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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