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CITY OF CUPERTINO
BUILDING DIVISION P 1' M
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BUILDING ADDRESS:
PERMIT NO.
20800 HOMESTEAD RD, BLDG 32A—H
WEST BUILDERS, INC.
08040235
OWNER'S NAME:
PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED
1608 4TH ST TE 120
05/05/2008
PHOtYEg i7 rr%T
SANITARY NO. CONTROL NO.
ARCHITECUENGINEER:
BUILDING PERMIT (NFO
UNDERGROUND WATER PIPE ONLY
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Jg]� Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
.-.....-, .. r. _,.. _ _ _........ ,., _
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and eff
License Ci a LIC. s
Date Contractor ?J _A M 0
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 Tile a signed statement
Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq.
(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 exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to it civil penalty of
not more than five hundred dollars (5500).
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License Law does not apply m an owner of
9 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
sale.).
.
❑ L as owner of the property, am exclusively contracting with licensed contractors to -
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li.
cense 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.
❑ I am exempt under See , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby &(firm under penalty of perjury one of the following declarations
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sadon, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I 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 Workers Compensation Insurance carrier and Policy numberam::/)�{
Carrier. ALZ ya Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKER.&'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
1 certify that in the performance of the work for which this permit is issued 1 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 Codo, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
I
' CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
"Lenders Name
,
Lender's Address
j1 certify dot I 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 minting to
building construction, and hereby authorim representatives of this city to enter upon the
above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
which may in any way against said City
i liabilides, judgments, costs and expensesaccrue
' in consequence of the granting of this permit
' APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURQEGU
JJJJ11 �� `\JR , S ' OA
Re -roofs `—
Type of Roof
Signature of ApplicariMontractor Date
HAZARDOUS MATMALS DISCLOSURE
Will the applicant or future building occupant store or handle haairdous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Core, Section 25532(a)7/
Yes 4O
All roofs shall be inspected prior to any roofing material being installed.
C][1t
If a roof is installed without first obtaining an inspection, I agree to remove
Will thea applicant or future building occupant use
PP g P equipment car devises which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Ya
1 have read the hazardous materials requirements under Chapter &95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534,1 understand that if the building
does not currently have a ant, that it is my responsibility m notify the occupant of the
mquile7K wl�metpriornissuanaofaceniraLcofOccupancy.
Signature of Applicant Date
I,
1fr `tel —Cnt S &' is
All roof coverings to be Class "B" or better
Owner or authorized ager D21c
tc
A
CI7i of
CUPEKI INO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
D�D�o2�3s—
APN #
2_& 0. ORP 52 -AP
Date:
�� r
Building Address:
2a500 -R-6 �z
Mailing Address (if different from building address):
Owner's Name• I
d 1 CLI Li vn i �dl l�✓�,
Phone #:
C�5o -7
Contractor:
Phone: t(0B,-7L(&, Svc
P67r_ _ew I"Mie-A 1_T_iU C
Fax: 8 . 7A0, d
Contractor License #: 6710573-11 S
Cupertino Business License #:
Contact: L
Phone: SGD Z, . 2g 53
Fax: �lv� 55v Z�S
Residential Commercial
Job Description:
CO -1
Is the project in the Wildland- Urban Interface Fire Area? Yes
❑ No
Building Permit Info:
Bldg ❑ Elect ❑ Plumb 2__� Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 11-B ❑ 11,111,V -AE] 11, 111, 1V V -B
1
Valuation:
Square Footage:
Project Size: Standard ❑ Large ❑ Major 0/
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.builditgreen.org
4--
CITY OF
CUPEIk1'IN0
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1 GENCOM
1BTEMPPER
Temporary Building Permit (good for
B
30 days)
1BBOILERI
For the installation or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1BBOILER2
Installation /relocation of ea
Ivi
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3
Installation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4
Install ation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1MECHINSP
Other Mechanical Inspections (per
M
hour)
`
1 PLMBINSP
Other Plumbing & Gas Inspections
P
1
er hour)
1 MEETING 1 HR
Application Meeting
B
CITY OF
CUPEI,TIN.O
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/Duplex New
B
IACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
1 ACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1 CHIMNEY
Chimney
B
1 CHIMNEYR
Chimney Repair
B
FENCES
1 FENCE>6FT
Non -masonry, over 6 ft in height
B
1 FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1 FIREPLMAS
Fireplace Masonry
B
1FIREPLFAB
Fireplace Pre-Fabricated./Metal
B
1 FLAGPOL>20
Flag pole (over 20 ft in height)
B
1MODUSTRU
Modular Structures
B
FOUNDATIONS
1 FOUNDREP
Foundation Repair
B
1 PILECAST
Pile Foundation Cast in place concrete
B
1PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete) .
B
3 of 5
Mo F
CUPEIk1'IN0
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONR
1 RETSTN
Standard (up to 50 ft)
B
1RETSP310
Special Design, 3-10' high (up to 50 `)
B
1 RETSP 10
Special Design, over 10' high (up to
50'
B
1RETCRB<
Gravity/Crib Wall, 0-10'high (up to
50 ft
B
1RETCRB>
Gravity/Crib Wall over 10' high (up to
50 ft
B
SIDING
1 SIDESTBK
Siding, Stone & Brick Veneer
(interior/exterior
B
1 SIDEOTHER
Siding all other
B
SKYLIGHTS
1 SKYL<10 SF
Skylight less than 10 sf
B
1 SKYL> l OSF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1 SRACKS>8
Storage Racks over 8' high (up to 100
st)
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4 of 5
IrY OF
CUPEVINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1 WINMEWSTR
New Window -structural shear
wall/maso (includes plan ck fee
B
1 EPERMITFEE
Electrical Permit Fee
E
1 MPERMITFEE
Mechanical Permit Fee
M
1PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone. Mechanical Pln Ck (hrly)
M
1 PLMPLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
1 BSEISMICR
Seismic Residential
B
1 BSEISMICO
Seismic Commercial
B
1 TRAVDOC
Travel & bocumentation
B
1 BUSLIC
Business License
B
( is P t-, C ---e4-
5 of 5
'
Green Building Plan Check
Index of Green Building
Points/Categories
A.
Category
Example of an Index or Table of Green
Plan Sheet or Page
Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
i
B.
Site
9.
Install H.E. Irrigation, (details/spec)'
L-1
2 points
11. Permeable Paving, Note
L-1
2 points
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
5 points
D.
Structural
3.
Uses Wood I-Joist, (See Spec.)
S-2
2 points
5.
Use Truss with heels, (detail)
S-2
2 points
6.
B. OSB Sheathing, detail
S-2
2 points
E.
Ext. Finish
1.
Composite Decking, (Note/Spec.)
A-3
2 points
4.
B. Fiber Cement Siding, (Note/Spec.
A-4
2 points
F.
Plumbing
1.
Insulate all H.W. pipes, (Note/Spec.)
P-1
2 points
5.
Tankless W.H., (Note/Spec.)
A-2
2 points
11. A 2500 Gal. Tank, (Note/Spec
L-1
10 points
G.
Electrical
4.
E. Ceiling Fans, (Note/Spec.)
A-3
4 points
H.
Appliances
1.
Energy Star Dishwasher, (Note/Spec.)
A-3
1 point
3.
Energy Star Refrigerator, (Note/Spec.
A-3
1 point
P.
Other
1.
List Green Features on Plans
A-1
1 point
TOTAL POINTS
1
40 points
Plan Review Process Work Book Page -12-Revised 3/25/08