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10040096CITY OF CUPERTINO BUILDING PERIYLIT BUILDING ADDRESS: 1091 NOVEMBER DR CONTRACTOR: D & G CONSTRUCTION PERMIT NO: 10040096 OWNER'SNAME: BRUCE ECKSTEIN 320 BACHMAN AVE DATE ISSUED: 04/152010 OWNER'S PHONE: 6509675394 LOS GATOS, CA 95030 PHONE NO: (408) 835-5520 JOB DESCRIPTION: RESIDENTIAL IJ CODWIF,RCIALE] ❑ LICENSED CON'TRACTOR'S DECLARATION ;779 5 Zy REMODEL 1004 SQ FT TO KITCHEN AND 90 SQ FT TO License Class_ Lie. N Contractor 74 G X5-/&� Date y'fS /D BATH NON-STRUCTURAL REPLACE FRONT WLNDONN' WITH hereby affirm that I am licensed under the provisions of Chapter DUAL PANE (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penaln. of perjury one of the following two declarations: I have told 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. Sq. Ft Floor Arca: Valuation: $4500 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36216025.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I.cenify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERAUT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned prop", for inspection purposes. (We) agree to save r i 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of die Issued by,: J r—�� Date: granting of this permit Additionally, the applicant understands mid will comply with all non -point source regulationsper the Cupertino Municipal Code, Section 9.18. Signature Date—��iJ RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a root is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Date: Signature of Applicant: hereby affirm that 1 am exempt from the Contractor's License Law for one of the following Ilio reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to ILA% %RDOUS dIATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safety Code. Sections 25505, 25533, and 25534. ["ill 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the declarations: Ilealth & Safety Code, Section 25532(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance ri ith the Cupertino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505. 2553333, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: /fv'CO� Dater �u permit is issued. I certify that in the performance of the work for "hich this permit is issued, I shall not employ any person in my manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's ;Name APPLICANT CERTIFICATION I ender's Address I certify that I have read this application mid state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. �6 F —/� Signature , ! Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36216025.00 DATE ISSUED.......: 04/15/2010 RECEIPT #......... :-BS000010195 REFERENCE ID # ...: 10040096 SITE ADDRESS .....: 1091 NOVEMBER DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: SylviaM COPY # : 1 OWNER ............: BRUCE ECKSTEIN ADDRESS ..........: 1091 NOVEMBER DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4129 RECEIVED FROM ....: D& G CONSTRUCTION CONTRACTOR .......: GREG LIC # 31591 COMPANY ..........: D & G CONSTRUCTION ADDRESS ..........: 320 BACHMAN AVE CITY/STATE/ZIP ...: LOS GATOS, CA 95030 TELEPHONE ........: (408) 835-5520 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCBSC ----------------------- VALUATION 4,500.00 -------------------- 1.00 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 4,500.00 0.50 0.00 0.50 0.00 1REMRESBAT SQ FEET 90.00 570.00 - 0.00 570.00 0.00 1REMRESKIT SQ FEET 100.00 570.00 0.00 570.00 0.00 1WINREP EACH 8 1.00 380.00 0.00 380.00 0.00 TOTAL PERMIT ---------- --- 1521.50 0.00 1521.50 ----- 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- CHECK --------------- 1,521.50 -------------------- 5908 TOTAL RECEIPT --------------- 1,521.50 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: 3 2 (- /,( e S Name of owner. 8/�UCE iFi lW4i Project address. - Ayyem gC/1 P Brief Contact person. !—�( % cG! Phone. _'fG Fax. Net footage lot. square of Existing Proposed Square footage: First floor: -� --"'— Second floor:' Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garau�Y !