09100205 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10524 S TANTAU CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100205
OWNER'S NAME: XIONG LIU DATE ISSUED: 10/29/2009
ER'S PHONE: 3108697188 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# —/ `7!� O
/ MECH RESIDENTIAL COMMERCIAL
Contractor /�cn. co-'sl � �� ° (Zate 1 � "� O
JOB DESCRIPTION:ADD INSULATION TO THE WALL AT FRONT
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions ROOM TO
CONSERVE ENERGY,REPLACE OLD SHEET ROCK
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.
1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$1000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:37537020.00 Occupancy Type:
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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source re4ions per the Cupertino Municipal Code,Section
9.18. y:
% Issued Date:
Signature �.J Date
L OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,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, Signature of Applicant: Date:
Business&Professions Code)
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 HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
i, inify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37537020 . 00
DATE ISSUED. . . . . . . : 10/29/2009
RECEIPT #. . . . . . . . . BS000009075
REFERENCE ID # . . . : 09100205
SITE ADDRESS 10524 S TANTAU
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER XIONG LIU
ADDRESS 10524 S TANTAU
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : XION LIU
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, 000. 00 2 . 00 0 . 00 2 . 00 0 . 00
1BSEISMICR VALUATION 1, 000 . 00 1 .00 0 . 00 1. 00 0 . 00
1SUPINSFEE HOURS 2 . 00 404 . 00 0.00 404 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 84 . 00 0 . 00 84 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 491 .00 0 . 00 491 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 491. 00 MC
---------------
TOTAL RECEIPT 491 .00
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: �-� 7-0Z
Name of owner. X eA/G 1 U
Project address. t v 5-2 �c 3- T a /`'"4 A,-,
Contact person. Phone. C?j l v)K5 —
Fax.
Net sc}uare_fa _
Existing Proposed
Square footage: First floor: /
Second floor: to
Garage:
TOTAL:
e there at least two 10 foot by 20 foot clear spaces inside the V 7 I^z
Is privacy protection planting required for the project? "- N
On what floor(s) is work being done?- � � k ^
Brief description of work. ti. u, � � ► � -2f� f �-
Code editions: 2008 CBC N)2008 CFC (Y-N)2008 CMC (Y-N)
2008 CPC (Y -N)2008 NEC (Y -N) >�,��� -� -�' ►f
,"PPftf iVED
IN AC('(441 ANI t dVI1ff 1HF CITY OF
CUPt 1-41 INC)r rt3t AN()ORDINANCES
Effective 1/1/08 DATE /'G-,2���Y
SIGp1E
This set of plans and speclfrcahor.s MUST
be kept on the lob at all times and it is
' ,; "
unlawtui to make ary changes r,r alterations Ti-I
on&.Ame without w fitter pt-nission from }`�
g 61 ` .�
the Nuddm De{>artr+irrt rt: )f Cupertino. / c}9
The stanipinq a it-,`,l.,n and Specifications
SHAt i NOT tw h,.i,!1�,1,errnrt ur to to an
apprrvaf of th,� �.c�+,,s,�_,n ,f.v ixrovisions .
of any City r),�tu�, f•,,r ' L�sr 1 aw.
Plan Review Process Work Book Page-8-Revised 1/1/08
CITY OF CUPERTINO oyp C�; 7>
CITY Of
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # ()v Date:
Building Address:
b Ta (r�,Q A-le
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 9- li yes, provide letter from HOA
Owner's Name: Phone#:
Contractor: Phone:
Fax: ( /�,)-- ( ,7� ( 7 CSL
Contractor License#: e C'�
Cupertino Business License#:
Contact: x l Cts, 4 LIi� Phone:
Fax: t
Residential-Ey Commercial
Job Description:
Building Permit Info:
Bldg [)-' Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B ❑
Valuation: Square Footage:
Project Size: Express Standard ❑ Large ❑ Maj 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 help, contact Build it Green at www.buildit2reen.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)
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
1 ELCPLNCK 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
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
j
1BUSLIC Business License B
61
5 of 5
M.lndDDr Air Quality and Finishes
1.Use f_owMo-VOC Paint 1 IAD/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAD/Health pts y--yes 0
3.Use LowNo VOC Adhesives 3 IACJHealth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes D
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.Sea 0,0� Wsbawdor MDF 41AQ/Health pts y:-:yes D
B.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 D
10.Install Whole Nouse Vacuum System 3 IAQ/Health pts y--yes D
1 1 D
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Rapidly Benewable 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 Sim
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes
1 1
Total Points Available:1 1 Available: 1401 1301 57
Total Points Project Recelved: 01 0 D
.. I
G:datalprogslgreenbuilclngguidelines/rarnodelers/greenpointsfina1212 Mprolaaled.As