07100064 CIT� OF CUPERTINO � � ° ('� 7�� 7� '
BUILD1Ni3 DIVISIOh �E1�1v1.iT �!�����-`��� �}�'� ���
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PERMIT NO.
BUIL q�yZcSp��esMC CLELLAN RD TBD — TC) BE DETERMINED 07100064 .
PERMTT LSSUE DATE
OWNER'S NAME:
C AR OL E E HOLMES 10/08/2007
SANITARY NO. CONTROL NO.
INE:
BUILDING PERMITINFO
ARCHITECC/ENGiNEER:
BLDG ELECT PLUMB MECH
C� 0 � 0
i p p LICENSED CONTRACCOR'S DECCARA7'[ON JOb D0SCT1PL10❑
'� ! 6creby afGrm that 1 am liccnscd undcr provisions of Chaptcr 9(commencing
'Z � withScction7000)ofDivision3of�hcBusincssandProfcssionsCodc 2 UPSTA=_RS BATHROOMS � N� STRUCTURAL REMODEL
�� y in full Corce and cffect
j � ? Licenu Ciazs �M• �
: E , i p Datc Conuacwr
�?a ARCHITECI'S DECLARATION
i�� I undcrstand my plans shall tx uuJ at public recorcis
)aU '
' u. F" Licenscd Pm[cuional
`� < OWNER-BUILDER DECLARATION
'�� 1 hcrcby alTirm �at 1 am cxcmpt from �hc ConUactors Liccnsc Law far Uic
� p O Collowing rcason. (Sccaoa 7U31.5, Busincss and Pro(cssioos Cak: Any city ar county
�,°, �i which requircs a permit to cnnswct, altcr. improvc, dcmolish, or repair any swclure
�' N prior to ils iscuancc, also rcquires thc applicant for such permit to filc a signcd siaicmcnt Valuation
-?< tha� hc is liccnscd pursuant to thc provisions of ihc Contractor's Liccnsc Caw (Chaptcr 9 3q. Ft. Floor Area $16 0 0 0
,� t �(commencing wi�h Scction 7000) of Division 3 oC�hc Busincss and Profcssions Cadc) ur
L�� �hat he is uempt Ncrefrom and the basis !or the allegcd exempdon. Any violation o(
SecQon 7031.5 by a�ry applicant (or a pertnit subjccts ihe applicant to a civil pcnalty o( 3 5 713 0 3�)�3�(� Number Occupancy Type
not more ihan fivc hundred dollars (5500).
❑ I, as owner oC Uie proputy, ar my cmployces with wages az the'v solc compensation,
will do thc work, and �he stcucture is not intendcd or offered for salc (Sec. 7044. Business Required Inspections
and Professions Cade: The Conuacwrs License Law does not apply to an owner of
property who �uilds or improves thereon, and wha does such work himself or through hu
own employccs, provided that such improvemenLe are not in�ended or otferod for sala It,
however, the building or improvement ia sold within one year ot completion, the owner-
builder will have the burdeo oC proving �hat he did not build or improvc (or pucpose of
salc.). ���
, 1�� , / I, u awner of the property, am exclusively convacting with littnsed convutors to
c3nstruct che projett (Sec. 7044. Husiness and ProCessions Code:) The Conuacwr's Li-
ccnse Law does not apply w an owner of propeny who builds or improves Ide¢on, and ,
who convacts Cor such projects with a contractar(s) lianted pursuant to the Contractors f'
License Law.
❑ I am exempi under_ c . B& P C(or this rcason
Own�� - ., Date J Q J _. .. _:
O K 5 COMPENSATION DECLARATION
1 hereby �cm under penalty a( pery'ury one o[ the (ollowing decfaratioos:
,� I hsve and will mainuin a Cenificatc of Consent to ulf-insure for Workcc's Campen-
sation, as providcd for by Secuon 3700 oC che Labor Code, for the pedormaxc of thc
work for whieh this pertnit is issucd.
Q I havc and will maintain Workcr's CompensaUan lnsurance, as icquited by Scction .