/ice ('rtei Is privacy protection planting required for the project?--Y� Build it Green Total Points s/ On what floor(s) is work being done? (5 -7 - Brief description of work. %-�f((H&I,, t 6W1 llfl AY04(4CF3( P11"Pt' 1� Iwd rI" Code editions: 2007 C13C � N)2007 CFC N)2007 CMC 2007 CPC (9- N)2007 NEC e- N) APPFu NED FIN ACCO) iDANCI WITH IHE CITY OF Effective 1/l/08 'CUPERTINO CODES AND ORDINANCES t0 SIGPIED _ rfhls get Qh ris'And sfications MUST peci ,�. w...w., iAh e1 bll times and it is unl9wfdl'fo AKe'any dhanges or elterahons do same t6houl'wrlhen pem115.^.lUri from tlie Building Derjrtment. C, of CupeAino The stamping O this - 061 and specUliiccetion: SHALL NOT -be held to Pe"il or to be an approval of the violation of any provisions of any Coy Ordinance or State Law. Plan Review Process Work Book Page -8-Revised 8/05/08 (1'- N) �12ECEIVED APR 15 2010 BY:® GLl� F 3OXi` W op -LQa� NoV Min r�k<<,� 5'hvvltA PAS i f7,w 2 it M (Al OR stim,crr Al//f.yl—1 M rr 1,,T F,4v, 30" crrcc[t ,o (k #t-,GKf1#vt p �� S-11OVIo Dog/I To /avi0 MiH 27" vN9t9riY<ve,'tr/ �GQCSf SNUW6R pVV" vr*r;i-ncj4-awlr' M IN 3n Ago✓t F-11' n f7AM h��Eu1Gf, ly O JUV / I vVp �t , � 7c p EciVta M )?X WM"in sc/7u iG /2f> ��rdt ovtakrir,nCrkl /tTod/r,r T° 8E RtAoOltO 2 .NEv+ Tall(f . 1. NCL+ SrNKI Z�-Nf-2Gy- 0 ccvplf-kcY Sff✓IDf( re &F p(gviof wr7re /VvM'VAL /�vro r c r QI✓ �� arr OMrN. yytk /ytva A"t DE(aY 2- �A MCI - 1-10 F O (j e(/ ci wtl- 9 c1 gr/V1(V6 eCt:oxrc O FHPOr`, .WtWt 20 A/V,, c1/I41r o'//0 Fon pk eEGe/nc,llf CF( WR -tom iii BA�2a�- /Ccs o, 34X?' In (a Da If SW k.PCact 4.1 IV "99 v&e '04f REGIS—is �,rED a . 15 2010 gY CITY OF CUPERTINO CITY OF CUPERTINO ADDITION/REMODEL PERMIT APPLICATION FORM 1I0LIa)q 60 APN# 36e2 to 025 b� Date: 4 Is a 2"0 unit being added? Yes ❑ No LVJ If yes, please fill out the permit application for 2"dunit. Building Address: I a 0 iv 11Ul'M13Cn p/1 Mailing Address (if different from building address): Owner's Name: L31eVC& &—YSTfIN Phone Contractor: p F LON tTj2V c Phone #: SOP X33 .9 Fax #: Contractor License #: 7 cl92 Cupertino Business License #: Contact: /— / % CH Phone #: '/OfZy -I S- I&It % Fax #: Building Permit Info: Bldg. � Elect. Plumb. rJ-' Mech. ❑ Hillside ❑ Job Description: Addition -What is being added?(Be Specific): What is being remodeled (not including addition ill CHCN� 64ry Lv/✓O�vyr w/TH Dvgc��j�E (1 00 Remodel Includes Re -Roof: Yes ❑ No [x If yes list number of squares Remodel Includes Structural: Yes ❑ No [✓7 Do you have the pre -application planning approval? Yes ❑ No 0 If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached /06� �/� Remodel: Kitchen Bath Other Type of Construction (Usage Class): Occupancy Type: I -A, I -B ❑ II/III/V-A ❑ II/111 B, IV -HT, V -B —9 Valuation: dam Please check this box if the project is a I second -story addition ❑ Project Size: Express ❑ Standard ❑ Large ❑ Ma'or ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieved: q include in plan set & the sheet index. / ***For Office Use Only*** Over -the -Counter ❑ Revised 07/06/09 In the Santa Clan Valley, stoat dobe flow directly to ata local creaks, and on to San Francisco Bay, with no besenent. Storm Binder pollution is a serious problem for wildlife dependent on our waterways end f. the people who live Offer polluted streams car baylands. Proper management of Compbuction sites reduces pollution Significantly. This sheet summadies the "Boat Management Practices" (BMPs) for atom) water pollution THE CITY OF CUPERTINO FOR NONPOINT SOURCE POLLUTION 3 WATERCOURSE PROTECTION: Chapter 9.18 9.111.041 Dbcluryelmd enr amfrn ttrdn proNrbd 11 n mdiWild m dbaurpe Q CBllre. aeeN. m pYXN m ane discharged!MR, any atom Main or ndbudl can Or raunitl as masa, bdWBp ba not mankind! W. aeWpe, IrbusMal.v du4mmn eMRMV Inarn Mmertn puodupdi, of l Side m IXkpamnpost a pbdrem, chat. Magft, r •aNtllb. WIM. pmb.d rotational Mnaland dWmminp Plead realer. orf�ai, llpllk]da• aM 1mL1�Bf•. 9.111.090 volas. Ny pmem 1Ng omr per PPr 3I. at alta a100m1 b W P of a mbadmednIX ark upon mows ttlwma sinal a plalWmd r prwded'n Clleptr [.