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10110012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22571 RICARDO RD CONTRACTOR: oERMIT NO: 10110012 OWNER'S NAME: DAVID&PAULINE WONG � �� t L,� DATE ISSUED: 11/02/2010 — ER'S PHONE: 4153057640 f�e. PHONE NO: Gd LICENSED CONTRACTOR'S DECL�A+-R—ATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB License Class Lic.# �G[o J r— F fie- " RESIDENTIAL COMMERCIAL Cont or Date (�' Z-1d I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ROOF TO WALL LEAK REPAIR.SOUTH WEST CORNER OF (commencing with Section 7000)of Division 3 of the Business&Professions FAMILY ROOM ADJACENT TO WEST GARAGE WALL& Code and that my license is in full force and effect. OVERHANG.REMOVE DAMAGED WALL SHEETING,BUILDING I 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. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this----, Sq.Ft Floor Area: Valuation:$3000 permit is issued. APPLICANT CERTIFICATION APN Number:35601052.00 Occupancy Type: I certify that 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 relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signatur Date I( Z �(D Issued Date: /(,4-2 10 rl OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must or' t: forthwith comply with such provisions or this permit shall be deemed revoked. -(0 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional Building Department 191 City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 22, PERMIT# loll V �— OWNER'S NAME: ��, ;n�, a PHONE# Q08 989-.5-196 GENERAL CONTRACTOR: �j� `�� h�, BUSINESS LICENSE# ADDRESS: Owt CITY/ZIPCODE: ��(2 *Our municipal code requires all b sinesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date M.In oor Air Qualdy and M-she 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes p 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes p 3.Use LowMo VOC Adhesives 3 IAQ/Health pts y=yes p 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes p p 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 7.Seal a!Exposed Parboleboard or MDF 4 IAQ/Health. pts y=yes p B.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 p 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes p 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 ! ! 1 Total Points-Available: 1401 1301 57 Total Points Project Recelved: 01 0 0 G:datalprogs/greenbuildngguidelines/2modelers/greenpointsfinal212.o4protected.xls CITY OF CUPERTINO C1TY 0'F CUPEKTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# 3�-� , d C , o� Date: Building Address: 2 5 7 Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes E No HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Owner's Name: Phone#: JAve- I f au l;n e ort - - - Contractor: ��// ?? IIPhone: mou �Cr�e D��dP.f 5, — _ Fax: Contractor License* 7/1 6 g o Cupertino Business License#: Contact: V-�- � Phone: a d Gk t / � Fax: �� $ $�7M rtesidential Comm al ❑ Job Description: pa o c_�p- riJ'a/G( lea�- ref:q� C'-- Aver" , S i\ ,�� view rvw"\Ids 4'�'J a'c olae czs Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ U/III/V-A ❑ I=B, IV-HT, -V-B Valuation: Square Footage: Project Size: Ex ess Standard ❑ Large ❑ Major ❑ 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. )ints Achieved: For help, contact Build it Green at www-builditgreen.orgr Revised 07/14/09 3