3700 oC �hc Cabor Codc, Cor ihc perCormanu of the work far which �his permit is issued.
My Workers Compensation Insurance carricr and Poliry number are:
Camer. Poliry No.:
CERTIFlCATE OF EXEMP7'[ON FROM WORKERS'
COMPENSATION INSURANCE
(i2�is scaion necd not be complcted i[ the permit is for onc hundred dollars (5100)
or Icss)
1 cenify that in the performarrce af �he work fw which �his pertnit is issued. ! shall not
employ any pecson in any mannc�so u w becomc subject to Workcrs' Comansatio�
Laws of Ca " Date � —7 /� f � ' r l��, �
Applican� ��'��Y.� � �� � '�
NOTICE APPLICAM: If, attcr making U�is Ccrtifica�c of Excmption, you shauld
become subjcct to �he Workcr's Compcnsation provisions of thc Labor Codc, you mus�
�,� forthwilh comply wi�h such provisions or this pccrnit shall bc dccmcd rewkcd.
Z O CONSTRUCTION LENDING AGENCY
[� ► I hcccby aftirm Uwt thcre is a consuucGon knding agcncy for thc performance uf .
�Y, � thc work for which this permit is issucd (Scc. 3097, Civ. CJ ,
W A Lcndcr's Namc
a � L.cnder s Address
U Q I certify �hat I have read this applieation and su�c that �he above infocmatiun is
�►-� cortcct. t agree to comply with all city and coanty onlinances and su�e laws rcla�ing to
rJ U building conswction, and hcrcby authome reprcscntativcs of this ciiy to cntcr u�n thc
� W abovc-mcntioncd property for inspccuon purposes.
a (Wc) agree �o save, indcmaify and kecp hartnlcss the City o( Cupertino against
,,H � liabiliti�s, judgmcn�s, costs and expenscs which may in any way accruc agains� said City
(� ,"� in consequence oC tAc gnnting of this permi� ° lt L/
►-� APPLiCANT UNDE ANDS AND WILL COMPLY W[TH ALL NON-POINT Issued by: Date U �J �7
SOURCE REGUL TION .
'� � O Re-roofs
urc oCAppliantlConuactor ' T e of F.00f
HAZARDOUS MATERIALS DISCLOSURE }�P
�11 ihc applicant or future building acupantstorc or handlc ha•rardous ma[crial
az defincd by We Cupenino Municipal Code. Chap�cr 9.12, and �hc Health and Safety
c� Scction 25532(a)? � All roofs shall be inspected prior to any roofing material being installed.
❑ �'� .
Will the applicant or fuwrc building occupant usc cquipment or dcvices which
If a roof is installed without first obtaining an inspection, I agree to remove
.nit ha•rardous air contaminan�s az Jcfincd by tl� Bay Area Air Qualiry Managcmcm all new r� �aterials for inspecr_ion.
oisvict?
Q Ycs �] Nu
� ..
