The URL can be used to link to this page

09060130 CITY OF CUPERTINO BUILDING DIVISION PERMIT C® RATQ � T ' BUILDING ADDRESS: PERMIT NO. A gnNRv OWNER'S NAME: PERMIT ISSUE DA'Z'E PHO A a 9 CONTROL NO. 777512 ARCHITECI7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 C LICENSED CONTRACTOR'S DECLARATION "-Z o I hereby affhrm'hat 1 am licensed under provisions of Chapter 9(commencing Job Description Z t, with Section 7000)of Division 3 of the Business and Professions Code,and my license is 'ny in fullforeeandeffecL REPAIR DAMAGED CHIMNEY, FM FIRE BOX UP ? License Class Lic.N n F,p Date Contractor ARCHITECTS DECLARATION D w U 1 understand my plans shall be used as public records tL i Oy Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the is D O following reason.(Section 7031.5,Business and Professions Code:Any city or county c m which requires a permit to construct.alter,improve,demolish•or repair any structure y Z prior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of 85850 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, 32635030 . 0 0 will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li. ccnse 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. ❑1 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 Worker's Compcn- .on,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('ibis section need not be completed if the permit is for one hundred dollars($100) or less.) 1 certify that in the performance of the work for which this permit is issued.1 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,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z. CONSTRUCTION LENDING AGENCY [�4 1 hereby affirm that there is a construction lending agency for the performance of fit> the work for which this permit is issued(Sec.3097,Civ.C.) WCL A Lender's Name Lender's Address U C) I certify that 1 have read this application and state that the above information is LL.►'I correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building convection,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way steric against said City U Z in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued Date SOURCE REGULATIONS. Re-roofs Signature of Applicant/Comractor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will 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)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Q No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which eft hazardous air contaminants as de0ned by the Bay Area Air Quality Management all new materials for inspection. trict? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Codc,Sections 25505.25533 and 25534.1 undcrstard 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 Occupancy. Signature of Applicant Date All roof coverings to be Class" 'or better Owner or authorized agent Date 0 C10 ° r te �Jr CITY OF C UPERTINO CITYCUPEI,TINO GENERAL BUILDING PERMIT APPLICATION FORM APN # � � �O � � Date: � _ Building Address: Mailing Address (if different from building address): Owner's Name: +) If yes, provide letter from HOA Contractor: np� Phone: yah. 7-'7 's/� Fax: �lC�s- -2 7• —/ S) .3 Contractor License #: Cupertino Business License#: Contact: Phone:jj/� - �,/7<„2—23,3t5 v Fax: Residential Commercial ❑ Job Description: G' ..C>� Cl�ir17 /7�Q- " L.� r '/CJ/,J Building Permit Info: Bldg ZElect ❑ F lumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, I-B E] II/III/V-A F1 11/111 B, IV-HT, V-13 P" (`—:3 Valuation: ��sO�p� Square Footage: Project Size: Express Standard ❑ Large [] Major ❑ Green Building: Please complete relevant portion or the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: For help,contact Build it Green at www.builditgret-n.or Revised 02/05/09 V I I(I� CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee De.,;cription Fee Permit Type Group 1GENRES or 1GENCOM 1 STUCOAP Stucco Applications (up to 400 sf) B addition it stucco application 1 WINREP Replacement windows/sliding glass B door (e,-. 8 windows) 1 WINMEWSTR New Window-structural shear B wall/ma;>onry (includes plan ck fee) 1 EPERMITFEE Electric,-.l Permit Fee E 1 MPERMITFEE Mecham cal Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand A one Electric Pln Ck (hourly) E I MECPLNCK Stand A.one Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand A'one Plumbing Pln Ck (hrly) P I STPLNCK-(3 Hr Min Standarc.Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1 BCBSC Cal Bldg; Standards Commission Fee B ALL PERMIT TYPES / I BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 CITY OF CUPERTINO attt nof GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWLDuplex New B IACOUSRESAD SFDWLDuplex-Addition/Alteration B 1 ACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1 CHIMNEY Chimne} B 1 CHIMNEYR Chimne} Repair B FENCES 1 FENCE>6FT Non-ma:onry, over 6 ft in height B 1 FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1 FIREPLMAS Fireplace; Masonry B 1 FIREPLFAB Fireplaco Pre-Fabricated/Metal B 1 FLAGPOL>20 Flag poli; (over 20 ft in height) B 1 MODUSTRU Modular Structures B FOUNDATIONS 1 FOUNDREP Foundati on Repair B 1PILECAST Pile Foundation Cast in place concrete B 1PILEDRIV Pile Foundation Driven (steel, pre- B stressed concrete) 3 of 5 INPUT ReSOLITreS Energy IAWHealth M.Indoor Air Quality and Finishes 1.Use Low/No-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/14o 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 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes D 7.Seal a8 EVosed Fartiolaboard or MDF 4 IAQ/Health. pts y=yes 0 S.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 1 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 3 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 1 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 1 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 1 Resource pts y=yes J 6.Install Recycled Content Carpet with Low VOCs 1 Resource pts y=yes 1 i 1 Total Points Available: 1 1401 1301 57 Total Points Project Received: 01 01 0 G:data/progs/gre:nbuildngguidelines/remodelers/greenpointsfina1212.D4proteoted.xls yw.; Community Development i 10300 Torre Avenue p Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Departmentoi JOB ADDRESS: �� -� ,�y,� PERMIT # OWNER'S NAME: /' FAX I am not using any subcontractors: E ignature Date 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 I <:� � 6 41ioq Wwner/Contractor Signature Pate