01090055i
ci TyOF
GUPERTTINO CONTRACTOR INFORMATION:
PERMIT
rWNER'S
UILDING ADDRESS PERMIT NO.
10106 CRESCENT RD 01090055
NAME'. APPLICAsUON S B DATE
'1
STEVE W AND LAURA L PATERSON 09/14%2001
PHONE: SANITARY NO. CONTROL NO.
O Q ARCHITECT/ENGINEER: BUILDING PERMIT INFO
A
a p. 7 BLDG ELECT PLUMB MECH
h a i I I O U I__.I
LICENSED CONTRACT'OR'S DECLARATION
5 4 z I b<rab (firm mat 1 am Taman under f Cha 9 (commencing Job Desert tion
y - L, r+ provisions o per O3
mtlu withSeaion]1100)ofDivisionloftheBusinessandProfessionsCndc.andmylicenu NEW SINGLE FAMILY DWELLII'p1
,aa� isinfaBrorceandiffer. LIVING SPACE 4051 SQ. FT. , ,e ��E®
z z 6 License Class Lic. a
a°a. Data contmcmr GARAGE 522 SQ. FT.
�' ARCHITECT'S DECLARATION JAN 2 s zona
u O ; I unde.mnd my plans shall be used as public records
oo ucrism Prorassional
OWNER -BUILDER DECLARATION u 1GV
1 m 1 hereby affirm that 1 am exempt from the Commoner's License law for the
:?a following muson.(Section 7031.5. Business and Pmfessions Code: Any city or county
i - a which requires a permit to construct. alar, improve, demolish, or repair arty structure
j 3 g
Pool I its iToannicat Naba,irax The filiation for such Demo, I fl signed taemem
that hislicensed p- ain to, the Provisions of the Contractor s License La(Chapter9 S Ft. Floor -Area - ,
(commencing thSection ]WO),rDivision 3ofThe Bmare dl efeiona,Code) b s L° r 9', $4087�tVation
4. ,�
or that he is excm I therefrom and the basis for the alleged eomo id n, An "` f. e ! }'- 1 . \ f ' 1 !'. 1 i .. _
g g p y lPenaan
-of Section e than v any applicant Tore permit subjects ane applicant to a civil penalty
or not more than five hundred auras (ssoo). 32641P>)Ifft-91b0'0 Occupancy Type
❑ i, as owner of the progeny, or my employees with wages as their sole compensation.
willBus ne me work, and the aracmre is not cors Li en a eredLaw for .ale (sec. to a, 101 - FOUNDAT TZWired Inspections
Rosiness and work,
and the
Cody The Cmmtaaor3 License Law docs not apply man
owner of property who builds or improves thereon, and who does such work Himself 102 - PIERS
or through his own employees. provided that such impmvemenes are not intended or
offered for sale. H. however, the building or improvement is sold within one year of 103 - UFER .. .. . _. .... ..
ompletion, the owner -Wilder will have the burden of proving that he did not build or
improve for ppoeors
sate.). 104 - REBAR
-K. as owner of pmyeid, am -exclusively contracting with ran.. contract.. m 105 - "ANCHOR BOLTS
construct the project (Sec. nrw, Business and Profession, code.) The Commemr's 10 6 - SEWER & WATER
um canse Law does not apply an owner or progeny who builds or imimaves thereon.
mad who contracts Tor such pmjeats with m coramom,) licensed ansurd, 10 the .. 202 - UNDERFLOOR PLUMBING
Comumaors License Law.- -- - .
❑I am <mpt wade s , B& P C for this reason 203 - UNDERFLOOR MECHANICAL
o�te/ µ 2- 2 204 - UNDERFLOOR FRAME
WO KER'SCOMPEN3�TIONDECLARATION 205 - UNDERFLOOR INSULATION
N, I heresy alum under gentry of perjury one or he following eecla aim,: 301 - ROUGH PLUMBING
C0 1 nava am will mainmin a certificate of Conant m self -insure Tor worker's 302 - TUB & OR SHOWER
ompensation.
ii she provided
whichbihisSpemm°i; s0ued. see labra cote, for the 303 - ROUGH MECHANICAL
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 304 - ROUGH ELECTRICAL
37M of the Labor code, for the performance of nae work -for which this permit is 3 0 5 - FRAME
' issued. My Worker's Compensation Insurance carrier and Policy number are:
306-,HOLDOWNS
Carrico i t l 1'�' Policy
'
CERTIFICATION OF IO wORK'ERSI � .307 +INSULATI0N
COMPENSATION INSURANCE'' •:
- - -----308 - SHEETRO@K.._
(This hart need not be anmplead iithe permit is for one hundred dollars
309 - EXTERIOR LATH
(5100) or lex..)