1 havc rcul the ha�ardous maicrials requimmcros undcr Chap�cr 6.95 of thc Califor-
nia HcalU� & Safcty Codc, Scctions 25505.25533 and 25534.1 undcrstand �hat if �hc bu��di�B
docs no� curtenlly havc a icnan4 �� it is my respoasi6ility w no�l'y Uu occupam of Ihc
� reyu� en�swhich b ' riorwissuance aCen o( � Signature ofApplicant 11 Date
� v���,���/�*-tJ ����" l'�,�'J� All roof coverings to be Class "B or better
Owner or authori�cd agcnt Datc
- � C��7/oon� �l
� � _ ` ag CITY OF C,UPERTINO
������F pERMIT APPL [CATION FORM
CUPEf�TINO
�PN #� Date:
�- /,3 Q3C�Y Or� /D y D
Building Address: Mailing Address (if di erent from building address):
�Q.. Cti � � �l �� �S� /
Own 's Name: � Phone #:
c� � �--f�` c�.-�'� ��--y��-..���7
Contractor: License #:
E ���'t 7�/` vc_ 7�'! ,� � `��,� 02 -
Cor�tact: Phone (%t��� Cupertino Business License#:
�� t.� �^ � �c:� S f'0� � Fax : g fv 3-'�/ �
Building Permit Info: C��// .�y � d'/ 3� d��- S y
Bldg ❑ Elect l'lumb ` Mech L7
Job Description: o? U�S��,i� s b���l ,^� ��S - nur -''��'�''r�'
Residential p Commercial ❑
Sq.Ft. Floor Area: S .Ft.:
�
Cost of Project: Occupancy Group:
�' /� p v o
Type of Construction: Please check this box if t� project is a
second-stor addition:
,'roject Size: Standard� Large ❑ Maior ❑
Quanti Fee ID Fee Descri tion Fee Grou
BAPPLOTHER ��ther Appliances MECHANICAL
BBOILERI Boiler <= 100,000 Btu MECHANICAL
BBOILER2 Boiler > 100K to SOOK Btu MECHANICAL
BBOILER3 Boiler > SOOK to 1M Btu MECHANICAL
BBOILER4 Boile r> 1 M to 1.75 M Btu MECHANICAL
BBOILERS Boiler > 1.75M Btu MECHANICAL
BCONSTAX ��onstruction Tax BUILDING
BCONSTAX In�i/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Co nstax - Resi/Mobile BUILDING
BELEC 1000 El ec 600V <= 1 OOOA ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD l:nergy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
_� -
CITY OF CUPERTINO
� ����f pERMIT APPLICATION FORM
CUPEF�TINO
Quanti Fee ID Fee Descri tion Fee Grou
BMISCELL P�Iiscellaneous Fee BUILDING
BMITIGATC Corr�m. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM Ne�� Comm Mechanical MECHANICAL
BNUCOMMP rfew Comm Plumb PLLTMBING
BOVERTIME Irspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLLTMBING
BPCESSPOOL Cesspool PLITMBING
BPERMFEE lild P.ermit Fees BUILDING
BPFIXTURE Pbl Fixture PLUMBING
BPGAS Gac; Piping System Fee PLUMBING
BPINTERCEP In�i Waste Interceptor PLIJMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Pl� n Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE �>ewa e Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lavm Sprinkler/Backflo PLLIMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLiJMBING
BPVENT Alt of Drain & Vent PLLTMBING
BPWATER Inst;ilVAlter Water Pi e PLUMBING
BPWHEATER V�'ater Heater/Vent PLUMBING
BPWSVCS N:ain Water Service PLUMBING
BREINSPECT 2einspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY F.emodel Busways ELECTRICAL
� BREMFIXT :�ighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Rel�� Furnace > l OK btu MECHANICAL
BREMHEAT ��eater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAFP Rerr� Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Pow��r Device/A aratus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA R elocation of Hood MECHANICAL
BREMREPALT Rf;pair/Alter Heating MECHANICAL
BREMRESAPP Rerlodel Res Appliance ELECTRICAL
2 of 3
� � }� ���_ � CITY OF CrUPERTINO
���n�� pERMIT APPL=[CATION FORM
CUPEI�TINO
2uantit Fee ID F'ee Descri tion Fee Grou
BREMSIGNAD Rm�il Signs Add Branch ELECTRICAL
BREMSIGNS Rerr: odel Signs, Mar uee ELECTRICAL
BREMTHEATR Thf:atrical Lighting Fix ELECTRICAL
BREMVENFAN Ve �t Fan Sin le Duct MECHANICAL
BREMVENSYS Ventilation S stems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Se ismic Commercial BUILDING
BSEISMICRE �eismic Fee Res BUILDING
BSPECIAL ��pecial Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP T em orary Power ELECTRICAL
BTEMPPERM Tem orar Bld Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC ]3usiness License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
/ EPERMITFEE El��c Permit Issuance ELECTRICAL
MPERMFEE 1�[echanical sq. foot MECHANICAL
J MPERMITFEE Mech Permit Issuance MECHANICAL
/ PPERMITFEE Plu mbin Permit Issue PLUMBING
PPLBG Pl umbing Fee s foot PLUMBING
PLLONGRNGC Plannin , LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Plannin Lon Ran e Residential PLANNING
:� of 3
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Name of owner.
