09090213 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10210 LEBANON DR CONTRACTOR:ZITTIN DAVID AND FLOY PERMIT NO:09090213
E
(""NER'S NAME: ZITTIN DAVID AND FLOY E 10210 LEBANON DR DATE ISSUED:09/29/2009
..NER'S PHONE: 4082533258 CUPERTINO CA, 95014-2648 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I- PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL KITCHEN,MINOR STRUCTURAL
(commencing with Section 7000)of Division 3 of the Business&Professions INCLUDE
Code and that my license is in full force and effect. ELECTRICAL,LIGHTING,PLUMBING&SUBPANEL(292SQ)
I hereby affirm under penalty of perjury one of the following two declarations:
1 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 Sq.Ft Floor Area: Valuation:$25000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:34214012.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Si—ature Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
I,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
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If,after making this certificate of exemption,I Ow r or u agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
v 'he above mentioned property for inspection purposes.(We)agree to save Lender's Address
i. zify and keep harmless the City of Cupertino against liabilities,judgments,
costs,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 I understand my plans shall be used as public records.
9.18. '
Signature Date
2 Licensed Professional
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 34214012 .00
DATE ISSUED. . . . . . . : 09/29/2009
RECEIPT #. . . . . . . . . BS000008791
REFERENCE ID # • . . : 09090213
SITE ADDRESS 10210 LEBANON DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER ZITTIN DAVID AND FLOY E
ADDRESS 10210 LEBANON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2648
RECEIVED FROM . . . . : DAVID ZITTIN
CONTRACTOR LIC # *OWNER*
COMPANY ZITTIN DAVID AND FLOY E
ADDRESS 10210 LEBANON DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2648
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 25, 000 . 00 1. 00 0 .00 1 . 00 0 .00
1BSEISMICR VALUATION 25, 000. 00 2 .50 0. 00 2 . 50 0 . 00
1ERT<200 UNITS 1 . 00 42 .00 0 . 00 42 . 00 0 . 00
1REMRESKIT SQ FEET 292 . 00 570 . 00 0 .00 570 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 615 .50 0 . 00 615.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 615 . 50 MC
---------------
TOTAL RECEIPT 615 .50
CITY OF CUPERTINO
ADDITION/REMODEL
CUPEI�TINO PERMIT APPLICATION FORM
APN # Date:
342 - 14- 01 � ;L 200
Is a 2"d unit being added? Yes ❑ No ❑ If yes, please fill out the permit application for 2" unit.
Building Address:
a2iD LEo4AI041 Ver F/& j cr-S o /�
Mailing Address (if different from building address):
Owner's Name: Phone#
41)10 FLO r 2 Al ofs 2-5- 3 .31 5-8
Contractor: Phone#:
Fax #:
Contractor License#: 62i
Cupertino Business License#:
Contact: Phone#: 4o5 5—f 5_ 7
91oue 2 t-tr► /V FAx—t O� /104 25 3 .7 Z S 8�
Building ermit Info:
Bldg. Elect. Plumb. Mech. Hillside ❑
Job D scription:
Addition-What is being added?(Be Specific): n bw
What is being remodeled(not including addition)? kS t"G K El/"
4�`NQY� fit`vw.h, < < G.c-(d ICApev o�
Remodel Includes Re-Roof: Yes ❑ No [K If yes list number of squares
Remodel Includes Structural: Yes No ❑ v, C
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen �- Z Bath Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B II/III/V-A ❑ 11/III B, IV-HT, V-B ok%if— IOAW T.4f7C
Valuationf.? 5� p4t) Please check this box if the project is a
second-story addition ❑
Project Size: Express ®'§'tandard f Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
***For Office Use Only***
❑ Revised 07/06/09
Over-the-Counter
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
DECKS 1R3SFDADD OR
1R3SFDREM
1 DECKWOOD Deck (Wood)-Each B
(Each)
1 DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1 GARDTW<=1 K Wood Frame up to B
1,000 SF (each)
1GARDTM<=1K Masonry up to 1,000 SF B
(each)
1 BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1 PATIOWOOD Wood Frame up to 300 B
SF
1 PATIOMETAL Metal Frame up to 300 B
SF
1 PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1 PATIOENCLW Enclosed Wood up to 300 B
SF
1PATIOENCLM Enclosed Metal up to 300 B
SF
1 PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM
,-� 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
n 300 SF check
1 REMRESBAT Bath Remodel up to 300 B "
SF
1 REMREOTH Other Remodel up to 300 B 66
SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1 MECPLNCK Stand Alone Mechanical M
Pln Ck(hourly
1PLMPLNCK Stand Alone Plumbing P
Pln Ck (hourly)
IB BSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
/ 1BSEISMICRE Seismic Residential B
1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
INPUT Resources Energy AO
01 Indoor Air Quality and Finishes
1.Use Lowft-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0
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 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF 4 IAQ/Health. pts y=yes 0
8.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 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 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 0
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
I 1 t
Total Points Available: 1401 130 57
Total Points Project Received: 01 0 0
2-11 2-&-9 l
G:datalprogs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.04protected.xls
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. _ All the work authorized by this permit
B. 1/ A portion of the work
C. — None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. - A portion of the work (complete section below)
Contractor Address/City. Phone # State License # Type of work to
10 �Z f6 z � y
G P� e
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City . Phone Number Type of work to be
performed
.........................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side
Property Owner's Signature:
Date: c/t{, 2y, �oo�
Job Address: I bl-1 o L E difPermit#
Achanges to the information provided on this form shall be submitted to the City of Cupertino Build
ny
Department.
