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10080037 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:SHAYNE STUBBS PERMIT NO: 10080037 BUILDING ADDRESS: 20891 MC CLELLAN RD DATE ISSUED:08/04/2010 OWNER'S NAME: SHAYNE STUBBS 20891 M::CLELLAN CUPER"INO,CA 95014-2957 PHONE NO: 0—NER'S PHONE: 6502732271 V LICENSED CONTRACTOR'S DECLARATION BUILD[NG PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH 1— RESIDENTIAL COMMERCIAL Contractor Date JOB D;-SCRIP'CION: INSTALL FENCE I hereby affirm that 1 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 Valuation:$1000 performance of the work for which this permit is issued. Sq.Ft floor Area: 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 APN N tmber:35913083.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 130 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Date: with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: 9.18. Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is install A without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. tire following two reasons: Date: 1,as owner of the property,or my employees with wages as their sole compensation, Signa ure of Applicant:_ will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed ntractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE 1 hereby affirm under penalty of perjury one of the following three declarations: 1 hay a read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's Calif a ��C rnia Health&Safetode,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air cont.tminants as defined by the Bay Area Air Quality Management District 1 will Section 3700 of the Labor Code,for the performance of the work for which this mail tain compliance with'the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. 1 certify that in the performance of the work for which this pen-nit is issued,l shall not employ any person in any manner so as to become subject to the Worker's Owl er or authorized agent: Date: Compensation laws of California. If,after making this certificate of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code,I in st forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hei eby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for,rhich this pen-nit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above infonnation is Lender's Name correct.1 agree to comply with all city and county ordinances and state laws relating to building construction,and ereby authorize representatives of this city to enter Lender's Address upon the above mentioned perty for inspection purposes.(We)agree to save indemnify and keep harm ss the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses whi may accrue a nst said City in consequence of the ng of thi mu ddi ally pplicant understands an will comply I ur derstand my plans shall be used as public records. II non- t so ere er the Cupertino Municip Code Section 5 t� Licensed Professional Signature D /v CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20891 MC CLELLAN RD CONTRACTOR:SHAYNE STUBBS PERMIT NO: 10080037 OWNER'SNAME: SIIAYNE STUBBS 20891 NIC CLELLAN DATE ISSUED:08,04/2010 OWNER'S PHONE: 6502732271 CUPERTINO,CA 95014-2957 PIIONf:NO: ❑ LICENSED CONTRACTOR'S DECLARATION (— r r BUILDING PERMIT INFO: BLDG ELECT PLUMBLicense Claus Lic,11 M ECH r RESIDENTIAL r COMMERCIAL r Conuactor Date — I hereby affirm that 1 an,licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL FENCE (commencing with Section 7000)of Division 3 of the Business&Professions Code and tlml my license is in full force and effect. 1 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 perlbmiance 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:S1000 Section 3700 of the Labor Code,for the performance of the work for which this pemtil is issued APN Number:35913083 00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 have read this application and slate that the above information is correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES I F WORK 1S NOT STARTED to building construction,and hereby authorize representatives of this city to enter Upon the above mentioned pmpeny for Inspection purpose's. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indcninily and keep hanniess tile City of Cupertino against liabilities,judgments, I8� DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit Additionally,the applicant undcrslands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: 9.18- Signature Date RF--ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed Ifa roof is installed without first obtaining an inspection,I agree to remove all new materials for 1 hereby affirm that 1 am exempt from the Contractor's License Low for one of inspection. the following Iwo reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date will do the work,and the structure is not intended or offered for sale(Scc.7044, Business&Professions Code) I,as owner of the properly,tan exclusively contracting with licensed mractorsto ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER cnnSIRucl the project(Sec.7044.Business&Profusions Code). 