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Net square footage of lot. � %`1 �'
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Exis ting Proposed
Square footage: First floor:
Second floor: ��
Garage: --� � -
TOTAL: ___—_____
Are there at two foot by 20 foot clear sp��ces inside the garage? . Yy� '!
Is rivacy protection planting required for the pr�►ject? �
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On what floor(s) is work being done? =
Q � �e r - �, ' .� � � /� i� �
Brief description of work. �-�"� ��� ✓�� �� � � �
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2001 CPC � 1�2001 NEC �� /;� � s.�, ��/v a.-. �.�r�
,�/ �r 1` vv`� s y �� l� c��� .
Effective 11/1/02 --f1��xas�-�wfi i � `�
c:�c_��r� �-� J������r
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Plan Review Process Work Book Page -B-Revised 8/22/OS
� �
° ° CMC Construction
°, Lic. '# 735215
Carole DiMatteo
22079 McCellan Rd.
Cupertino
10/5/07
City of Cupertino
Shower doors will all be up to city code-:empered glass.
Any and all gypsum board installed will I�e up to city code- water-resistant (green
board). �
Exhaust fans will have a light kit, light ki: is fluorescent.
All toilet's will be 1.6 gallon toilet.
Any and all shower values that will be rE�placed- anti-scalding unit's will be
installed.
No electrical circuits will be installed. �%'=��` r� ��'��
All work preformed by CMC Construction will be up to city code's.
i `� ,, -� �� �� _ s ��- � �
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6087 Larios Ct., San Jose, CA 9:�123 • Phone/Fax (408) 363-4197
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Assessor's Parcel Number: �� ' ��-� - �' `� � �
Name of owner.
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Contact person. �Or.� /.�- ��� ��� — � _ �s-3 �
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Net square footage of lot. � �� �
l
Exis � Prouosed
Square footage: First floor:
Second floor:
Garage: �_
TOTAL: �''
st two-10 foot by 20-foot clear-spaces inside the ara e? _Y� �
Are there at
_ g-- g __
Is rivac rotection planting required for the prcject? � �
p YP
On what floor(s) is work being done? �� -----
e ( 2,�S �Q � � a. � t�'e /" ' l/ �.� 7-� �' l l/�" c'_
Brief description of work. .�7'� � � ��—"
y— J ,t�.tlr v / /2 r, o r-�` � •- �ho � � � a n _
�^ e � � C ° L O / / T `��� L'✓'�J /� ��-' � C . L / ; ` � � /Yt `� ��? �L a�
� I� 2001 CFC �� 2001 CMC �� ti' � � �' � � �°� �`�'�'- a /
Code editions: 2001 CBC �
2001 CPC I�2001 NEC �� /,h � s. ��/� a.-, h,,.��
,�/ � � vrr`� s y �� l� < � a( .
Af ,.
Effective 11/1��Y2ACCURDRNCE WITH THE CfTY Ofi ��dy'� �%� J~
CUPERTINO CODES AN� QRDINANCE3 `�
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�IGNEG -----
fhis set ci p;ar�:; �������speca;icalions MUS�
oe kept on ir±e j;h �t e:l tin�GG ar�1 it i� urz
lav�fui to r��a�� .,�y ch;:r��; or a�±e,�ati�n�
an same w;ii��:�.;� r�d ifi�,n p��m;sst�n fran.
�rre bui;din� ,::<<��;;r.., C?t;� uf C..��^,f�n��.
rre st�r,�:r. �3f t";:� �?��n srrd s�aec;tication�
�HALL Pl�f bo (�te�i t:z pa rnit c,r t:� he ar
3pproval af the vi�l�fit:rt of at,y ��t�o�lt,�r���
` anv f;itv ��tt�nxri^a �r �*ar„ 1 ,�P�
Plan Review Process Work Book Page -8-Revised. 8/22/OS
�°
° ° CMC Co�nstruction
°, Lic.at 735215
Carole DiMatteo
22079 McCellan Rd.
Cupertino
10/5/07
City of Cupertino
�
Shower doors will all be up to city code-i empered glass.
