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09100143 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10156E ESTATES DR CONTRACTOR:HALE CREEK PERMIT NO:09100143 CONSTRUCTION,INC. OWNER'S NAME: BURNS ROBERT C AND SHERRY O TR 23500 CAMINO HERMOSO DR DATE ISSUED: 10/22/2009 ER'S PHONE: 4082554979 LOS ALTOS HILLS,CA 94024 PHONE NO:(650)941-4836 LICENSED CONTRACTOR'S DEC(LLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class —6Lic.# 700-1-3 CJ �_�,�� 22, MECH r RESIDENTIAL f— COMMERCIAL� Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW LIGHTING&OUTLETS;REPAIR/REPL (commencing with Section 7000)of Division 3 of the Business&Professions SHEET ROCK AS Code and that my license is in full force and effect. NECESSARY,NEW APPLIANCES,CABINETS,COUNTERS, FIXTURES;NO STRUCTURAL&NO RE-ROOF(I62SQFT) 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:$50000 permit is issued. APPLICANT CERTIFICATION APN Number:36907033.00 Occupancy Type: 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 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 no - urce regulations/frHeertino Municipal Code,Section 9.18. Signat �—'`-� Date d Z Issued ❑ 2 OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that 1 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, Business&Professions Code) Signature of Applicant: Date: 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 I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will 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 must O r or uthorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 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 u—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 cu.,..,,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 ARCHITECT'S DECLARATION 9.18• I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36907033 . 00 DATE ISSUED. . . . . . . : 10/22/2009 RECEIPT #. . . . . . . . . : BS000009006 REFERENCE ID # . . . : 09100143 SITE ADDRESS . . . . . : 10156 E ESTATES DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BURNS ROBERT C AND SHERRY O TR ADDRESS . . . . . . . . . . : 10156 E ESTATES DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3304 RECEIVED FROM . . . . : BRYAN M TEMMERMAND CONTRACTOR . . . . . . . : BRYAN TEMMERMAND LIC # 30617 COMPANY . . . . . . . . . . : HALE CREEK CONSTRUCTION, INC. ADDRESS . . . . . . . . . . : 23500 CAMINO HERMOSO DR CITY/STATE/ZIP . . . : LOS ALTOS HILLS, CA 94024 TELEPHONE . . . . . . . . :. (650) 941-4836 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 50, 000. 00 2 .00 0 . 00 2. 00 0 . 00 1BSEISMICR VALUATION 50, 000. 00 5 .00 0 . 00 5 . 00 0 . 00 1REMRESKIT SQ FEET 162 . 00 570 .00 0 . 00 570 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 577 . 00 0 . 00 577 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 577 .00 MC --------------- TOTAL RECEIPT 577. 00 0 j ool y3 CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO PERMIT APPLICATION FORM APN # n D —7 c) 3 .v Date: v(g?=J7 d v Is a 2,dunit being added? Yes ❑ No Y If yes, please fill out the p rmit application for 2" unit. Building Address: Mailing Address (if different from building address): Owner's N e: Phone# �� - 65 -� 4771,6EzrA 5 Contractor: Phone#: &50 ,�c f L4B(o Vh4L-6 CR.EE{, (f-D/J5► R, Fax #: Contractor License#: '105-7-3b Cupertino Business License#: C)" _'/L Contact: Phone#: t�l S79� n/ M OF yyV4nl Fax #: Building Permit Info: Bldg. a Elect. [� Plumb. ❑--- Mech.--[:T— Hillside ❑ Job Description: Addition-What is being added?