')
1RETCRB< Gravity/Crib Wall, 0-10'high(up to B
50 ft)
1RETCRB> - Gravity/Crib Wall over 10' high (up to B
50 ft)
SIDING
1 SIDEST/BK Siding, Stone & Brick Veneer B
(interior/exterior)
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st)
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CITY OF CUPERTINO
Cin OF GENERAL BUILDING APPLICATION
CUPEkTINO 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)
1 EPERMITFEE Electrical Permit Fee E
IMPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
I 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
1 TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
ITRAVDOC Travel & Documentation B
1BUSLIC Business License B
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