10010027 TY OF CUPERTINO BUILDING PERMIT
CI PERMIT NO: 10010027
0 VIA ESPLENDOR V-58 CONTRACTOR:TBD-TO BE
BUILDING ADDRESS: 2330 DETERMINED
DATE ISSUED:01/06!2010
,WNER'S NAME: SANDRA WALKER PHONE NO:
OWNER'S PHONE: 6502691520
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
10007EXISTING GAS LINE IN UTILITY CLOSET I
�, TAP OFF OF SUPPLY GAS TO FIREPLACE A,44
License Class Lac.# GARAGE TO
14� f__5t�jrp& 4 WKte c�:` 2 L--i Jh 4s
Contractor
licensed under theChapter
I hereby affirm that I am 7000)of Division 3 o the Business&Professions
(commencing with Section
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following
consent to self-insure r two declarations:
I have and will maintain a certificate ct on 3700 of the Labor Code,for the Valuation:$350
Compensation,as provided for by Se Sq.Ft Floor Area:
performance of the work for which this permit is issued. provided for by
I have and will maintain Workers Compensation Insurance,as p Occupancy Type:
Section 3700 of the Labor Code,for the performance of the work for which this
APN Number:34255043.00
permit is issued.
APPLICANT CERTIFICATION ation is PERMIT EXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the above
es and state laws relating
correct.I agree to comply with all city and county
o WITHIN 180 DAYS OF PERMIT ISSUANCE O
d hereby authorize representatives of this city to enter 180 DAYS FROM LAST CALLED INSPECTIO •
to building construction,anyfor inspection purposes. (We)agree to save
upon the above mentioned property p judgments,
indemnify and keep harmless the City of Cupertino against liabilities,judg ed b Pate:
costs,and expenses which may accrue against said unde stands and will comply
e of the
ity in consequeric Issued yl .....,....: ..
granting of this permit. Additionally,the applicant
with all non-point source regu( ion per the C ertino Municipal Code,Section RE-ROOFS:
.- ,,$
9.18. �/" roofing material being installed.If a roofis
Date l All roofs shall be inspected prior to any g to remove all new materials for
,Ynature installed without first obtaining an inspection,I agree
inspection.
OWNER-BUILDER DECLARATION Signature of Applicant:
Date:
I herebyaffirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
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, OSURE
Business&Professions Code) HAZARDOUS MATERIALS DISCL
I as owner of the property,am exclusively contracting with licensed contractors to 25533,and 25534. I will
I have read the hazardous materials requirements under Chapter 6.95 oft e
California Health&Safety Code,Sections 25505,
construct the project(Sec.7044,Business&Professions Code). al Code,Chapter 9.12 and the
of the following three maintain compliance with the 25532 is°should Is tore or handle hazardous
I hereby affirm under penalty of penury one Health&Safety Code,Section ( )
'ons: Worker's material. Additionally,Should I use equipment or uality Managementemit
eDistrict hazardous
I
declarations: Area Air Q h'
I have and will maintain a Certificate of Consent to self-insure
Code, the air contaminants as defined by the Bay Chapter 9.12 and
as provided for by Section 3700 of the will maintain compliance with the Cupertino Municipal Code,
Compensation,
of the work for which this permit is issued. the Health&Safety Code,Section 5505,255 nd 2553 .
performanceas provided for by
I have and will maintain Worker's Compensation Insurance, Dat .
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age
permit is issued.
�f
I certify that in the performance of the work for which this permit
the1Wo Workessued,I r's
ONSTRUCTION LENDING AGENCY
an person in any manner so as to become subject t C
not employ y
laws of Cajifornia. If,after making this certificate of exemption,I 3097 Civ C.)
Compensation
Code I must I hereby affirm that there is a constructionlendingagency for the per ormance o
become subject to the Worker's Compensation provisions
shall bethe deemabor ed revoked. work's for which this permit is issued(Se
forthwith comply with such provisions or this perm Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state ote laws relating
�a-tThe ab
correct.I agree to comply with all city and county rdinanes and sta
to building construction,and hereby authorize representatives of this city to enter ARCHITECT'S DECLARATION
for inspection purposes.(We)agree to save
n the above mentioned property P judgments,
mnify and keep harmless the City of Cupertino against consequence of the I understand my plans shall be used as public records.
costs,and expenses which may accrue against said City erstands and will comply
granting of this permit.+dditio ally,the apP'Cupertino Municipal Code,Section Licensed Professional
with all non-point sg e r ations per up
9.18.
�,,,.,,,...,,- Date
Signature
CITY OF CUPERTINO
OPERATOR: SylviaM
ITEM 1 OF 1 PERMIT RECEIPT COPY # � 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 34255043 . 00
DATE ISSUED. . . . . . . : 01/06/2010
RECEIPT #. . . . . . . . - : BS000009505
REFERENCE ID # 10010027
SITE ADDRESS . . . . . : 23300 VIA ESPLENDOR V- 58
SUBDIVISION : : : _ : : : CUPERTINO
CITY .
