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10080030 CITY OF CUPERTINO BUILDING PERMIT . GILDING ADDRESS: 20607 PARADISE DR CONTRACCOR:LAGUNA MADISON INC. PERMIT NO: 10080030 VVNER'S NAME: WINNIE KOSOLCHAROEN 3030 OSGOOD CT DATE ISSUED:08/03/2010 NER'S PHONE: 4082578954 FREMONT CA 94539 PHONE NO:(510)353-1600 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB r ense Class C_ � � Lie.# �� 2 ��lC% MECH f— RESIDENTIAL r COMMERCIAL r itractor � i'� ( + ,,�� Date ereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEN(10)VINYL REPLACEMENT WINDOWS,3 ARE CUT mmencing with Section 7000)of Division 3 of the Business&Professions DOWN de and that my license is in full force and effect. SILLS IN BE BROOM FOR EGRESS UNDER EXISTING HEADER ereby affirm under penalty of perjury one of the following two declarations: ive and will maintain a certificate of consent to self-insure for Worker's mpensation,as provided for by Section 3700 of the Labor Code,for the formance of the work for which this permit is issued. ive and will maintain Worker's Compensation Insurance,as provided for by ;tion 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$5600 mit is issued. APPLICANT CERTIFICATION APN Numb(r:35915011.00 Occupancy Type: :rtify that I have read this application and state that the above information is rect.I agree to comply with all city and county ordinances and state laws relating wilding construction,and hereby authorize representatives of this city to enter to the above mentioned property for inspection purposes. (We)agree to save PEW WIT EXPIRES IF WORK IS NOT STARTED emnify and keep harmless the City of Cupertino against liabilities,judgments, ts,and expenses which may accrue against said City in consequence of the WITl3IN 180 DAYS OF PERMIT ISSUANCE OR nting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. h all non-point source regulation per the Cupertino Municipal Code,Section Issued bye- Date: c` 2,—(!] nature /' / Date � i'' T' OWNER-BUILDER DECLARATION RE-ROOFS: ereby affirm that I am exempt from the Contractor's License Law for one of All roofs sha I be inspected prior to any roofing material being installed.If a roof is following two reasons: installed witl out first obtaining an inspection,I agree to remove all new materials for s owner of the property,or my employees with wages as their sole compensation, inspection. I do the work,and the structure is not intended or offered for sale(Sec.7044, siness&Professions Code) Signature of lipplicant: Date: s owner of the property,am exclusively contracting with licensed contractors to struct the project(Sec.7044,Business&Professions Code). E,LL ROOF COVERINGS TO BE CLASS"A"OR BETTER ereby affirm under penalty of perjury one of the following three larations: ive and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE npensation,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 formance of the work for which this permit is issued. California H ealth&Safety Code,Sections 25505,25533,and 25534. I will maintain ive and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& tion 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 mit is issued. contaminants as defined by the Bay Area Air Quality Management District I will rtify that in the performance of the work for which this permit is issued,I shall maintain con apliance with the Cupertino Municipal Code,Chapter 9.12 and the employ any person in any manner so as to become subject to the Worker's Health&Sa fety Co ,Sections 25505,25533,and 25534. npensation laws of California. If,after making this certificate of exemption,I ome subject to the Worker's Compensation provisions of the Labor Code,I must Owner or aJu f�t .Id agent: Date: hwith comply with such provisions or this permit shall be deemed revoked. % �✓ APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY rtify that I have read this application and state that the above information is I hereby affir n that there is a construction lending agency for the performance of work's -ect.I agree to comply with all city and county ordinances and state laws relating for which thi: permit is issued(Sec.3097,Civ C.) wilding construction,and hereby authorize representatives of this city to enter Lender's Na ne n the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Ad cress and expenses which may accrue against said City in consequence of the sting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION r all non-point source regulations per the Cupertino Municipal Code,Section ;• I understand ny plans shall be used as public records. nature Date Licensed Prr fessional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35915011 . 