[2 a D® mole 9.19JOD Civil pwrty ser vlaeam Airy prem mlc ..sates Bin laorblm m u®alaamr IX airy small be a tory pal. W Met d Pumlem m fund scouter air De oduJ•garbm Me Caymedun roti, Sexed tlW deans pmvia0M (uit D$nl COMB Section 5474a ado.S)de.5(up b 25,00Per pre violation]. T1w City ny WIE. and, Superior rA0t IJmauam m 1303BTmrq coda same sa.o m mpwe. ..per r,d tont.. Seal tome. TM1e mA Palet IRoriaea b mu demon h Izmmwa ark rot errASAn, rind slre11 te k Seamon SFederal M pus mmeMolla3a.ub m tld dry oiler Stated eM Fe FederalIMP ink bel bdhw®. Fukd mtedde Pawn m tea aecgan drat ane poo m Gya Fmkmmrdal Yanepempa pcmlmL 9.19.101 Ciba peulelly for Ruch dbcN Any pas. ddm eXxAbpr Palladino. M notation of Mb di pw. by Mem d rem mmeabn w11 a way Ibule m lie Ct te d roto adi mrcrd tv..dy.ar tlJoeweM eo0em Pr deny Per ddeaon fIX seal Ery M wMial oxo vipmpon ovaJm. TMCay nay PeDgm the U 740 up impso PdMIBdk m kierinrr.ralll D(kG $9akn •JIT.D m illQmd. Bray amJ mmW rlRtl Ya116. 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You may be held responsible for any environmental damage caused by your subcontractors or employees. %dremw ❑ ...P.w.d..bwnw.. nrea.aemadmrvaer maladaa. n[elbPwrd-N ❑ aala� war-we..,r.aaadp +aarw_�s para Mddarn deal..•a"seia D w-,wPaP odedab .. .....—Mod. .d ao.dond enoP.•easa, yb-MWlpter dua-1 Mr. add Nnnml"w irk, rear ddMddddddRdRdM dmr.d,dd�.rdwaden- w ra ddrea"ed e � record Pd.a m.Pa.em. rai,.ed, ebam.vPpd.b.r.b.e dabodanded rare Year lrrb•aswmd bmbYJ ❑ .ld.a.w lwrNesadetN _ r°'wmb deaddeduccur la.an Naar�..1dodddwad�" tlbbbdpa rehmyerwe M1b VAIP r Sbaar vQYabn ❑ D ..clbd Meds. a �.pa.doeeada rba.vYea RPmm]yd. ❑ pR... .. .a.Rddarande r �reYbra.rd de.P ✓PM1 n,.rabbmbaedwJ D da�aoPrmYr>msm�l Roadwork and Paving now et.g� P].cely D G.rv.m.rp.Ie.dPlpda•am.. evmal ante b,mrl Pdr4wr ❑ rnmeaoeredpevoemnv ��. D Q fb.. n.Ir YYa.Pbwl ❑ Psbm.dPrdaaa ear.. 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Small Business Hazardous Waste Disposal"Pi gm Businesses that generate less than 27 gallons or 220 pounds of hazardous waste,per month. are eligible to use this program: Call 408-299-7300 for a ouote. w_1� _. �GI to y or C J S IREti d 6 l 0 SHEET: � �4•� CONSTRUCTION BEST MANAGEMENT PRACTICES Ply µ IU1.PH QUAILS, B RCE WORKS ¢3 5 DATE Dlnecroa OF PUBLIC wolucs DEPARTMENT OF PUBLIC WORKS CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1091 NOVEMBER DR CONTRACTOR: D & G CONSTRUCTION r"VNER'S NAME: BRUCE ECKSTEIN . VNER'S PHONE: 6509675394 ❑ LICENSED CONTRACTOR/''S DECLARATION C-17License Class__ Lic.# a- ( 2 Contractor D `f- G X5_1,I!`1'41f4t9,1 Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 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 permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1-i nature Date 'fel% OWNER -BUILDER DECLARATION 320 BACHMAN AVE I hereby affirm that I am exempt from the Contractor's License Law for one of 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). LOS GATOS, CA 95030 JOB DESCRIPTION: RESIDENTIAL PERMIT NO: 10040096 DATE ISSUED: 04/15/2010 PHONE NO: (408) 835-5520 COMMERCIAL REMODEL 1004 SQ FT TO KITCHEN AND 90 SQ FT TO BATH NON-STRUCTURAL REPLACE FRONT WINDOW WITH DUAL PANE Sq. Ft Floor Area: I Valuation: $4500 I hereby affirm under penalty of perjury one of the following three 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 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's 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 forthwith comply with such provisions or this permit shall be deemed revoked. APN Number: 36216025.00 I 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 n the above mentioned property for inspection purposes. (We) agree to save nnify 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. i�� 4iunatnre Date PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by.: '�— Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505,25and 25534. Owner or authorized agent: ` Date:j CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional