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09090154CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21836 HYANNISPORT DR CONTRACTOR: THE SCREEN SHOP PERMIT NO: 09090154 OWNER'S NAME: GLENDAY DAVID AND MARGARETL T 601 HAMLINE ST DATE ISSUED: 09/22/2009 ER'S PHONE: 4082528969 SAN JOSE, CA 95110 PHONE NO: (408)295-7384 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— � License Class Lic. # (J ELECT PLUMB MECH RESIDENTIAL COMMERCIAL Contractor Date �d I hereby affirm tilt 1 an ense nde the provisions o hapter 9 JOB DESCRIPTION: REPLACEMENT OF 5 (commencing with Section 7000) of Division 3 of the Business & Professions WINDOWS;CONTRACTOR(THE SCREEN Code and that my license is in full force and effect. SHOP)RENEWD BUS LIC 9/22/9 1 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: $5830 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35614063.00 _ Occupancy Type: APPLICANT CERTIFICATION 1 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 [oo 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 acc c against said City in consequence of the granting of this pe t. Additi ally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -poi so rce re ations r the Cupertino Municipal Code, Section 9.18. ,.�- Issued b ' ----"-,----- Date: fid Signature _ _ Date_�o / G OWNE -B ILDER DECLARATION RE -ROOFS: 1 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, Signature of Applicant: Date: Business & Professions Code) I, 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 1 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. 1 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 de£ d by the Bay Area Air Quality Management District I will 1 certify that in the performance of the work for which this permit is issued, I shall maintain complia a 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 ode, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must Ow er or h Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that 1 have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.) correct. 1 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 upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address i nify and keep harmless the City of Cupertino against liabilities, judgments, 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. Signature Date Licensed Professional CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35614063.00 DATE ISSUED.......: 09/22/2009 RECEIPT #.........: BS000008735 REFERENCE ID # ...: 09090154 SITE ADDRESS .....: 21836 HYANNISPORT DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER GLENDAY DAVID AND MARGARET L T ADDRESS 21836 HYANNISPORT DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4014 RECEIVED FROM ....: JOSEPH J SALAMIDA CONTRACTOR THE SCREEN SHOP LIC # 25459 COMPANY THE SCREEN SHOP ADDRESS 601 HAMLINE ST CITY/STATE/ZIP ...: SAN JOSE, CA 95110 TELEPHONE (408)295-7384 FEE ID ---------- UNIT ------------- QUANTITY ---------- AMOUNT PD -TO -DT THIS REC NEW BAL 1BCBSC VALUATION 5,830.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 5,830.00 0.60 0.00 0.60 0.00 1BUSLIC FLAT RATE 1.00 114.00 0.00 114.00 0.00 1WINREP EACH 8 1.00 380.00 0.00 380.00 0.00 TOTAL PERMIT ---------- 495.60 ---------- 0.00 ---------- 495.60 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 495.60 --------------- 495.60 REFERENCE NUMBER -------------------- MC )/09/2009 07:30 FAX 6509039299 HALO OPERATIONS Dj I Y�- N Ned CVM(, �-v nn.-.c,� Margaret Glenday 21836 Hyannisport Drive Cupertino CA 95014 I ( Ve rR (rV�e el�e)ry ss 2ov7 � c�G y( y� Bedroom Bedroom Living Room Paint for outside walls is Kelly Moore Frost flat . Laundry 16002 Kitchen - Family Room Dining Room Garage APPROVED IN ACCORDANCE WITH THE CITY OF CUPERTINO CODES AND ORDINANCES DATELi 0 O SIG . Jbis set of plans a .. MUST �� be kept on the lot' at all ties and it is unlawful to make any change or alterations on same without written permission from the Building Department. City' fno. - Mas ter t r of this plan, ands ions --- L141R. held if permit or n aster approval of the vrol,,tion of a )y F ath of any City ur ' lqt-, I aw y( y� Bedroom Bedroom Living Room Paint for outside walls is Kelly Moore Frost flat . Laundry 16002 Kitchen - Family Room Dining Room Garage 1/09/2009 07:30 FAX 6509039299 HALO OPERATIONS Margaret Glenday 21836 Hyannisport Drive Cupertino CA 95014 I ( Ve r� lrV`e e5�✓� ss 2c>57 C 43�. Master Bedroom as ath Bedroom Laundry Bath Bedroom Living Room Paint for outside walls is Kelly Moore Frost flat Kitchen - Fami: Q 002 Dining Al. ro +°fir Room .Garage CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # �J-J/'1 Oma' �l Date: Building Address: -VQfJ LfL U 2(-ir70 L7. d l Y Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes El No HOA: Exterior work only) Yes ❑ No If yes, provide letter from HOA Owne Name: Phone #: G oc ,e w! 2S(�w Contractor ' �c Phone: s o Fax: qO 2 r Zy 3a Contractor License #: 6k, ?)Ig ©V Cupertino Business License #: Contact: E4tOIV14%Fax: Phone: S - ResidentialCommercial El Job Description: 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 Eg-- V, -- Valuation: Square Footage: Project Size: Express ED--' 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 r4�C 3 st� CITY OF CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B / 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE 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 when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 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 1' Use LD °-� �''� 1 IAQ/Health pts y=yes 2. Use Low VOC, Water -Based Wood Finishes ' 2 IAQ/Health pts y=yes 3. Use Lowft VOC Adwom 3 IAQ/Health pts y=yes 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 5. Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Se Ola gMWiAXj"Nj AVF 41AQ/Health pts y=yes 8. Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 Resource pts y=yes 10. Install Whole House Vacuum System 3 IAQ/Health pts y=yes N. Flooring 1. Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 2. Use f3apicly Renewable FFloorin 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 p 1 1 1 Total Points Available: 1 1401_1301—_57 Total Points Project Received: 01 0 0 G:data/progs/greenbuildingguidelines/remodelers/greenpointsfina12.12.D4protected.xis JOB ADD Bui Vin De art KESS: meet Yo m< < o f 4 N4 ,,,s PERMIT # OWNER'S NAME: G c• (C��� GENERAL CONTRACT R: 0 PHONE # Yo K )-ef s FAX # yGv I am not using any subcontractors: Please check a Dlicable subcontractors and c1 Ie the follow' SUB CONTRACTORI BUSINESS NAME— Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Linoleum / Wood Glass / Glazing Heating Insulation Landscanin� Masonry Ornamental Sheet Metal Pting / Wallpaper Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature 2 ��d information: Date BUSINES�LIC`EN§­E# Date Community Development 10300 Torre Avenue CJTY OF .: UPEkTINO Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 JOB ADD Bui Vin De art KESS: meet Yo m< < o f 4 N4 ,,,s PERMIT # OWNER'S NAME: G c• (C��� GENERAL CONTRACT R: 0 PHONE # Yo K )-ef s FAX # yGv I am not using any subcontractors: Please check a Dlicable subcontractors and c1 Ie the follow' SUB CONTRACTORI BUSINESS NAME— Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Linoleum / Wood Glass / Glazing Heating Insulation Landscanin� Masonry Ornamental Sheet Metal Pting / Wallpaper Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature 2 ��d information: Date BUSINES�LIC`EN§­E# Date