RE IDEI TTTAL F O EC'T O ER HEFT
Assessor's Parcel Number: 392
Name of owner. ) rj-U 1 1 ) 2 l
Project address. O L
Contact person. f Phone. O SSS 71
Fax
Net square footage of lot.
Existin Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
,kre there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done?
;Br:ieWfdecription of work.
15-42471 dc15�w�l.4�4
Code editions:2008 CBC -N)2008 CFC N)2008 CMC ON) CU c (-5
2008 CPC -N)2008 NEC ( N)
x5
Effective 1
Plan Review Process Work Book Page-8-Revised 1/1/08
tA Oo c26
_..� CP 14
in
19tr
c �
43" Oo' ow
� z
89Z£ £SZ SOb Nl3042129
yO'owqjedn0
enup uouege-1 0 LZO L ~_
UC399624 UC2Io$M4
UEWZ pine Q
............1_.......'-------------------------------•-------........................ 1 '
6N {
Q ZZM o +, 4
r
�T v m94 ON 1
t ^ N mmmo
OmO"�
O «�
o � .
V 0C �' e
Wd
Db
•ssv��
N MNSIO'1►Z
.01 f
7r�7�r '.y {}.✓v r. :•.v rani? vis:.•w r{ •��•.4!ti• ,L�'i'. .{...x;. ..ii• �::riYi:.
,M91Z 0
��or4 S
d
EET
5 fr
Assessor's Parcel Number: 312
Name of owner. rj-U 1 (D 2 t
Project address.
Contact person. f Phone.
Fax.
Net square footage of lot.
Existin Proposed
Square footage: First floor:
Second floor:
Garage: _.. .._
TOTAL:
re there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done?
Brief description of work. ,f eL /
�5- 1 d c 5�f cvu��i1
a-70� &A�
Code editions:2008 CBC -N)2008 CFC N)2008 CMC O)N)
2008 CPC -N)2008 NEC $ N) 415yb
0-5
cUHE HTIN( '`+t ( ITv ot~
i" � i,N)INANCFS
Effective 1/1/ oA-[E__
SIGNF5���—
This set of
be k �I i, r„ ,;»h ifi::,n' MUST
w { ept or=+ ,r,s
' unlawt(,l to ni,i, Ind,t is.
on;,Mme with ""I' 1 Aterations
, ern r i
the I'ml ftny I)- t ss+on from
Thi,Cutgm it,,� �` ` 'ty�)I Cupertino.
SHAI i s[�cifications
N( 1 r... �,.-� : I:
a �,ern�rt or to he an
PGri.�;ff of thr ,t,ny i�r(rvt;rUnS
of:u,y cit
aw.
Plan Review Process Work Book Page-B-Revised 1/1/08
C
198-
IC
r ME £5Z SOV M0042128
V:) 'outiedn0 N
snup uouegel 0 LZO L
UC3000982
24 UC244 �
MIZ PIAS. a
.................... ..............................................••............._.
:y
M>MZZMV0
"A � ?C M p o Z I
t N pmGA
r
.... INI
a is� • O (N(��
o G M:
w m � y
r: ......................... j, NAN.n
Op+go nro d
a` K A
Axa � 1 L*
d
_WA
r-
•:r�.elf .�'{••$hl:�:••f1Y,J1Jy'l�}•1�f W
•I ::.•r A:•h1. 't.
MHSIO1►Z
. .
p L
A911 n1■ .•
iV�7��/ ��f''f � •+:{v:x•. :•x•:::::Jr.•:•v f f}�•�f•�9r 1• :�'fi: .•+r• J.h r.J:..r.lr J •�:.;.�h•.
Yh•.rrhJ rr?.�w:i?•:�:.A:v. i.. :v.:{.f:v `'r.:•:•.
�i141f4
d