Any and all gypsum board instalted will k�e up to city code- water-resistant (green
board).
Exhaust fans will have a light kit, light kii is fluorescent.
All toilet's will be 1.6 gallon toilet.
Any and all shower values that will be rEplaced- anti-scalding unit's will be
installed.
No electrical circuits will be installed. ��"=-��` r� �`�➢��
All work preformed by CMC Constructio� will be up to city code's.
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`' 10300 Torre Avenue
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� Cupertino CA 95014
Telephone (408) 777-3228
- C1TY O� Fax (408) 777-3333
�;UPE�,T
Building Department
All Cupertino building permits must rr eet certain conditions related to maintaining
envirortmental quality ai�d public peact� and safety. The two most common
conditions are described below.
STORMWATER POLlUTION CONTROL
State law requires that Cupertino, 12 oth�r Silicon Valley cities, Santa Clara County and
the Santa Clara Valley Water District corr:rol stormwater pollution. Educating local
residents and businesses and enforcing s:ormwater pollution control laws are key parts
of the City's compliance efforts.
Stormwater pollution prevention: It'�: up to us
In northern Santa Clara Valley, storm dr� ins flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater pollution is a serious problem for wildlife
dependent on our waterways, for people living near streams and baylands, and for the
local water supply. Common sources of �;tormwater pollution include:
• Dripped oil, fuel, and antifreeze fr�m vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• Landscaping runoff containing pe�ticides or weed killers; and
• Any material dumped or spilled into streets or storm drains
The property owner and the contractor stiare ultimate responsibility for activities
occurring at a construction site and will te held responsible for any environmental
damage caused by subcantractors or em��loyees.
For more information on construction-rel,�ted stormwater requirements, see the
Stormwater Quality Regulations section c�f the City of Cupertino web site at:
http•//www.cu�ertino.org/city qovernment/departments and offices/
environmental services
COMMUNITY NOISE CONTROL
The basic noise control requirements for �onstruction sites are as follows:
• Typical construction work hours a
- Weekdays - 7 a.m. to 8 p.m,
- Weekends - 9 a.m. to 6 p.m.
• Construction other than street coristruction is prohibited on holidays.
• Residential daytime noise levels fi•om complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise coritrol, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be aco:ssed at http•/lwww amlegal.com/cupertino ca/
Greg Casteel
Building Official
CITY OF CUPERTINO
9 ITEMS OF 9 PERMI'�' RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bl}:: Lot:
APN ......... 35"13030.00
DATE ISSUED.......: 10,'08/2007
RECEIPT #.......... BS('00002926
REFERENCE ID # ...: 07:_00064
SITE ADDRESS .....: 22()79 MC CLELLAN RD
SUBDIVISION .......
CITY .............. CUI�ERTINO
IMPACT AREA .......
OWNER ............: CAIZOLE E HOLMES
ADDRESS ..........: 221)79 MCCLELLAN RD
CITY/STATE/ZIP ...: CU]'ERTINO CA, 95014-4005
RECEIVED FROM ....: CA]ZOLE E HOLMESDIMA
CONTRACTOR .......: TB]) - TO BE DETERMINED LIC # 00096
COMPANY ..........: TB]) - TO BE DETERMINED
ADDRESS ...........
CITY/STATE/ZIP ...: ,
TELEPHONE .........
FEE ID UNIT QUANTITY :�MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 234.36 112.49 0.00 112.49 0.00
BPERMFEE VALUATION 16,000.00 234.36 0.00 234.36 0.00
BPFIXTURE UNITS 6.00 54.00 0.00 54.00 0.00
BREMFIXT NO. FIXTURES 2.00 2.40 0.00 2.40 0.00
BREMVENFAN NO i7NITS 2.00 52.41 0.00 52.41 0.00
BSEISMICRE VALUATION 16,000.00 1.60 0.00 1.60 0.00
EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 579.63 0.00 579.63 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 579.63 MC
---------------
TOTAL RECEIPT : 579.63