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09010021 CITY OF CUPERTINO -: BUILDING DIVISION PERMIT *> BUILDING ADDRESS: PERMIT NO. E OWNER'S NAME: PERMITrjSSUEDATE °NO S A CONTROL NO. 650 631-4330 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 90p LICENSED CONTRACT'OR'S DECLARATION Job Description U 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p 7r� with Section 70(10)of Division 3 of the Business and Professions Codc,and my license is oCn infullforceandeff '_,1 6�3ys �y KITCHN RMDL;ELECT/MECH/PLMB—NO RE—ROOF OR C 4 Licensc Class /v Lic.S- -0 Date o Contractor >- STRUCTRL ARCHITECTS DECLARATION rt. U 1 understand my plans shall be used as public records O y Licensed Professional 0 OWNER-BUILDER DECLARATION i<z 1 hereby affirm that I am exempt from the Contractor's License Law for the is a O following reason.(Section 7031.5,Business and Professions Code:Any city or county K a Pi which requires a permit to construct,alter,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to rile a signed statement £=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Y F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he fa e.pl therefrom and the basis for the alleged exemption.Any violation of 530000 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy not more than five hundred dollars(5500). 36609050 . 00 p y Type ❑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,Business and Professions Code:The Contractees License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion.die owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). JANI" TARY ❑I,as owner of the property,am exclusively conuacting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workees Compen- .ion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Workees mpensation Gtsurarta carrier and Polity number arc: Carrier � �� ��Nd Poiiry No.:/4y&61 2�� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less) I cenify 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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,atter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z~- CONSTRUCTION LENDING AGENCY [-r►�.c I hereby affirm that there is a construction lending agency for the performance of pw the work for which this permit is issued(Sec.3097,Civ.C.) WCI.Q Lender's Name z Lender's Address U Q 1 certify that I have read this application and state that the above information is lL,icorrect.I agree to comply with all city and county ordinances and state laws relating to Q V construction,consction,and hereby authorize representatives of this city to enter upon the Oabove-mentioned property for inspection purposes a (We)agree to save,indemnify and keep harmless the City of Cupertino against c.c tj liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. 1 � 1"" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA NS. -j f,4 J�,L'R.� G �i�G9 Re-roofs Signature ol'Appliant/C tractor Die — HAZARDOUS MATERIALS DISCLOSURE Type of Roof Wilt the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? ❑Ya No All roofs shall be inspected prior to any roofing material being installed. '� Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it harardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. .trice? Cl Yes %No 1 have read the ha=ck 7lxus materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occup cy. Signature of Applicant Date __T CJ 0oR-g— a� All roof coverin s to be Class" ``or better Owner or authorized a cnt ate g CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36609050 . 00 DATE ISSUED. . . . . . . : 01/07/2009 RECEIPT #. . . . . . . . . . BS000006915 REFERENCE ID # . . . : 09010021 SITE ADDRESS . . . . . : 11229 STAUFFER LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . WILLIAM LO ADDRESS 11229 STAUFFER LN CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 RECEIVED FROM . . . . : KEANE CONSTRUCTION CONTRACTOR . . . . . . . : TONY WARREN LIC # 25150 COMPANY . . . . . . . . . . : KEANE KITCHENS ADDRESS 295 OLD COUNTRY RD. CITY/STATE/ZIP . . . : SAN CARLOS, CA 94070 TELEPHONE . . . . . . . . : (650) 631-4330 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 30, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00 1BSEISMICR VALUATION 30, 000 . 00 3 . 00 0 . 00 3 . 00 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00 1REMRESKIT SQ FEET 150 . 00 429 . 00 0 . 00 429 . 00 0 . 00 1STPLNCK HOURS 1 . 00 122 . 00 0 . 00 122 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 670 . 00 0 . 00 670 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 670. 00 #16119 --------------- TOTAL RECEIPT 670 . 00 CITY OF CUPERTINO ADDITION/REMODEL CITY OF CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: slrl-yzlltl-�L� ;(y z11KJ Mailing Address (if different from building address): Owner's Name: Phone# Contractor: _ Phone#: C•.S�=- �� :c i e4 3 3 K_ ti'C / iC'�-�C. �.� Fax #: ( 3i � 367 Contractor License#: 8 Cupertino Business License#: Contact: Phone#: 6 SO 7.1' P4-fw(cxC� �L h'r�/� Fax #: Building Permit Info: Bldg. ❑ Elect. Plumb. ® Mech. ® Hillside ❑ Job Description: Addition-What is being added?