(Be Specific): 000E: What is being remodeled (not including addition)? NCW L-t6t4TIN Gt,:IR5 LrU�S j REF t R/ L . P NC Stt�'[ � fl S NCc ��iJ f}- PZ� �& —'T3J CZXJi� /x70�5. Remodel Includes Re-Roof: Yes ❑ No [� If yes list number of squares Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: / Garage: Detached Attached -- Remodel: Kitchen t l01, Bath Other Type of Construction (Usage Class): Occupancy Type: I-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Valuation: 4� Please check this box if the project is a ��Ui� second-story addition ❑ Project Size: Express ❑ Standard ❑ Large ❑ Ma'or❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved- inc lude chieved:include in plan set& the sheet index. ***For Office Use Only*** Over-the-Counter ❑ Revised 07/06/09 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1 DECKWOOD Deck (Wood)-Each B (Each) 1 DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) 1 BCONSTAXR Construction Tax Res (new detachedgarage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1 PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF IPATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM IPATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF I PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check 1REMRESBAT Bath Remodel up to 300 B " SF 1 REMREOTH Other Remodel up to 300 B " SF M.Indoor Air Qua ity and Finishes 1.Use Lowffiio-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowtNo VOC Adhesives 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.Seal 4 IAQ/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 Flooring 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 t t Total Points Available: 1 1401 1301 57 Total Points Project Received: I Z 01 0 0 l G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xis ppr�y, _._.�..>"......-,..-�,r_...-...-.....,...-:....�.,.,.>.�.�._,•......,f.,..,,..,,,..r._ _.._ ......:.......»........_.,..,._-_:.... _..... . �.v�..._...:�... t S ............. a; E c1-4 ,'61 V I e ...� x „0 r iA � TSF +� `�`fj(F,i�, ' {r' ' � -� ��/` � �. /1 tai,;ii )v[D ' IN ACCOi i!AN''E vVf 1 H i HE CITY OF r CUF'E.IZTINO G001 AND ORDINANCES � I DATE ; v clou SIG -- t � f ' l This set 4plans afiC100fications MUST be kept on the job at all times and it is an c unlawful to make i � r._•• y hanger or alterations on same without written permission from -. • the Building Department'C' of Cu rtino. • ' :` j a ;'1. .� ., . A, , J The stamping of the an and ifications ` SHALL p n9 � spec �.''•�,:�,,:� . �: ;�� ;; ....'.:L NOT be held to permit or to be an ►' approval of the violation of any provisions 'rr i of any City Or:J nam.r•,x Stat I HALE 9 C RE: ,,,.,J �..� =s C O N 5 T R U C T 1 0.1d , 12 Boston Ave.,02 Sai kfte.CA l ` /// /A�yMELEC f,; 'a. .:rYeller&am HE(AJ ZOO • •1 `' I �.:I i' ',e'..+ La,�."'�-.', at 3 .+'7 •eft 'p ( 408)291-05ft L) . i _. _ _._.__ --- i .fit•—* et I.SP- T .RlRnr IS, �,.i 1 f .,,t►•., , � � �,bus"" y''� d " ~:, .t� •`! a� � �,� : r• t ��i � �y,,.,,,.�. -e `ems,..� � L.>,:+w.+. ` .ems,1Fm,�al i .� rA 3 0 c Oc LA HAJLEs.0 -REEK �+ � �°'�r•�� tom,` �S 11i.�i ��c1 ! �� ... E +. • l.�Y y..�". 4'4,y` � , it � � ( l � a ' �«�. � i L , , C ON S T R U C T 1 92 lei 12 BOOM Ave.,02 Sew Jew,CA SWS i •n s..: ,fir S -SNkon VeNep&dw�M�leitls �Q ,e• .�,—.. :^� ..t , �-. �„y"�`"5 r :d x Lic.7r 05738 ('TW,i X 1 t� Q 6-1 Ir iN �-- 17PJ�ws.• �•'��G�i�s'••s.�Wit` ' G to, - ' Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPERTINO Building Department JOB ADDRESS: PERMIT # 73 [DIS& E, 0 S c( 1 c�cv l OWNER'S NAME: R PHONE # GENERAL CONTRACTOR: S FAX # ( - I am not using any subcontractors: �y t 2 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 �a22 � D to Owner/Contractor Signature