1 hereby affirm under penally of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of file 1 have and will maintain a Cenilicatc of Consent to self-insure for Worker's California Health&Safety Cade,Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of die Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth& pertiimtance of the work fix which this pennil is issued. Safety Code,Section 25532(x)should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additiaially,should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Cade,for the performance ofthe work for which this contaminants as defined by the Bay Area Air Qualily Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 certify that in the pedimnance of the work for which this permit is issued,I Shall Health&Safely Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent Compensation laws of Califullia. If,after making this certificate of exemption.I Date: become subject to the Worker's Compensation provisions of the Libor Code,I in st forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby afftnn that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this pennil is issued(Sec.3097,Civ C.) I certi f y that I have rend this application and stale that the above information is Lender's Name correct. I agree to emnply with all city and county ordinances and state laws relating In building const mciinn,anJ hereby authonzc representatives of this city to enter Lender's Address upon the above nienlioncd pony I'or inspection purposes.(We)agree to save indemnity and keep hams ss the City of Cupertino against liabilities,judgments, costs,and expenses whi may accmc a t said City in consequence of the ARCHITECT'S DECLARATION granting 0":ili' mu Edit ally pplicant understands an will comply I understand my plans shall be used as public records. with all non- o' t so r a re erthc Cupertino Munici Code ecoon Licensed Professional iignature D L �Cl 57 =(c.. CITY OF CUPERTINO CITY OF CUPERIINO GENERAL BUILDING PERMIT APPLICATION FORINT APN # . Date:. 35 - i3— Z I o ►n Building Address: 2L �) [( ,,,\, ca& Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes El No HOA: Exterior work only) Yes No ❑ If yes, provide letter from HOA Owner's Name: Phone#: } � — ZZ � Contractor: Phone: Fax: Contractor License #: Cupertino Business License#: Conta t: \ Phone: Fax: Residential JK Commercial Job Description: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Cbnstruction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/IIIfV-A ❑ II/III B, IV-HT, V-B 0� Valuation: Square Footage: I CM Project Size: Ex resss-� Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Bu' ding/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.builditgreen.org Revised 07/14/09 10300 Torre Avenue Cupertino, California 95014 Telephone: (408) 777-3308 FAX: (408) 777-3333 COMMUNITY DEVELOPMENT curEIMMO FENCE, APPROVAL, SAY/,mia (DATE) I am an adjoining property owner of SIjdA it t' 44,01 (N ME) whose property is located at 2400q/ ML t4le.1/Ad /2 (ADDRESS) I approve(per Section 16.28.040 of the Cupertino Municipal Code) the allowance of a 0r foot high fence facing my property. (8 FT. MAXIMUM) SIGNEDA4�-- ��✓ Si4-vTi ova• �; 5 ati.�o Name: Address: 2i0 trt or 771 CC to C F0 G:IFlamingUppformlFencelFenm Approval Famdoc Updated 7/3/2007 Green Points Rating System for Remodeling Projects Due to the diversity of remodeling project types,assigning a'total points'value to a project to be considered environmentally friendly is not feasible. However,25 measures have been highlighted to signify that every effort should be made to incorporate them into your projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with ease of implementation and relative low cost These measures can be used as a starting point for'greening'your project. .7:-de Joti Silo Constrrrctiret 8 f)eniolitioitWaste!=.e s�'> fi5°h=lipemK 75%= 2 por r�BD96 c'4 Point_T _ up to 4 Resource pts 0 .- ro 2 Sall agzAeusatile;Bu ldmg`,M'edalsF? 4 Resource pts yeses 0 3.Remodel for Mixed Use,Adaptive Reuse,and Historic Preservation 4 Resource pts y=yes 0 4.Protect Native Soil 2 Resource pts y=yes 0 5.Minimize Disruption of Existing Plants&Trees 1 Resource pt y=yes 0 6.Implement Construction Site Stormwaier Practices 2 Resource pts y=yes 0 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0 B:?lash!'R�o�ce�fFa�rtluPesardGaais;^''•:%o� 4Resourcepts y=yes D 9.Reuse Matedals/Use Recycled Content Materials for Landscape Areas 2 Resource pts y=yes D 10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0 11.Provide for On-Site Water Catchment/Retention 2 Resource pts yeses D 1 1 1 B.Founda6on 1.Incorporate Recycled Flyash in Concrete 25%Recycled Flyash=2 points;Add 1 point for every 10% increase of flyash,up to 5 points up to 5 Resource pts D 2.Use Recycled Content Aggregate 2 Resource pts y=yes D 3.Insulate Foundation/Slab before backfill 3 Energy pts y=yesFI 0 1 1 1 C.Structural Frame 1 Substih�S_id5armlJm wdh'Frgorearedlsnnbers 3Resource pts y=yes 0 2.Use FSC Certified Wood for framing (For every 10%of FSC lumber used=2 points,up to 10) up to 10 Resource pts. 0 3.Use Wood IJoists for Floors and Ceilings 2 Resource pts y--yes 0 4.Use Web Floor Trusses 2 Resource pts y=yes 0 5.Design Energy Heels on Trusses 6'or more 2 Energy pts y=yes 0 6.Use Finger-Jointed Studs for Vertical Applications 2 Resource pts y=yes 0 7.Use Engineered Studs for Vertical Applications 2 Resource pts y=yes 0 B.Use Recycled Content Steel Studs for Interior Framing 2 Resource pts y=yes 0 9.Use Structural Insulated Panels(SIPS) a.Floors 3 Energy pts y=yes 0 b.Wall 3 Energy pts y=yes 0 C.Roof 3 Energy pts y=yes 0 10.Apply Advanced Framing