(Be Specific): (= What is being remodeled (not including addition)? 7 C Remodel Includes Re-Roof. Yes ❑ No g If yes list number of squares Remodel Includes Structural: Yes ❑ NoC Do you have the pre-application planning approval? Yes ❑ No , If es, lease provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen 0 , _r-Bath Other Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B ©--*" � Valuation: $ !-30, 000. O ci Please check this box if the project is a second-story addition F-1Project Size: Express Standard E] Large [:] Major E] Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieve: include in plan set& the sheet index. C? ***For Office Use Only*** Over-the-Counter ❑ Revised 10/01/08 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) 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 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW 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 1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check) 1REMRESBAT Bath Remodel up to 300 B " SF 1REMREOTH Other Remodel up to 300 B " — SF 1 REMRES2 Remodel Residential B Greater than 1000 sq ft 1REMRES3 Remodel Residential B Greater than 2500 sq ft. 1REROOFRES Residential Re-roof Each B 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft / 1BSEISMICRE Seismic Residential B 1 TRAVDOC Travel &Documentation B 1 BUSLIC Business License B RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number:gff 0<?,o--6 Name of owner. Project address. r�� �(�G�FFA= C(�,S Contact person. PIt Phone. '6��- 3�7 G Fax. 6,'(3 -- K:3 3 6 91 7 Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: "re there at least two 10 foot by 20 foot clear spaces inside the garage? Y Is privacy protection planting required for the project? JAN E� On what floor(s) is work being done? Brief description of work. CLA en on o`\ cJ-,a. Z ' v� Code editions:2008 CBC O-N)2008 CFC A-N)2008CM-C (�P-N ) 2008 CPC (9-N)2008 NEC a,)-N) APPROV EU M ACCORDANCE WITH THE CITY 0, ..�, CUPOMNO CODES AND ORDINANCES Effective 1/1/08 SATE_ �%=--7,,p�- AGNQ1 _ M 'his set of plilns )e kept on ♦ J BNIfUl to nlaf.e n sameC> je buiOn? 9t , 'no. Mo ne stamping .' ;t,,1ticaUc;, SHAD. NO be i Ll be ,ppiCNed of the vtu1ail,.11 �sl ally prewsto: )t any City Urdinance or Mate Law. Plan Review Process Work Book Page-8-Revised 1/1/08 - - - —— — OC>O ca r• .. xom >- MM�� W �Omm Drln 1 r'1 ;� � LCDs DGv CI_. m CC CD CL m Oo CL . CL �- CD O a�m f –(0 m D NC IW v m ag ci 3v D A N O �\j Quof. ma A a .(Tp /�. r m O CA a0 =:2 co co rn - l� o0 CD W 6 W m °d° O o W3642 D t — 3 o DB36 C y vt A caN C O fn a= W N CCDm0 N?per I Oo LA Q = O "0 O �O 'O V o �• 0 Op u ( (D f� c"v D Zb = �CD 0 i/ CD S9 a0 I£ O.'G O. 9E 8n 8 S of 0 O .;L 2CD CD CD cr W S `G d �. CD CD C. CD d N • CN UIQ 0 �N 000 C .r 00 s r � ! � /� � 7 e`� x 2 r re ✓ s ��J* '_ � r F a .$ ��Y�f.����kF',,,,� t � Y �-k `�a�-•xRe3�i s..x EgKitchen At least 50% of the total wattage is high efficacy: Fixture Type High efficacy Relamping x Quantity = High-efficacy or Low-efficacy (y/n) wattage wattage wattage ZG x or or 41% (t "Sc)� x or ibp U x = or (Complies if A.> B) Total: A: B: t 6 Compliant? YES NO ❑ Additional requirements YES N/A NO Recessed fixtures installed in insulated ceilings are rated ICAT and certified ❑ ❑ ASTM E283 or equivalent. Installation is airtight(caulking, gaskets). High-efficacy and low-efficacy fixtures are switched separately. M ❑ ❑ Ed Bathroom(s) YES N/A NO All light fixtures are high efficacy. ❑ ❑ ❑ Incandescent fixtures are switched with manual-on/automatic-off occupancy sensors. ❑ ❑ ❑ Recessed fixtures installed in insulated ceilings are rated ICAT and certified ASTM E283 or equivalent. Installation is airtight (caulking, gaskets): ❑ ❑ ❑ -High-efficacy and low-efficacy-fixtures are switched separately. ❑ ❑ ❑ E9 Laundry Room / Utility Room YES '}d} NO All light fixtures are high efficacy. ❑ ❑ Q) :a Incandescent fixtures are switched with manual-on/automatic-off occupancy sensors. ❑ ❑ C:, Recessed fixtures installed in insulated ceilings are rated ICAT and certified 4 QASTM E283 or equivalent. Installation-is airtight(caulking, gaskets). ❑ ❑ High-efficacy and low-efficacy fixtures are switched separately. ❑ ❑ �' [ifGarage C YES .A NO ❑ "- ❑ N All light fixtures are high efficacy. a� Incandescent fixtures are switched with man ual-on/autorrra�_off occupancy ~ sensors. ❑ ❑ ❑ Recessed fixtures installed in insulated ceilings are rated ICAT and certified+Y' ASTM E283 or equivalent. Installation is airtight (caulking, gaskets). ❑ ❑ ❑ Q) High-efficacy and low-efficacy fixtures are switched separately. ❑ ❑ ❑ a Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `;UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: �np6' FAX # 3G '7 I am not using any subcontractors: gnature ate Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 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 Owner/Contractor Signature Date