310 - INTERIOR•LATH -
1'cmify that in Ise per Tomtanc of Ina wore* rut which This permit is issued, 1 .. _ .
shall n I empfor any perion m any r su t become ye Io m< workers 311 - SCRATCH COAT- ,.
comycnsaay,J, law: orQQ firpry °° ss°( �0o1 313 - ROOF NAIL _
Appli amA Q.L(/1 as !V as -
NOTIChOAPPLICANT:Vf.mfacr making thisCmirca¢of Exemption, you should 501 - FINAL ELECTRICAL ENERGY
be<mne nuhjca m the Worker's Cnmpcnsanan pmvisieris of the Labor Cale, you most
forthwith comply with such provisions orThis permit JadIbedeammmvokea. 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY - 503 - FINAL MECHANICAL ENERGY -
> I hereby alfimt that them is a construction lending agency for the perfomtance
of the work Tor which this .it is issued (Sec. 3097, Civ. e.) 504 - FINAL BUILDING ENERGY
Undcr's Name -- ...
505 - FINAL ELECTRICAL
z LenchnsAddress
O T(certify That Ihavu rend his application timemahe sand above inmrmwon is 506 - GAS TEST - ^
>[:. aortect. I egra ao comply with all city and enunty ndinances and state laws relating 507 - FINAL PLUMBING /li/•(7/�`
[) 1.htildingconswaion. andM1crebyruthodssrepresentativesofthiscitytoenterupon 508 - FINAL MECHANICAL
r� the above-memgeny ioncd profor inspection pit"...
L (We)agree to lave, iadcmnify and kap hamJess the City of Cupertino against
m
liabilities, judgments, costs and expenses which may in any way acerae .gaits, said 509 - FINAL GRA E
sat City in I cANTUnceof the granting D this permit.
PPLI ANT UNDER$T DS D WILL COMPLY WITH ALL NON -POINT'' 51 Z N NG V (�
.. S G I no Issued Date
ys� 7�Gr�o — ;2�42 W-_� t51
Signature of Applicaatloat—roam. Dca Re-roo6M - ROOF PLYWOOD NAIL
HAZARDOUS MATERIALS DISCLOSURE' - ROOF BATTENS _
Will the aal r pphiafuture Wilding occupant marc ser handle Infamous andmial Type o f
as defined by the Cupertino Municipal Code, Chapmr 9.12. and Ne Health and Safe,, 04 -.ROOF -IN-PROGRESS -
Code; Section 255321aU. t 1
oY •• ' _ All roofs shall e inspected pnor'to any roofing material being installed.
Will rte,fictam an future W (ding occupant use cq 'p t device, which If a roof is installed without first obtaining P g an inspection, I a ree.to remove
m t Incestuous a contaminants as defined by the Bay Area Air Quality Management
�District'
th It' Yes �No all new materials for inspection. Applicant understands and will comply with
all non -point -source regulations. -
I have it the Thai. doses materials requirements under Chdpter 6,95 of the '
CalifoTo a Itralth & Safely Code, Sections 25505, 25533 and 25534, 1 understand that
if The be ilding ares sol currently have a mnam. that it is my responsibility m notify the -
dvecu ant f the requitepwpls which all be mel prior to issuance of a Certificate of
a Signature of Applicant Date
wne, or euthotiutl agent Date All roof coverings to be Class "B" or better
' OFFICE
' OFFICE
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Y OF
CITINO
DIV SINNCONTRACTOR
FFRMTI
INFORMATII�
BUILDING ADDRESS:
PERMIT NO.
10106 CRESCENT RD
01090055
OWNER'S NAME:
STEVE W AND LAURA L PATERSON
APPLICATIONS DATE
0914 2001
4d
PHONE:
SAN—. hF) VO. CONTROL NO-
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u o u L.1
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby that licensed under provisions of Chapter 9 (commencing
NEW
SINGLE FAMILY DWELLING.
with Section 7000)0) of of Divisionn 3 3 of the Business and Professions Code. and my license
is in fun force and effect.
LIVING SPACE 4051 S Q . FT . ,
License Class Lic. R
Date Contractor
GARAGE 522 SQ . FT .
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code. Any city or county
which requires a permit to construct, alter. improve. demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft. Floor Area.
4 0 g '�(yation
that he is licensed pursuant tq the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code)
or that he is exempt therefrom and the basis for the alleged cAemption. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
3 2 lG1L9* jr0
Occupancy Type
❑ 1, 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,
101
NDAT FOU
- RQNired
Business and Professions Code: The Contractor's License Law does not apply to an
Inspections
owner of property Who builds or improves thereon, and who does such work himself
102
- PIERS
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
103
- UFER
completion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
104
- REBAR
�(1, as owner of the property, am exclusively contracting with licensed contractors to
105
- ANCHOR BOLTS
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
10 6
— SEWER & WATER
License 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
202
- UNDERFLOOR PLUMBING
Contractor's License Law.
❑ 1 am cent t unde c. , B & P C for this reason
203
- UNDERFLOOR MECHANICAL
o e MZ7
204
- UNDERFLOOR FRAME
W KER'S COMPENTION DECLARATION
205
— UNDERFLOOR INSULATION
I hereby affirm under penalty of perjury one of the following declarations:
301
— ROUGH PLUMBING
❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's
302
— TUB St: OR SHOWER
Compensation, as provided for by Section 3700 of the Labor Code, for the
303
— ROUGH MECHANICAL
performance or the work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
304
— ROUGH ELECTRICAL
3700 of the Labor Code, for the performance of the work for which this permit is
305
- FRAME
issued. My Worker's Compensation Insurance carrier and Policy number are:
306
— HOEDOWNS
Carrier. Policy No:
CERMCATION OFEXEMPTION FROM WORKERS'.
307
— INSULATION
COMPENSATION INSURANCE
308
- SHEETROCK
(This section need not be completed if the permit is for one hundred dollars
309
- EXTERIOR LATH
(5100) or less.)
310
- INTERIOR LATH
I certify that in the performance of the work for which this permit is issued, I
shall employ any person for so as t become sub jc�t to the Workers'
311
— SCRATCH COAT
pneot
Com nsat Laws of ali a.DO Z
atU r
313
ROOF NAIL
Appli an
Nar,c O APPLICANT: f, after making this Certificate of Exemption. you should
5 01
_
FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
502
- F I NAL PLUMBING ENERGY..
CONSTRUCTION LENDING AGENCY
503
- FINAL MECHANICAL ENERGY
1 hereby affirm that there is a construction lending agency for the performance
504
- FINAL BUILDING ENERGY
of the work for which this permit is issued (Sec. 3097, Civ- C.)
Lenders Name
505
- FINAL ELECTRICAL
Lender's Address
506
- GAS -TEST
I Certify that 1 have read this application and slate that the above information is
corect. I agree to comply with all city and county ordinances and state laws relating
507
- F I NAL PLUMBING
to building construction, and hereby authorize representatives of this city to enter upon
the above-mentioned property for inspection purposes.
508
- FINAL MECHANICAL
(we) agree to save, indemnify and keep harmless the City of Cupertino against
509
- FINAL G E
liabilities, judgments, costs and expenses which may in any way accrue against said
City in consequence of the granting of this permit.
5 1 0
N NG V�
P LICANT UNDERST S ND WILL COMPLY'WITH ALL NON -POINT
Issued by
Date
Signarurc of ApplieanU ontractor Dae
Re-roo6M
— ROOF PLYWOOD NAIL
HAZARDOUS MATERIA] -.S DISCLOSURE(
Will the applicant or future building occupant store or handle hazardous material
Type o
— ROOF BATTENS
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Halth and Safety
604
— ROOF IN—PROGRESS
Code, Section 25532(a)?
❑Yes '6xNo
All roofs shall
be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Ara Ao Quality Management
District?
all new materials for inspection. Applicant understands and will comply with
❑Y`s XNo
all non -point source regulations.
