09100114 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10661 CARVER DR CONTRACTOR:RICCARDO FORLEO PERMIT NO:09100114
OWNER'S NAME: RICCARDO FORLEO 10661 CARVER DR DATE ISSUED: 10/20/2009
3R'S PHONE: 4088490919 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACING WALL HEATER WITH NEW
(commencing with Section 7000)of Division 3 of the Business&Professions FURNACE&DUCTS&
Code and that my license is in full force and effect. A/C UNIT,REPLACING MAIN ELECTRIC PANEL WITH A NEW
ONE WITH SWITCHES,REPLACING WATER HEATER TANK
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 Sq.Ft Floor Area: Valuation:$5000
permit is issued.
APPLICANT CERTIFICATION APN Number:37534050.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date Issued Date:
lr �---`" /�Z
6
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,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
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532 )should I store or handle hazardous material.
permit is issued. Additionally,shoul uipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as fine the Bay Area Air Quality Management District I will
maintai com i nce the Cupertino Municipal Code,Chapter 9.12 and the
/1
not employ any person in any manner so as to become subject to the Worker's He a S ctions 25505,25533,and 25534.
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 Ow r r' t:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
Aq�l
4� r)�APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby autho ' representatives of this city to enter Lender's Name
upon the above mentioned property for i sp tion purposes.(We)agree to save
i nify and keep harmless the C' C ertino against liabilities,judgments, Lender's Address
c and expenses which may ecru a' st said City in consequence of the
granting of this permit.Addi. nally, plicant understands and will comply
with all non-po t sou a ions' r he Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
,
9.18. 1 understand my plans shall be used as public records.
Signature I Date 10 Licensed Professional
CITY OF CUPERTINO
10 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37534050 . 00
DATE ISSUED. . . . . . . : 10/20/2009
RECEIPT #. . . . . . . . . BS000008961
REFERENCE ID # . . . : 09100114
SITE ADDRESS . . . . . : 10661 CARVER DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER RICCARDO FORLEO
ADDRESS 10661 CARVER DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM RICCARDO FORLEO
CONTRACTOR LIC # *OWNER*
COMPANY RICCARDO FORLEO
ADDRESS 10661 CARVER DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 5, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 5, 000 . 00 0 .50 0 .00 0 .50 0 .00
1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00
1MPERMITFE FLAT RATE 1 . 00 42 .00 0.00 42 . 00 0 . 00
1MRRAA UNITS 2 . 00 126 . 00 0 . 00 126 . 00 0 . 00
1PGASRES OUTLETS 1 . 00 63 .00 0. 00 63 . 00 0 . 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1PREPPIPE FLAT RATE 2 . 00 84 .00 0 .00 84 . 00 0 .00
1PRWHEATR UNITS 1. 00 25 . 00 0 . 00 25 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 467 .50 0 . 00 467. 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 467 .50 AMEX
---------------
TOTAL RECEIPT 467 .50
09, ori l
CITY OF CUPERTINO
ET
OF
CUPR
INO GENERAL BUILDING
PERMIT APPLICATION FORM
APN 4 Date:
Building Address:
.0
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No
HOA: Exterior work only) Yes ❑ NoIR If yes, provide letter from HOA
Owner's Name: Phone#:
C e rit Ln .r-2,r le Q t c j a
Contractor: l ,-� Phone:
Fax:
Contractor License#:
Cupertino Business License#:
Co tact: Phone: ':4�& �u, - 011 It
(I'A P YD Foat&io Fax:
Residential t9i Commercial ❑ _ _l
Job Description: '_z -L A ` (A" � (1,4L- u6�� AJ+•�/
1G ►ke, PrlJIi JL, d/r7N A NaVJA1 (k),tLf /�O�ti' 1 LAS
IC i P W G- a) CT w Itn 4*Z 6~�, u^ls
Building Permit Info:
Bldg ❑ Elect Er Plumb Mech
Type of Construction (Usage Class): Occupancy Type:
I-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B
Valuation: Square Footage:
Project Size: Express d Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved: -3
For help, contact Build it Green at www.builditgreen.org
Revised 07/14/09
T CITY OF CUPERTINO
C U
CITY
OF O GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
I1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1 BUSLIC Business License B
I2A^ 5 of 5 ( P6,4 °l /�Y'
RESIDENTIAL PROJECT COVER SHEET
I
Assessor's Parcel Number:
Name of owner. tz.YIP o
Project address. 0 06 C r v-e r �k Y
Contact person. Phone. _/40$— ��t
Fax.
Net square footage of lot.
Existin.2 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^�N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done?
(3ar-x_fafd§ u,/uL ff rA-ttfdt_ U"iTK Mtsti(l ��ACi�
Brief description of work. p: ,&C _ 6V A,0,.W ,—sF,,, k t
"160 o z&%g
LO(4fr rtr14T:li1-rte ,� ► 1-W 17�> �
UPL,a m6 ROMVa ► WA �S n(PS- 607
Code editions:2008 CBC ®-N)2008 CFC N)2008 CMC -N)
2008 CPC �-N)2008 NEC N)
Effective 1/1/08 APPH�)VED
IN ACGORDANCI YVITN 1 HE CITY OF
CUP(-RTINO GODES AND ORDINANCES
DATE--- L/)-2-G S
SIGNS
This set tans and specifications MUST
be kept on the job at all tones and it is
unlawful to make any changes or alterations
on same without written pe rrnrssron from
the Building De`>artn c+nt. City of Cupertino.
The stamping o this plan and Specifications
SHALL NOT be hehi t, panrntt or to be an
approval of the rel, ,p,ovisions
of any City Or,1v1.,ry rr `,t.itr•Law.
Plan Review Process Work Book Page-8-Revised 1/1/08
RESIDENTIAL PROJECT COVER SHEET
f
Assessor's Parcel Number:
Name of owner. 3 ( ( n(J t* Tv Y le o
Project address. (C (a 6( (''U r v-e DY
Contact person. J?Ac Ca rr�c) �t,`f let Phone. WO
Fax.
Net square footage of lot. s�C
Existin LY Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
re there at least two 10 foot by 20 foot clear spaces inside the garage?
IsYP vac riprotection planting required for the project? YC
p
On what floor(s) is work being done? .rte
fZ01 C/SC4 w�l,t KarArfW_ IM7K luso! -pvi 1✓,4
Brief description of work. -
(?aLA-Uf (111Th
Code editions:2008 CBC (('T>-N)2008 CFC Q -N)2008 CMC (J5)-N)
2008 CPC N)2008 NEC 'Y N)
Effective 1/1/08
"ass
Fss
o,P
00
Plan Review Process Work Book Page-B-Revised 1/1/08
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. _ 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
bbe per f..-mae.1
r w
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.
PersorVFirm Address/City . Phone Number Type of work to be
performed
................................................................................................................................................................... .
I declare under penalty of perjury that th o s true and correct. I have read and understand the
Owner-Builder Information(rev rs
Property Owner's Signature: Date: O 2
/00//
Job Address: Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.