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09070122 CITY OF CUPERTINO BUILDING DIVISION PERMIT �1 'TI � '+� t �ttTIE7�N. BUILDING ADDRESS: PERMIT NO. 10633 LA RODA DR DOMINIC IP `JER'S NAME: PERMIT ISSUE DATE DOMINIC 112 10-60-2-3 Lk RGDA DR PHONE: S A CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u0p LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing z t, with Section 70(10)of Division 3 of the Business and Professions Code,and my license is ?may in full force and effect. REPLACE 7 WINDOWS LIKE FOR LIKE �23Z License Class Lic•M n E-jZ DateContractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records �yU L OH Licensed Professional rn 3 OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the i p O following reason.(Section 7031.5,Business and Professions Code:Any city or county t m Pi which requires a permit to construct,alter,improve,demolish,or repair any structure Zprior to its issuance,also requires the applicant for such permit to file a signed statement FE< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 5q.Ft.Floor Area Valuation Y.f- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 2 2 0 0 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars(5500). 36933029 . 00 ❑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,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sak. 1,as owner of the property,am exclusively contracting with licensed contractors to trust the project(Sec.7044,Business and Professions Code:)The Contractor's u. cc Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the contractor's License Law. Q lam exe=un — ,B&P C for this reason ,e Date VaRM-S COMPENSATI 1 TION I hereby affirm under penalty o[perj f following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,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 required by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Q 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z 0.4 CONSTRUCTION LENDING AGENCY [~i►�-h I hereby affirm that there is a convection lending agency for the performance of . (1, the work for which this permit is issued(Sec.3097,Civ.C.) aA Lender's Name aLender's Address U O 1 certify that I have read this application and state that the above information is V. cormcL 1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any true against said City U Z in consequence of the granting of this permit. Date APPLIC N�ANDWILL COMPLY 1 A NON-POINT Issued by:S E REGUL NSRe-roofs Signature of Appiicant/ContraDate Type of Roof HAZARDOUS MATERIALS DISCLO RE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety k,Section 25532(a)?� All roofs:;hall be inspected prior to any roofing rial being installed. ❑Yes No Will the applicant or fu rc building occupant use equipment or devices which If a roof i:.installed without first obtaining an inspect n, tee to re e emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new In iterials for inspection. District? ❑Yes ° 1 have read the hazardous materials requirements under pter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534 undc d that if the building does not currently have a tenant that it is my responibii y to no fy the occupant n e requirements which mast be met prig to issuance ofa C Pica cul Signature of Applicant Date o cora orizr gent Date All roof coverings to be Class'n"or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: BlY: Lot: APN . . . . . . . . : 36533029 . 00 DATE ISSUED. . . . . . . : 07/15/2009 RECEIPT #. . . . . . . . . BSC00008198 REFERENCE ID # . . . : 09C70122 SITE ADDRESS . . . . . : 10E33 LA RODA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER DOMINIC IP ADDRESS 10E33 LA RODA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4430 RECEIVED FROM . . . . : DOMINIC IL CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY DOMINIC IP ADDRESS 10E33 LA RODA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4430 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY I,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 200. 00 1 .00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 2, 200. 00 0 .50 0 . 00 0 .50 0 . 00 1WINREP EACH 8 1 . 00 380 . 00 0 . 00 380 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 381 .50 0 . 00 381 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 381.50 1286 --------------- TOTAL RECEIPT 381 .50 k., Community Development ;y 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEI�TINO Building Department JOB ADDRESS: `` PERMIT # g070/0 4 Z-. OWNER'S NAME: PHONE — a GENE CTOR: FAX # I am not using any subcontractors: Si;nature 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 ner/C tractor Signature -. Dat �- G .moa-t/v/c � 3 O 47X 4� TZ615;A� �� k-KA� Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 1 OF Fax(408)777-3333 CUPEkTINO Building Department All Cupertino building permits must meet certain conditions related to maintaining environmental quality and public peace and safety. The two most common conditions are described below. STORMWATER POLLUTION CONTROL. State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and the Santa Clara Valley Water District cortrol stormwater pollution. Educating local residents and businesses and enforcing !tormwater pollution control laws are key parts of the City's compliance efforts. Stormwater pollution prevention: It's up to us In northern Santa Clara Valley, storm drains flow directly to local creeks and San Francisco Bay, with no treatment. Storniwater 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 Stormwater pollution include: • Dripped oil, fuel, and antifreeze from vehicles and heavy equipment; • Construction debris, including dire:, concrete and paint; • Landscaping runoff containing pesticides or weed killers; and • Any material dumped or spilled irto streets or storm drains The property owner and the contractor scare ultimate responsibility for activities' . . occurring at a construction site and will he held responsible for any environmental damage caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations section of the City of Cupertin vygbsite at: http://www.cupertino.orci/city gcvernment/departmen of i a. environmental services COMMUNITY NOISE CONTROL ----------- The basic noise control requirements for construction sites are as follows: • Typical construction work hours are: - Weekdays - 7 a.m. to 8 p.m. - Weekends - 9 a.m. to 6 p.m. • Construction other than street construction is prohibited on holidays. • Residential daytime noise levels f-om complaint site - 60 dBA • Nonresidential daytime noise levels from complaint site - 65 dBA For more information on noise control, please see Chapter 10.48 of the Cupertino Municipal Code, which can be accessed at http://www.amlegal.com/cupertino ca/ Greg Casteel Building Official CITY OF (,UPERTINO CUPE�TiNO GENERAL BUILDING PERMIT APPLICATION FORM j22- APN# q 33 O 2 9.o Date: / O Building Address: LL Mailing Address (if different from building address): Are Hazardous Materials being used as part of thio project? Yes 11 No HOA: Exterior work only) Yes ❑ No If yes, provide letter from HOA Owner's Name: Phone#: Conor: Phone: O Gad�✓ Fax: Contractor License#: Cupertino Business License#: Contact: O/`4/A.)/ (5 //V Fax:Phone: C4451&0,) -411f-f1f- o2g D Residential Commercial Job Description: e-ePLAci vg AC/s 7/-A)4- td,1AJJ) a u)S �i��� ��rz L kzz Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: ,G j II/Ill B IV-HT 3 k�f� S 1 I 1-A, 1-B ❑ II/III/V-A E] ,V-: Valuation: Square Footage: [Project Size: Ex ressE Standard 96 Large 1] Ma'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.builditgr:en.or Revised 07/14/09 CITY OF (�UPERTINO CU CITY OF O GENERAL BUILDING APPLICATION 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 I'J 1WINREP Replacement windows/sliding glass B door ea :3 windows) 1 WINMEWSTR New Window-structural shear B wall/masa (includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alc ne Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alc ne Mechanical Pln Ck(hrly) M 1PLMBLNCK 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) hourl -su nd alone I 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5