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
if the building does not currently have a tenant, that it is my responsibility to notify the
u
occupan f the requireptepts which must be met prior to issuance of a Certificate of
° ccu
P /)
Signature of Applicant Date
All roof coverings to be Class "B" or better
wner or authorized agent - Date
0
F
z
F
W
a
a
U
Lr.
Q
F
U
INSP.
TEAR OFF INSPECTION:
INSP
DATE INSP.
BATTENS:
DATE INSP
DATE INSP._
FINAL:
DATE [NSP.
DATE
DATE
NOTE. OSHA APPROVED ACCESS TO ROOF SHALL BE PROV11DED FOR INSPEC'111ON
A`IP ICAANITiS POSTING COP.'
BUILDING DIVISION
IT
PERMIT
BUILDING ADDRESS-
PERMIT NO.
ci
OWNER'S NAME.
-i.-nmn-Ci
APPLICATION SUB DATE
/
:.HONE:
SANITARY NO.p�/14�2M1
CONTROL NO.
_
ARCHITECT/ENGINEER.
PHONE n
BUILDING PERMIT INFO
BLDG ELECT
PLUMB NIECH
J I- I
I 1
:Z
INSPECTIONS
DATE INSPEC
TO ARRANGE INSPECTION JOB DESCRIPTION
CALL TTI- 3228 MONDAY - FRIDAY 24 HOURS RESIDENTIAL:
OUNDATION/PIERS/H.D.S.
BEFORE REQUIRED INSPECTIOM JOB ADDRESS E)SFDWL
El KITCHEN REMODE
• ND PERMIT # APE NEEDED WHEN PHOiN'LNG. ❑ ADDITION
❑ PLUMBING RE -PIPE
UFER GROUND
�Z
❑ MULTI -UNIT
❑ STRUCTURAL
PAD/SET BACK -CERT ✓
6,LB t
77 /�—
ESII�fFPf COMMERCIAL OTHER
MODIFICATION
I
GARAGE SLABS/PREGUNITE
El
❑ CHIMNEY REPAIR
u
J
t
POUR �r O COItCPF_TEU rl CII_ABO✓E HAS fiYI, Sir, -ED
HAZARDOUS FIRE AREA IMPROVEMENT
F1 SWIMMING POOLS
i C
UNDERGROUND/SLAB
❑ YES If yes - 1 understand that a CI- A roof assambly is required. ❑ BATH REMODEUREPAIR
❑ DEMOLITION
❑ OTHER
PLUMBING
❑ NO Initial I.C.B-O- #
a
ELECTRICAL
DO.NOT• POtOt FLOOR UlsITIL ABOVE HAS BEEN SIGNED
EXISTING ROOF COVERING COMMERCIAL:
❑ NEW BLDG/ADDITION
❑ DEMOLITION
PLUMBING
Number of existing coverings ❑TENANT
El FOOD SERVICE
MECHANICAL
/ O�Z
IMPROVEMENT
ELECTRICAL
To be removed To be retained ❑ OTHER
FRAMING VENTS
INSULATIONg
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
- `^
+`? P� I Pli C1oQ0•C(14m�dC
ROOF SHEATH/DIAPHRAM
,EXISTING: t PROPOSED: v
PLUMBING
❑ Built -Up Roof ❑ Buih-Up Roof
TUBS & SHOWER PAN
_
❑ Asphalt Shingles ❑ Asphalt Shingles
MECHANICAL
❑ Wood Shakes ❑ Wood Shakes
ELECTRICAL/POOL BOND
❑ Wood Shingles ❑ Wood Shingles
FRAMING/STAIRS/E. EGRESS
'
❑ Other (Specify) ❑ Other (Specify)
INSULATION/VENTILATION
Provide I.C.B.O. Report No.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
Provide Mfgn Installation Specs.
EXTERIAL SHEARMOLD DOWN
z
INTERIOR SHEAR/HOLD DOWN
i .-',"- -' :'
4-
INSPECTION SPECIAL INSPECTION REQUIRED ❑
DATE INSP
SHEETROCK/SHEETROCK SHEAR
EXTERIOR LATH/W-SCREED
4 �.
v,.