IMPACT AREA . . . . . . •
OWNERSANDRA WALKER
ESS . . . . . . . . . . : 23300 VIA ESPLENDOR VILLA 58
ADDRESS
CITY/STATE/ZIP . . • ; CUPERTINO, CA 95014
RECEIVED FROM JOHN TESORO
CONTRACTOR . . . . . . . TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . • • •
CITY/STATE/ZIP
TELEPHONE . . . . . . . . •
PD-TO-DT THIS REC NEW BAL
QUANTITY AMOUNT --
FEE ID --UNIT----- ---------- ---------- ---------- --------- ---------
0 . 00
------ 350 .00 1. 00 1 .00 0 , 00
1BCBSC VALUATION 63 .00 63 .00 0 .00
1 .00 0 . 00 0 . 00
1BREMFIXT NO. FIXTURES 350 . 00 0 .50 0 .50 42 . 00 0 . 00
1BSEISMICR VALUATION1 . 00 42 . 00 0 .00 0 . 00
JEPERMITFE FLAT RATE 63 . 00 63 .00 0 .00
1 . 00 42 . 00 0 .00 0 . 00
1PGASRES OUTLETS 1 .00 42 . 00 0 .00 0 . 00
1PPERMITFE FLAT RATE 1 .00 42 . 00 42 . 00 - ----------
1TR.AVDOC FLAT RATE ----253 . 50 211 .11
----2 .50 -----42 . 00 0 .00
TOTAL PERMIT :
PAYMENT AMOUNT' REFERENCE_NUMBER
METHOD OF PAY --------------- ___
42
CREDIT CARD ---- _00 visa
42 . 00
TOTAL RECEIPT VOICE ID DESCRIPTION
DESCRIPTION -_-__-_____-________--
VOICE ID -------- -------- -------PLUMBING
-------- ---_----- ----- 507 FINAL PLUM
301 ROUGH PLUMBING
CITY OF CUPERTINO
w
REPIPE/SEWERIMAIN SERVICE
CITY OF
CUPtklINO PERMIT APPLICATION FORM
0b tM2;-7
APN# Date:
`3442. 55 0&-t3 .
��-
Building Address: V S
Owner's Name:
Phone#:
Phone#: 2-
Contractor:
rte. ;� C; :, �-%;
s ', .. , �- Fax#:
Contact:
Phone#: /•- 5 Z'�
i
Fax#: V
Contractor License#:
Cupertino Business License#:
Job Description:
Residential Commercial El
Valuation:
Project Size: Express Standard Large Major❑
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.
Green Buildin Points:
Quantity Fee ID Fee Description Fee Permit Type
Grou
IPCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1
BPREPIPE Commercial re-pipe per fixture P 1CPRP
1 PGASCOM Commercial Gas Piping System P
1-4 Outlets
1 BCBSC Cal Bldg Standards Commission B ALL PERMIT
TYPES
Fee
1 BSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY OF CUPERTINO
r SERVICE
REPIPE/SEWERIMAIN
C 1n FEE�� SCHEIDULE
CUPEkTINO
. Fee Permit Type
Quantity Fee ID Fee Description
Q ty Group
Commission B ALL PERMIT
1BCBSC Cal Bldg Standards ,TYPES
Fee P
1 BSEISMICR Seismic Residential
P 1RPSS
1 PRSEWER Residential building
sewer/sanitary sewer P 1RPRP
1 PRREPIPE Residential re-pipe per fixture
P 1CPWS or
1BPWSVCS Water Service 1RPWS
1PPRSEWG Private Sewage Disposal System
P
Cesspool P
Cess
1PCESS p
1 BPWATER
Install/alter Water Pipe P
1BPFIXTUR
E Plumbing Fixture P
1PGASRES Residential Gas Piping System
P
1-4 Outlets P
1 BPGAS Gas Piping System 5+ Outlets
RMITFEE Plumbing Permit Fee Issuance
P
1 PPE
f P
1 PLMBLNCK Plumbing Plan Check
1 PLMBINSP
Other Plumbing/gas Insp. P
VDOC Travel & Documentation Fee
B
1 TRA
1 BUSLIC Business License
B
�/3
�ffPr21 -
M.Indoor Air ua ity an meshes 0
1 IAQ/Health pts y=Yes 0
1.Use -VOC Paint 2 IAQ/Health pts y=yes.
0
2.Use Low VOC,Water-Based Wood Finishes 3 IAQ/Health pts y=yes
3.Use Low/No VOC A&AWves 0
3 Resource pts y=yes
4.Use Salvaged Materials for Interior Finishes 0
5.Use Engineered Sheet Goods with no added Urea 6 IAQ/Health pts y-yeS 0
Formaldehyde 1 IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 4 IAQ/Health. pts y-yes
7.Seal E ,. _.P .W MOF 0
4 Resource pts y=yeS 1 Resource P
B.Use FSC Certified Materials for Interior Finish is y=yes 0
0
9.Use Finger-Jointed or Recycled-Content Trim 3 IAQ/Health pts y-yes
10.Install Whole House Vacuum System 1
N.Flooring0
8 Resource pts y=yeS 0
1.Select FSC Certified Wood Flooring 4 Resource pts y-yes
2.Use Rapicly Renewable Mooring Materials 0
4 Resource pts y=yeS p
3.Use Recycled Content Ceramic Tiles 5 IAQ/Health pts y=yes
4.Install Natural Linoleum in Place of Vinyl 0
4 Resource pts y=YeS 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y-yes
6.Install Recycled Content Carpet with Low VOCs Y=
Yes
130 57
Total Points Available: 0
0 01
t Received:
Total Points Pro ec
r� e>6
ata/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.o4protected.xis
RESIDENTIAL PROJE
CT COVER SHEET
Assessor's Parcel Number:
Name of own er. ���y
3
C�. 0
Project address. ! � �"l 3
41
°,,, Phone. _
Contact person.
