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09090049 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDiaESS: 20421 VIA PORTOFINO CONTRACTOR:NOR-CAL CONSTRUCTION PERMIT NO:09090049 OWNER'S NAME: CINDI MA 5255 STEVENS CREEK BLVD#178 DATE ISSUED:09/09/2009 4ER'S PHONE: 4084536790 SANTA CLARA,CA 95051 PHONE NO:(408)295-0813 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB License Class Lic.# C[2 3 Yo (q �y MECH f— RESIDENTIAL f— COMMERCIAL Contractor NO1r ( Date—J-11 (_a JOB DESCRIPTION:REPAIR KITCHEN FROM WATER DAMAGE. I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions REPLACE DRYWALL 4'UP FROM FLOOR. REPLACE CABINETS TO PRE-EXISTING Code and that my license is in full force and effect. LAYOUT.KITCHEN SINK FAUCET,COUNTER TOP,PAINT; 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$15000 permit is issued. APPLICANT CERTIFICATION APN Number:31601143.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.1 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, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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. '1-9-07 Date: Issued bv' Signature Date Lr 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 I,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, Business&Professions Code) Signature of Applicant: Date: 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 Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. 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,l 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 become subject to the Worker's Compensation provisions of the Labor Code,I muster a ize a �A D forthwith comply with such provisions or this permit shall be deemed revoked. Date: 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 relating 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 upon 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 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 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 31601143 . 00 DATE ISSUED. . . . . . . : 09/09/2009 RECEIPT #. . . . . . . . . BS000008631 REFERENCE ID # . . . : 09090049 SITE ADDRESS . . . . . : 20421 VIA PORTOFINO SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CINDI MA ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : NORCAL CONSTR & DEV CONTRACTOR KEN SILVA LIC # 23863 COMPANY NOR-CAL CONSTRUCTION ADDRESS 5255 STEVENS CREEK BLVD #178 CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051 TELEPHONE (408) 295-0813 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ------- 1BCBSC VALUATION 15, 000. 00 1. 00 0 . 00 1.00 0 . 00 1BSEISMICR VALUATION 15, 000 . 00 1 .50 0. 00 1. 50 0 . 00 1BUSLIC FLAT RATE 1. 00 114 . 00 0 . 00 114 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 .00 1SUPINSFEE HOURS 1. 00 126 .00 0 . 00 126 . 00 0 .00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 326 .50 0 . 00 326 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 326 .50 #020726 --------------- TOTAL RECEIPT 326 .50 y . �!fl '` CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# Date: Building Address: ZD yZ l V 41 �Op,' 170 Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No'1!5g HOA: (Exterior work onl ) Yes ❑ No If yes, provide letter from HOA Owner's N e: Phone#: NRe,: y�3 -G 79� x/08 L57- 1/j Contractor: Phone: bD'� CAVS 7,eY fl Fax: Contractor License#: �L 3 q01 Cupertino Business License#: Contact: Phone: J OAA fa-64 Fax: ao5 y q 9 - 70 a Residential Commercial ❑ Job Description: ff& p afio Building Permit Info: Bldg Lam' Elect ❑ Plumb Q`- Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B �� TZ— Valuation: ` —Valuation: i 5/06") 4r, Square Footage: Project Size: Express E4---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.buflditgreen.org Revised 07/14/09 CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEI�TINO 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) 1WINMEWSTR 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 IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1 PLMBLNCK 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 TYPES / 1BSEISMICR Seismic Residential B I IBSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 M.Indoor Air Ouality and Finishes 1.Use LDw ND-V©C Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAD/Health pts y=yes 0 3.Use LDwNo VOC Adhesives 3 IAD/Health pts y--yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts yeses D 5.Use Engineered Sheet Goods with no added Ursa Formaldehyde 61AQ/Health pts y=yes 0 6.Use Exterior Grade Ply+r000d for Interior Uses 1 IAQ/Health pts y=yes D 7.Seal a11:Fosarll' iolebcar�l or h4lDF _ 4 IAQ/Health pts y7-:yes B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes I 1 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0 1 1 D N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewgble Flooring Materials 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D 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 D 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes 0 1 1 1 Total Points Available: 1 1401 13.0 57 Total Points Project Received: 1 01 01 0 G:datalprogslgreenbuildingguidelines/ramodelerslgreenpointsfina1212D4prote-,led.xis SI� �� . PRO S C0 � 'T Assessor's Parcel Number: Name of owner. Project address. Z �Z I ��Q �T� n� P/i Contact person. y HCl yl ��� �,a _Phone. �o — 3 Z Fax. 7,5'- y 11-F70 O footage a Net square f a of lot.g Existin Proposed Square footage: First floor: Second floor: Garage: zz— , TOTAL: "re there at least two 10 foot by 20 foot clear spaces inside the garage? N Is privacy protection planting required for the project? Y On what floor(s) is work being done? l5� Brief description of work. &4-;r ,e khen ,/V a'E lie C, I f lV> lw er,P-�V-ki c a l Code editions:2008 CBC lt'V-N)2008 CFC (Y-N)2008 CMC (Y-N) 2008 CPC N)2008 NEC (Y -N) - 0';�r,vt 0 Effective 1/l/08 IN AccORI),aN('t v41 I�l I HE CITY of CUPERTING CODE ANI)ORDINANCES DATE -t9 SI 6 NED This set of plans arid specifications MUST be kept on the fob at all times and it is unlawful to make any changes or alterations on same without written permission from the Building Departn,,•r,t. City of Cupertino. The stamping of this i,,r1,inrf specifications f SHALL NOT be NA- f t,,j,ernut or to be an epprcw.-ai,i the vrolat� r, ,f,ir, ;),)visions _ of .Iny (;rty 0rkJwx,cN ur r,oft !av, Plan Review Process Work Book Page-8-Revised 1/1/08