-4
SHOWER LATH
Z +
/ 6
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNEU
SCRATCH COAT
,�
6 -EWE ATE
TEMPORARY APPROVALS
/A
OCCUPANCY
�ID�
FINALS
3
PLANNING 777-3308
Jz3
z
OGAS
TEST
- 73
/
GRADE
r
FIRE
r
HANDICAP
z
0
ELECTRICAL
F—
PLUMBING
WMECHANICAL
�Z
ENERGY
„_,,,�
VISUAL FINAL ONLY
BUILDING—,�
OCCUPANCY" OF BUILDING 1.5 NOT PERNII•FTED
UNTIL BUILDING FINAL IS SIGNED BY_BUILDING
INSPECTOR.
CERTIFICATE OF OCCUPANC
PRE -INSPECTION:
PLYWOOD: IN -PROGRESS
INSP.
TEAR OFF INSPECTION:
INSP
DATE INSP.
BATTENS:
DATE INSP
DATE INSP._
FINAL:
DATE [NSP.
DATE
DATE
NOTE. OSHA APPROVED ACCESS TO ROOF SHALL BE PROV11DED FOR INSPEC'111ON
A`IP ICAANITiS POSTING COP.'
INSTALLATION CERTIFICATE(Page 1 of 13) CF -6R
Site Address
Permit Number
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required, however, use of this form to provide the information is optional.) After
completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at
occupancy, per Section 10-103(b).
HVAC SYSTEMS:
Heating Equipment
Equip.
Type (pkg.
heat u
# of
CEC Certified Mfr Name Identical
r Systems
Efficiency
(AFUE, etc.)'
> value
Duct
Location
t
Duct or
Piping
-v
Heating
Load
(Btu/hr
Heatin_
Capacity
ut/hr
S
�- X ]
ti�'7.r
a . Z
% 2� _
)1(, l�c0
--l-r
CA:�2 21A
Cooling Equipment
Equip.
CEC Certified Compressor # of
Efficiency
Duct
Cooling
Cooling
Type (pkg.
Unit Mfr Name and Identical
(SEER, etc_)'
Location
Duct
Load
Capacity
eat um
Model Number Swerris
r>CF-1 R value
attic etc.
R -v lug
BwAr
Btu/hr
(:;42a-_7,r4A BR,08c, I
i z
A 'ZG
- -
1. > reads greater than or equal to.
I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more
efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the Ener -i-
.1
Efficiency Standards for residential building and 3) equipment that meets or exceeds the appropriate requirements for
manufactured devices (frorrythe Appliance Pfflciency Regulations or Part 6), where applicable.
V_
Date
TING
Heater CEC Certified Mfr
Tye Name & Model Number
7 i- ,
5 m/_/'q C"'L..1b S --, c 7 C ti S
Installing Subcontractor (Co. Name)
OR General Contractor (Co. Name) OR Owner
Distribution If Recir- # of Rated' Tank Effi- External
Type (Std, culation, Identical Input (kW Volume ciency Standby Insulation
'oint-of-Use) Control Tvpe Svstems or Btu/hr) (gallons) (EF. RE) Loss (%) R -value'
�. L;
2 For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor.
For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Recovery Efficiency, Standby Loss and Rated Input.
For instantaneous gas water heaters, list Recovery Efficiency and Rated Input
3. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.58.
Faucets & Shower Heads:
All faucets and showerheads installed are certified to the Commission, pursuant to Title 24, Part 6, Section 11 1.
I, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2) equivalent to
or more efficient than that specified in he certificate of compliance (Form CF -1 R) submitted for compliance with the
Energy Efficiency Standa ds f resrential buildings; and 3) equipment that meets or exceeds the approprialc
requiremen for manufac ed evices-//(from the Appliance Efciency Regulations or Part 6), where applicable.
gnature, Date Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
Compliance Forms August 2001 A-23
19.28.150 Cupertino - Zoning 40
Date
Property Location
Address:
I agree to waive or modify the privacy protection measures required of the Single -Family Residential Ordinance as follows:
i
SI� I I d (o cf?--sc4 c f-
Propert3
Address
Phone:
Signatur
(Ord. 1860, § 1 (part), 2000; Ord. 1834, (part), 1999)