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09100151 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10619 NATHANSON AVE CONTRACTOR:TBD-TO BE PERMIT NO:09100151 DETERMINED )WNER'S NAME: BUCHANAN MURIEL T DATE ISSUED: 10/22/2009 OWNER'S PHONE: 4087394490 PHONE NO: EL LICENSED CONTRACTOR'S DECLARATION r— j" BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 1J Lic.# 12�q"g I f` (" r— MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMODEL-BATH,NEW TUB VANITY SINK (commencing with Section 7000)of Division 3 of the Business&Professions TOILET,INSTALL Code and that my license is in full force and effect. CF OUTLET,CEILING FAN 45'NO REROOF,NO STRUCTURAL. HAMMER HOUSE CONSTRUCTION PD FOR I hereby affirm under penalty of perjury one of the following two declarations: BUS 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:$4500 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:32643076.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certifv that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the rD �_,-� granting of this permit. Additionally,the applicant understands and will comply Issued _ _/'��— Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. J�—Z?; F�7 RE-ROOFS: ;nature Dat¢ 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 inspection. ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code 'ees� 05,25533,and 25534. / Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Data:D, permit is issued. --- 1 certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 building construction,and hereby authorize representatives of this city to enter m the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION lAdemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional _ 9.18. Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32643076 . 00 DATE ISSUED. . . . . . . : 10/22/2009 RECEIPT #. . . . . . . . . : BS000009011 REFERENCE ID # . . . : 09100151 SITE ADDRESS . . . . . : 10619 NATHANSON AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BUCHANAN MURIEL T ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1330 RECEIVED FROM . . . . : THOMAS BUCHANAN 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 4, 500 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4, 500 . 00 0 .50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00 1REMRESBAT SQ FEET 45 . 00 570 . 00 0 . 00 570 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 685 .50 0 . 00 685 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 685 .50 MASTERCARD --------------- TOTAL RECEIPT 685 .50 r CITY OF CUPERTINO s_a, ADDITION/REMODEL CUPEI�TINO PERMIT APPLICATION FORM ��l-5-/ APN # 3 -�6 q- ,3 6 -7(, Date: I 2-2- Is Is a 2" unit being added? Yes ❑ No ZJ If yes, please fill out the permit application for 2" unit. Building Address: Mailing Address (if different from building address): Api Owner's Name: Phone# Contractor: ''Eu L.}-1AN4:4(-" Phone#: q/'S, 'SI b5 t'1 X11 Crt!_ v Go!L !�L Fax #: Lil� ? 15 Contractor License#: a Cupertino Business License#: Contact: TV4e-ia,,, Phone#: 111S-S)b Fax#: t-)I S 7` 3 a Building Permit Info: Bldg. Elect. Plumb. Mech. C9-- Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled(not including addition)?rSq-7 4 9-tM n0 G-L--- ) rJcv-n c ,--7v(3, -71 o�, VKW_" `TV�be VMN011, MZ0. lr�Y7AG( G ) 5,n,ttl m'ZD • t-A0,, 7t,L4� AS'vu'�D Tu(D' Remodel Includes Re-Roof: Yes ❑ No),E If yes list number of squares Remodel Includes Structural: Yes ❑ No,® Do you have the pre-application planning approval? Yes ❑ No Z If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath AIS- Other Type of Construction (Usage Class): {Occupancy Type: I-A, 1-B ❑ II/III/V-A ❑ II/Ill - 1`-III B, IV-HT, V-B Eg- 3 Valuation$e 4. ;00, Please check this box if the project is a 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: include in plan set& the sheet index. 6- ***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) I DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1GARDTM<=1K Masonry up to 1,000 SF B (each) 1BCONSTAXR Construction Tax Res (new detachedgarage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1 PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1 PATIOENCLM Enclosed Metal up to 300 B SF 1 PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS IR3SFDREM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check �S 1 REMRESBAT Bath Remodel up to 300 B " SF 1 REMREOTH Other Remodel up to 300 B SF M.Indoor Air Quality and Finishes 1•Use tawwvoc Paw 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use LowlNo VOC Aftifives 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 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7•Seal'a0 E*mWP�pieiboandz1 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 ! 1 Total Points Available: 1401 1301 57 Total Points Project Received: 01 0 0 G:data/progs/greenbuilcingguidelines/remodelers/greenpointsfinal2.12.04protnted.xls u ff In S5 W SAoJ Bmt 2-Z, 101241 T.-j4onn-�, L>e-.}i,AN I4N 71-1 CY r M 1�.r7 �c4 R� ��IW' 6 i (BIZ 0 r ��&D M � C G + > a TOILET-2 IN 0 CUPE-RT1NU AND O NCS DATE--- � � - -- x •� ,., L�z Thisset of plan,,W)d sl-vc ifications MUST � � �`i t/: be kept on tr, jot),,:j :ri!fines and it isunlawful to mak(- i7V c:'I,v,yes or alterations �-.- on same witho�,,, t-P permission from the Building �tof Cupertino. The stamping o <,i�• r tr ,n( specifications SHALL NOT r>� 'etd t ti -,rt-nn or to bean approval of tt�t, . pr,�e. r'� f any-provisions --- of any City < ii r=, .r ;;t.jte Law. ` ICU t E 9.1 nowo tea -► 4114WO t9 U O �i eve dne Apt '----- - '' _ 0 .0 r Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 -UPEI�TINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: (`l�vR-� C--(- AME }1PHONE #-)-4, 9 Li qc7 GENERAL CONTRACTOR: H AM M FAX# I am not using any subcontractors: 1� 22' C 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