09110136 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22330 HOMESTEAD RD APT?�D�'�Q� CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09110136
DATE ISSUED: 11/24/2009
OWNER'S NAME: FERRIARI MGMT
PHONE NO:
ER'S PHONE: 6509488977
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# MECH r- RESIDENTIAL f- COMMERCIAL
Contractor_ /� � Date
JOB DESCRIPTION: RE-INSTALL INSULATION&DRYWALL 25SQFT
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
(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:$1500
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 APN Number:32659999.209 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
with all non-point source regulations per the Cupertino Municipal Code,Section Issued 6y Datel'-"
9.18.
Signature �-�-� � Date,/L-^2
RE-ROOFS:
.L, OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
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
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.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. 1 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. Safety 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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
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 e /
not employ any person in any manner so as to become subject to the Worker's Owner or authorized a=s%�--� C �U�
Compensation laws of California. If,after making this certificate of exemption,I Date:
_--_— �
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
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
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
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
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 32659999 .209
DATE ISSUED. . . . . . . : 11/24/2009
RECEIPT #. . . . . . . . . BS000009267
REFERENCE ID # 09110136
SITE ADDRESS 22330 HOMESTEAD RD APT 209
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER FERRIARI MGMT
ADDRESS 22330 HOMESTEAD RD APT 209
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM NAZAK CONSTRUCTION
CONTRACTOR TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---------- --------
1BCBSC VALUATION 1, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 1, 500 . 00 0 .50 0 . 00 0 .50 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0. 00 114 . 00 0 . 00
IINSPMIS 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 283 .50 0 . 00 283 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------
CHECK 283 .50 #15266
---------------
TOTAL RECEIPT 283 .50
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
Building Address: v
2
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
Owner's Name: Phone#:
Contractor: Phone:� , �s`J Fax:
k Comers �
Contractor License#: e I--it 60 0 8 2
Cupertino Business License#:
"A T7— �.� ?-,AA /� Phone: 5-�o ._ 7 3 y
Contact: /
Fax:
Residential-x Commercial
Job Description:
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A 1-B IUIII/V-A ❑ II/III B, IV-HT, V-B � (2--1
' ❑
Valuation: Square Footage:
a5
U t>
Project Size:—Express Eg— Standard ❑ Lar e ❑ Ma'or ❑
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 hel , contact Build it Green at www.buflditgreen.org
Revised 07/14/09
slt`rll� CITY OF CUPERTINO
nof 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)
1 WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1ELCPLNCK 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 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
/
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 of 5
A
NPUT •
In oor it ua rty and Finis es
1.USS O-VOC Pah 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/%, VOC Adha*es 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 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.5eWAj P QtVDF 4IAQ/Health pts y=yes 0
8.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 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use'Rapidly Renewable Flowing 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
1 1 1
Total Points Available: rNn 1401 1301 57
Total Points Project Received: 01 01 0
G:data/progs/greenbuildingguidelines/remodelers/greenpointstinal2.12.D4proteoted.xis
Community Development
. 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
.'UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: ��,,,�;,�,��' �`t n i PHONE # 5-7d, -,P7-3 ((
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: :
Signature Date
Please check applicable subcontractors and complete 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