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09070203 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10238 RICHWOOD DR (ONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09070203 OWNER'S NAME: FAUCETT JOHN W AND DELORES A DATE ISSUED:07/30/2009 f ER'S PHONE: 4082573394 PHONE NO: Cl LICENSED CONTRACTOR'S DECLARATION Tri I.UILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACING FURNACE&INSTALLING 4 TON (commencing with Section 7000)of Division 3 of the Business&Professions /,IR CONDTION Code and that my license is in full force and effect. UNIT 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:$9000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. �.PN Number:36908026.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 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 regulations per the Cupertino Municipal Code,Section 9.18. Issued byDate: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: /,ll roofs shall be inspected prior to any roofing material being installed. If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of i istalled without first obtaining an inspection,I agree to remove all new materials for the following two reasons: i ispection. 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, ignature of Applicant: Date: Business&Professions Code) _ 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 HAZARDOUS MATERIALS DISCLOSURE declarations: 1 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 `,afety 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 itdditionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 certify that in the performance of the work for which this permit is issued,I shall health Safekode, ections 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 t) r autnt: become subject to the Worker's Compensation provisions of the Labor Code,I must - Date: 0,5� forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's I certify that I 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 bender'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 it lify and keep harmless the City of Cupertino against liabilities,judgments, ct.,_ and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point sour regulations per the Cupertino Municipal Code,Section 1 understand my plans shall be used as public records. 9.18. �7 Licensed Professional Signature Date G 4 CITY OF CUPERTINO 7 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 36908026 . 00 DATE ISSUED. . . . . . . : 07/30/2009 RECEIPT # . . . . . . . . . : BS000008315 REFERENCE ID # . . . : 09070203 SITE ADDRESS . . . . . : 10238 RICHWOOD DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FAUCETT JOHN W AND DELORES A ADDRESS 10238 RICHWOOD DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3361 RECEIVED FROM . . . . : JOHN W FAUCETT CONTRACTOR TBE - TO BE DETERMINED LIC # 00096 COMPANY TBE - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 9, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 9, 000 .00 0 . 90 0 . 00 0 . 90 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MRRAA UNITS 2 . 00 126 . 00 0 . 00 126 . 00 0 . 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 .00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 295 . 90 0 .00 295 . 90 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 0 q(�-, CITY OF CUPERTINO `' FUWiACE/AC CUPEkTINO PERMIT APP11CATION FORM APN # Date: 3 � �P ` `� 71-3 -3o p Building Address: , I Owner's Name: Phone#: JDttA) 0 . �/� 1�c2 00-- ZS 7- 1-1 Contractor: Phone#: n " i 0 �����' Fax#: Contractor License#: Cupertino Business License#: � z6_'9� Contact: Phone#: Fax#: Building Permit Info: Elect ❑ Plumb ❑ Mech ❑ Residential Commercial ❑ Job Description: 74SW1 ,A)l For Residential Ins llations: Attic El1St floor [S, 2°d floor ❑ Adhere to minimum setback requirement For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): Strapped ❑ On Platform - Bonded New Location Replacement Project Size: Express [T__*�S_tandard ❑ Large [] Major ❑ Valuatio,-W I C5 a Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Revised 01/07/09 CITY OF CUPERTINO aw- FUWr ACE/AC CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1MRAPPVNT Residential for the install/rel o te/or M replacement of ea applic vent install &not it cl in an ;Prpermi t. FURNACE FURN/AC 1PGASRES iLdentiaL4inrr ea gas piping system of P 1-4 Outlets 1 BPGAS For each gas piping system of 5 or P more per outle:. 1BCB Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSE SMICR Residential Se smic B 1 ME PLNCK Mechanical PI in Check M 1MF <100 Furnace Syst =100k BTU install or M relocate ea for-,ed-air/gravity type furnace/burnei, incl ducts/vents attached to such appliance up to and include 100,000 Btu/h 1MFR >100 Furnace Syst 100k BTU install or M relocate ea for-,ed-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h 1EPERMITFEE Electric Permit Fee E 1MPER ITFEE Mechanical Permit Fee M 1PPE ITFEE Plumbing Permit P 1TRAVDOC Travel Documentation B 1BUSLIC Business Licerise B M.Indoor Air Ouality and Finis -e 1.Use LOW No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes i IAQ/Health pts y=yes 0 3.Use Lowft 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 31AQ/Health pts y=yes 0 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.SaWatEr)oser?WTbdsboard_orMDF 41AQ/Health. pts y=yes 0 S.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 N.Flooring 1.Select FSC Certified Wood Flooring E Resource pts y=yes 0 2.Use Rapiciiy Renewable Flooring Materials I Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl .i IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor I Resource pts y-yes 0 6.Install Recycled Content Carpet with Low VOCs Resource pts y=yes 0 Total Points Available: 1401 1301 57 Total Points Project Received: 01 0 0 &data/progs/greei buildingguidelines/remodelers/greenpointsfinal2.12.D4prolected.xls CITY OF (.1UPERTINO CITYCUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN# f ©33, 0 0 Date: 7Z-0 or Building Address: 770 s&A i (ZEIN«-,. =- T CL i.tj a G `4 �� C� /4.1 Mailing Address (if different from building address): Are Hazardous Materials being used as part of thi.-; project? Yes El No X, HOA: Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Owner's Name: Phone#: T,e-WD R-i Z> C -e C L40 Contractor: Phone:(qcO -o6Zo Fax: (`toA &.V& -Obl' Contractor License#: � � S Cupertino Business License#: Contact: Phone: t Lt Cl?r) 66"&--0&z o P/4(-L Pqb/«,3 Fax: Residential K Commercial Job Description: �,, 1;k.e �c1%►�� ���d � c„�• 2�. v �'t Gl)5a . 111 (�'�►fi r. �-E; s NAC-i7 h, 41 tecLe Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, I-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-13 E9— Valuation , Square Footage: 000 Project Size: Express ❑ Standard ❑ Large 1] Maj or ❑ Green Building: Please complete relevant portion Df the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: IFor help, contact Build it Green at www.builditgren.or Revised 07/14/09 S�' Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .;UPEkTINO Building Department JOB ADDRESS: ,� p PERMIT # ` {� OWNER'S NAME: �Jc jF =7T—' PHONE #Yo t$ - , GENERAL ' .GENERAL CONTRACTOR: FAX# I am not using any subcontractors: 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 713 ev _ v Owner/Contractor Signature Date