00 DATE ISSUED. . . . . . . : 08/03/2010 RECEIPT #. . . . . . • • • : BS000011080 REFERENCE ID # . . . : 10080030 SITE ADDRESS . . . . . : 20607 PARADISE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINC IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WINNIE KCSOLCHAROEN ADDRESS . . . . . . . . . . : 20607 PARADISE DR CITY/STATE/ZIP . . . : CUPERTINC, CA 95014 RECEIVED FROM . . . . : DAVID MORKIN CONTRACTOR . . . . . . . : ROBERT BENTLEY LIC # 28883 COMPANY . . . . . . . . . . : LAGUNA MADISON INC. ADDRESS . . . . . . . . . . : 3030 OSGCOD CT CITY/STATE/ZIP . . . : FREMONT, CA 94539 TELEPHONE . . . . . . . . : (510) 353-1600 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 600 .00 1 . 00 0. 00 1. 00 0 .00 1BSEISMICR VALUATION 5, 600 . 00 0 .60 0. 00 0.60 0 .00 1WINREP EACH 8 10 . 00 506 . 00 0 .00 506. 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 507 . 60 0 .00 507.60 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 507 .60 VISA --------------- TOTAL RECEIPT 507.60 CITY OF CUPERTINO CITY OF CUPE�T1NO GENERAL BUILDING PERMIT APPLICA'T'ION FORM APN # r, Date: Building Address: J -:) 1c, r �, cl ,� 1 Mailing Address (if different from building address): J(, LHOA Hazardous Materials being used as part of this project'' Yes No: xterior work onl ) Yes ❑ No EJ If es, pro ide letter from HOA Owner's Name: I Phone#: Contractor: I � �.\(j G i`)'1 S L"', T t Phone: Q Fax: Contractor License#: z_2_'; v,(, Cupertino Business License#: 7� & Contact: Phone: 1(,) (-Z-t(.i-'� G1 ° �'' �:r •� Fax: S /e,_) 1C.-IG Residential Commercial ❑ Job Description: `, / II ( �.`, J( r J Building Permit Info: Bldg ff Elect ❑ Plumb C] Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IVIII B, IV-HT, V-B 0� - Valuation: �— 0 �J Square Footage: Project Size: Express Sg--Standard ❑ Large ❑ Maior ❑ Green Building: Please complete relevant portion of the Green Bu' ding/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.builditgreen.org Revised 07/14/09 i CITY OF CUPERTINO FEE ESTIMATOR- BU][LDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: °VALUATION: 1$5,600 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY OVERTHE APPLICATION or Duplex 1GENRESUSE: COUNTER? i:-)Yes 0 No TYPE: MECHANYCAL ® Yes. Q Io,.',P : TC Q Yes Q o.,. ��C' fCAL Q Yrs a No a 00 3U OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s .ft. TOTALS: 0 $0.00 s $0.00 7_7 T-1 11 . 1 . i NOTE. Thesefees are based on the preliminary information available.and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Fee Resolution 09-051 A'11' 7-1/09) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 107 # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT 19.01 hrs $0.00 $506.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: Q Yes (E) No $0.00 0 Work Without Permit? Q Yes (E) No $0.00 Q Planning E ee: $0.00 Select a Non-Residential Q Building or Structure Strong Motion Fee: IBSEISMICR $0.56 Select an Administrative Item Bld-_Stds Commission Fee: IBCBSC $1.00 B �I'ALS. $1.56 $506.00 ! T'(�I'AIy isx $507.56 Revised: 7/27/2010 M.Indoor Air Quality and Finishes 1.Use Low/NoNbC:Paint 1 IA)/Health pts y--yes p 2.Use Low VOC,Water-Based Wood Finishes 2 IA YI-Isalth pts y--yes p 3.Use Low/No VOC Adhesives 3 IA /Health pts y--yes p 4.Use Salvaged Materials for Interior Finishes 3 RE source pts y--yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61A�yHealth pts y--yes p 6.Use Exterior Grade Plywood for Interior Uses 1 IAII/Health pts y=yes p 7: ea1;311 ae�l�d�r MDF __--_. 4 IAOJHealth is Y=-Yes p B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes p 9.Use Finger-Jointed or Recycled-Content Trim 1 Re source pts y=yes D 10.Install Whole House Vacuum System 3 IAD/Health pts Y--yes p 1 1 D N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes p 2.Use i3apidlyReneir«ahle flooring Materials 4 Res)urce pts y--yes p 3.Use Recycled Content Ceramic Tiles 4 Res wrce pts y=yes p 4.Install Natural Linoleum in Place of Vinyl 5 IAC'Health pts y=yes p 5.Use Exposed Concrete as Finished Floor 4 Res)urce pts y=yes D 6.Install Recycled Content Carpet with Low VOCs 4 Res wrce pts y--yesp M . M 1 1 1 Total Points Available: 140 -1301 57 Total Points Project Recelved:j 01 OF 0 G:data/progs/greenbwldin iguidelines/remodelers/greenpointsfina1212D4protecled xls rd (-j v Z � v `,v1Fl11HE ;ITY OF )VA 1NANGE5 IN AC t,t)F 1 ANFi e� COPE}F11N1 . DATE SI aeons MU ST This set of Plan's a 11'1 A t Ps and�t t ons be kept on thy'1 r altera ke s�.�, �ha��9 Perm�s'�o rtino. on►a,rrtul to Wftt1oUn v LR of Cupe on same De TWAWI s +fications the�tamPg tr,�s Nl�llipermit or to t an ing o ` the NOT tit'heed A,, SHAD of IV,,v�al�,t�nn`'t 3PP�Ova1 0! s x C1S, r Dv A`r I rl C I X M s � �s x _ J � x M M FS \ -J z , -t CIP, x -r �' x fob