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09090134CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6199 SHADYGROVE DR CONTRACTOR: SMITH ELECTRIC INC PERMIT NO: 09090134 OWNER'S NAME: BRAINARD LORETTA L AND ROBERT 15732 LOS GATOS BLVD DATE ISSUED: 09/17/2009 NER'S PHONE: 4082527944 LOS GATOS, CA 95032-2504 PHONE NO: (408) 835-2122 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class `' Lic. # 2 -,:a MECH f- RESIDENTIAL f- COMMERCIAL y99 1 ��l c r:l q ( ` Contractor {� 11� .Q 1(� _Date JOB DESCRIPTION: REPLACE MAIN ELECTRICAL SERVICE WITH I hereby affirm that I am licensed under the provisions of Chapter 9 200AMP 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. Sq. Ft Floor Area: Valuation: $1000 1 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 APN Number: 37540018.00 Occupancy Type: permit is issued. 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 Date: with all non-po . t source regulations per the Cupertino Municipal Code, Section Issued byr 9.18. l n L%- Date y� Signature RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is OWNER -BUILDER DECLARATION 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: 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 the Cupertino Municipal Code, Chapter 9.12 and the Health & Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with Safety Code, Section 25532(a) should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally, should I use equipment or devices which emit hazardous air 1 have and will maintain Worker's Compensation Insurance, as provided for by I wi contaminants as defined by the Bay Area Air Quality Management District ll 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 to become subject to the Worker'sO n"..thize�n. �+} not employ any person in any manner so as Date: Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY forthwith comply with such provisions 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 Lender's Address to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save iia -,unify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION and expenses which may accrue against said City in consequence of the ang of this pen -nit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. g... with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37540018.00 DATE ISSUED.......: 09/17/2009 RECEIPT #.........: BS000008709 REFERENCE ID # ...: 09090134 SITE ADDRESS .....: 6199 SHADYGROVE DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER BRAINARD LORETTA L AND ROBERT ADDRESS 6199 SHADYGROVE DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014 RECEIVED FROM ....: SEAN SMITH ELECTRIC CONTRACTOR SEAN SMITH LIC # 27853 COMPANY SMITH ELECTRIC INC ADDRESS 15732 LOS GATOS BLVD CITY/STATE/ZIP ...: LOS GATOS, CA 95032-2504 TELEPHONE (408) 835-2122 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC --------- NEW BAL ----------------------- 1BCBSC VALUATION ---------- 1,000.00 -------------------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 1,000.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1ERT<200 UNITS 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.000.00 ---------- 42.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 127.50 0.00 127.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CREDIT CARD 127.50 VISA --------------- TOTAL RECEIPT 127.50 alV CITY OF CUPEI�TINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM 09 Oq 0 1 --54 APN # 2 � 00 Date.'q— , Building Building Address: 6 ! qq S"OAOyp Mailing Address (if different from buildin d ess): Are Hazardous Materials being used as part of this project? Yes L No HOA: Exterior work onl ) Yes ❑ No [�If es, rovide letter from HOA O ner's Name: ars, �o M Phone # �� s� - 9� C ractoN j-/ , hon . �OS 3s 2i 2 Z Fax: Contractor License t 9 9C`'w Cupertino Business License #: Contact: Phon : 10k) 9,3Y-,;,2 %aQ C", a Fax: Residential Commercial Job Description: U- 4" m AA�7 `C6,1-4 g�(,r v � W t goo - Building Permit Info: Bldg ❑ Elect R( Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IUIII/V-A ❑ II/III B, IV -HT, V -B 0 ---- Valuation: Square Footage: DG'S 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 Revised 07/14/09 CITY OF CUPERTINO Cin OF GENERAL BUILDING APPLICATION CUPERTINO 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 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 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 - r 1BSEISMICO Seismic Commercial B 1TRAVDOC 1BUSLIC Travel & Documentation B Business License B I 5 of 5 Z�f%t- 1. Use LowMaVOC Paint 1 IAQ/Health pts y=yesl 2. Use Low VOC, Water -Based Wood Finishes 2 IAQ/Health pts y=yes. 3. Use LowMo VOC Adhesives 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 4 Resource pts y=yes Formaldehyde 61AQ/Health pts y=yes 6. Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7. Sea] all Exposed Particleboard or MDF 4 IAQ/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 2. Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 5. Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes Total Points Available: Total Points Project Received: G:datalprogslgreenbuildingguidelines/remodelerslgreenpointsfinal2.12.04protected.xls CITY OF �UPEkTIN0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS• 5&->,cW q ro vL 1��PERMIT # ()-� CP -�14 OWNER'S NAME: (. PHONE # Io � 5 - � GENERAL CONTRACTOR: �(,Q C ,- C_ FAX # A i4l /- -O I am not using any subcontractors: Lr ignature Date rmmnlPte the following information: / g~ / 7 -a,q Owner/Contractor Signature Date SUBCONTRACTOR - BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical ceLum 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 T e / g~ / 7 -a,q Owner/Contractor Signature Date