Fax. 2eL'
footage, of lot.
Net square g proposed
Existin �,�
Square footage: First floor:
Second floor:
Garage:
TOTAL:
clears aces inside the garage? -=
Are there at leasp
A t two 10 foot by 20 foot �
N
-�
Is privacy protection Planting lantin required for the project? �--�
Build it Green Total Points
ein done9 l a S
On what floor(s) is work b g
Brief description of work. ��„
_ 2007 CMC �N)
Code editions:2007 CBC �2007 CFC ��N)
2007 CPC -N)2007 NEC
Effective 1/l/08 r, >t<c,vF[) (.;F
� ;.
�4t[iF,t�k F YITF NC E
()[ADINA S
TINCT
SIGNED� - , itcat,vns MOST
This set of plans��,`d:�t trr��P` and it is
to kept on the Ob �.. e�,Or alterations
ai to makr'aY �ar��t
uniawt' ��rien oe",,,Ssi�r,troy,
me wittlo��t w {_•,t �f Cupertino.
on rlv)l,)
artn gent. l Y ��i{it,ations
the uilciing Oaf)and�� dr,
The stamping° .r to�'
S}iALt NOT t)ti hYlci t��t,errnt �Yr�;ions
vrcliir +� _f < ,
aypr ov at of the t t e aw
i
Page-8-Revised 8/05/08
Plan Review Process Work
Book
CITY OF CUPERTINO
OPERATOR: SylviaM
6 ITEMS
OF 6 PERMIT RECEIPT COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 34255043 . 00
DATE ISSUED. • • • • " ' 01/06/2010
BS000009504
RECEIPT #• • • • " " . 10010027
REFERENCE ID # • • • •
SITE ADDRESS 23300 VIA ESPLENDOR V- 58
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . .
CUPERTINO
IMPACT AREA . . . . . .
OWNER SANDRA WALKER
23300 VIA ESPLENDOR VILLA 58
ADDRESS . . . . . . . . . CA CA 95014
CITY/STATE/ZIP . • •
RECEIVED FROM JOHN TESORO ED LIC # 00096
TRACTOR TBD - TO BE DETERMINED
CON TBD _ TO BE DETERCOMPANY . . . . . . . . . .
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP
TELEPHONE . . . . . . . .
PD-TO-DT
THIS REC NEW BAL
UNIT QUANTITY AMOUNT ----- ---------- ----------
FEE ID -------- ---------- ----- 1.00 0 . 00
------- ----- -- 1. 00 0 .00 0 .00
VALUATION 350 . 00 0 .00 63 .00
1BCBSC 1 .00 63 . 00 0 .50 0 .00
1BREMFIXT NO. FIXTURES 0 .50 0 .00 0 , 00
350 .00 0 .00 63 . 00
1BSEISMICR VALUATION 1 .00 63 .00 42 . 00 0 .00
1PGASRES OUTLETS 42 . 00 0 . 00 0 . 00
1 .00 0 .00 42 . 00
1PPERMITFE FLAT RATE 1 .00 42 .00 ------- --
ATE FLAT RATE ---------- ---------- --- 0 . 00
211.50
0 . 00 211 .50
TOTAL PERMIT
AMOUNT REFERENCE NUMBER
METHOD OF PAYMENT ------------- --------------------
___ _ __
----------------- 211.50 visa
CREDIT CARD _______________
211. 50
TOTAL RECEIPT DESCRIPTION
DESCRIPTION VOICE ID _______________
VOICE ID DESCR _---------- -------- -------------
-------- ----------------- 507 FINAL PLUMBING
301 ROUGH PLUMBING
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
w.
Fax(408)777-3333
CITY�OF
,.;UPE TINS ,
�
.
art a nt
Bu'01d1l
n D e a
PERMIT # J ,
KESS:
JOB ADD Z-
I e PHONE # Y4' �-
R'SNAME: S`�s��,��� �✓��� # � �.� �^_�4�
OVVNE
FAX
GENERAL CONTRACTOR -�
I am not using any subcontractors: Date
Signature
and CO lete the f ollowin information:
Please check a licable subcontractors BUSINESS LICENSE #
SUB CONTRACT
OR BUSINESS NAME
Cabinets &Millwork
Cement Finishing �-7-z-`l
Electrical ��`'� �- `ee
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
Date
owner/Contractor Signature