Techniques 4 Resource pts y=yes D 11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0 12Ike0S8i T � a Subfloors ��; r'q 1 Resource pt y=yes D h Stag. ' 1 Resource pt y=yes 0 M.Indoor Air Quality and Finishes, 1.Use LOWND-VOC Paint: 1 IAQ/Health es p • P� Y=Y 2.Use Low VOC,Water-Based Wood F shes 2 IAQ/Heatth pts y--yes D 3.Use Low/tiD VOC Ai➢iesives 31AQ/Health pts yy as D 4.Use Salvaged Materials for.lntedor Finishes 3 Resource pts y--yes 0 5.Use Engineered Sheat Goods with no added Urea' Formaldehyde ' i 61AQ/Health pts Y-Yps 0 6.Use Exterior Grade Plywood for Interior'Uses' 1 IAQ/Health pts y--yes D _ 4 IA ealth is - es FS B.Use C Cert fled Materials for Interior Finish 4 Resource pts y--yes 0 9.Use Finger-Jointed or Racyclad•Content Trim 1 Resource pts yyes 0 10.Install Whole House Vacuum.System 31A0/Health pis y yes 0 N.Flooring f 1.Select FSC Certified Wood Flooring B Resource pts yryes 0 2.Usa8apmyReneoua6leFloorirgMatari�ls ,; 4Resouce pts yryes p 3.Use Recycled Content Ceramic,Tiles , 4 ReeDurDq pts yryes 0 4.Install Natural Linoleum in Place of Vnyl,-, } ' S IAO/Health pts y yes D 5.Use Exposed Concrete is Finished Floor 4 Resource pts yrYes D 6.Install Recycled Content Carpel-with Low VOCs_ 4 Resource pts yryes D . 1otal Points 1 140130 57 Total] ints Project Received: D 0 0 r:d3f!l gmmbuldlnNLddefres/wDdJsrslgn;mVdintAnal21204pm:eziedAs OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333- buildino5c:ner no.Orn CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADORES BP# OWN NAME OWNERADDRESS DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, Initialed your understanding of each provision, signed, and returned this form to us at our official address Indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRE TIONS: Please read and initial each statement below to signify you understand or verify this information.) _1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Bullde uilding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial ihomeofor any insurance s may edtby an unlicensed person and his or her employees while working on my property. Y provide coverage for those Injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. ✓ L� ' I understand building permits are not required to be signed by property owners unless they are responsible for struction and are not hiring a licensed Contractor to assume this responsibility. 7Z:nderstand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her 7na fa instead of my own. '`4`�understand Contractors are required by law to be licensed and bonded in California and to list their license num ers on permits and contracts. num if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be co sidered an "employer"under state and federal law. understand if I am considered an"employer" under state and federal law, I must register with the state and ederal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject meserious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family re siden ial structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work isp rf ed under contract with a licensed general building Contractor. _ derstand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. 6imerBuilderFornt_1010.doc remised 04/14/10 At4srll understand I may obtain more information regarding my obligations as an"employer"from the Internal Revenue Service,the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State License Board (CSLB)at 1-800-321-CSLB (2752)or www.csib.ca.gov for more information about licensed co tra tors. am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that ;a7m .eparty legally and financially responsible for proposed construction activity at the site address listed above. 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide �'byZppllcable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions,or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,the Contractors'State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,t s fo ust be completed and signed by the property owner and returned to the agency responsible for Is uing a permit. Note:A copy of the property owner's drivers license, form notarization, or other verifi ' n acce tabl to the city may be required to be presented when the p rmit is ' sued to ver the_Pro a owners si a re. Property Owner's Signature: / Date: 41 --- --- ---- ---------- ----- --------- ------ -------- -( - -- -- - ---- - --- --- - - ------ -- - - --- ---- -- ----- - -- ------ NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owners drivers license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OxmerBuilderForm_2010.doc revised 04/14/10 1 t ' - -!---�_ - - � _� -- I _ I1�Al �i 1 i�, �-�I -i - -1� I - - -- -- J� — 4TT �� -TIT I 1 :I uffAA)I-1 �VVNTAL vjvl- s� Tti •-� I��T1 T.. - I I- - LAU � I - I t I 9 X61 � sLs - -- - --- - -- - ' --- - l - - - - - - - - - -- . - - - -- - - �z l I I i t I I I . - ' I'-/K!o I�iGSTS – •.. . —. . ,_ I- --- , � --�- I -- �--.— -- - - - — -..... T _ A I � � I I I I � - - - I�dkilJ I I a I --1 Q,p I •_i _ i , _ I I I ( I - - -- - � I N[')TI TSI C At - -i— - - - - - - T - - - -=- - - - I I. _ I l I ! S LIE '/ = I.�. 1 r-. I - -- I - — t1�1_�z_ (D ,K) Ep i ! I --- ' - - 2xy-Dmw2� n�,�-%�� = - _�' i ! 9 l 3 a 8 I - - - - - � -- - - --- �-- � -- - - -- ;- � - r ' - • - I �_ _ "I�q _ I I ! 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