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10080021
CITY OF CUPERTINO BUILDING PERMIT JILDING ADDRESS: 10444 LOCKWOOD DR CONTRAC rOR: PERMIT NO: 10080021 NNER'S NAME: MING LEE -� �/,� tl✓) �JzDATE ISSUED:08/03/2010 PHONE NO: VER'S PHONE: 4084068829 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG� ELECT r PLUMB� tense Class L►�cp�q# 2,(�( S f MECH T_ RESIDENTIAL r— COMMERCIAL �ntractor — ��\�T 1 � S 0 111 R Date y�O F — ' JOB DESCRIPTION:TEAR FOWN OLD CHIMNEY&REBUILD W/FHA STRAPS rereby affirm that I am licensed under the provisions of Chapter 9 commencing with Section 7000)of Division 3 of the Business&Professions 1(1P L-iE K )de and that my license is in full force and effect. ►ereby affirm under penalty of perjury one of the following two declarations: lave and will maintain a certificate of consent to self-insure for Worker's >mpensation,as provided for by Section 3700 of the Labor Code,for the ,rformance of the work for which this permit is issued. ►ave and will maintain Worker's Compensation h►surance,as provided for by Sq.Ft Floo-Area: Valuation:$3900 action 3700 of the Labor Code,for the performance of the work for which this ;rmit is issued. APN Number:34229013.00 Occupancy Type: APPLICANT CERTIFICATION ,ertify that I have read this application and state that the above information is :rrect.I agree to comply with all city and county ordinances and state laws relating building construction,and hereby authorize representatives of this city to enter PER YIIT EXPIRES IF WORK IS NOT STARTED )on the above mentioned property for inspection purposes. (We)agree to save demnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR rsts,and expenses which may accrue against said City in consequence of the 180 'DAYS FROM LAST CALLED INSPECTION. -anting of this permit. Additionally,the applicant understands and will comply ith all non-point source regulatio s per the Cupertino Municipal Co e,S tion 18. 0 Issued by� Date: 2' o ignature Date RE-ROOFS: OWNER-BUILDER DECLARATION All roofs sl gall be inspected prior to any roofing material being installed.If a roof is hereby affirm that I am exempt from the Contractor's License Law for one of installed w thout first obtaining an inspection,I agree to remove all new materials for ►e following two reasons: inspection. as owner of the property,or my employees with wages as their sole compensation, +ill do the work,and the structure is not intended or offered for sale(Sec.7044, Signature(f Applicant: Date: lusiness&Professions Code) ,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER onstruct the project(Sec.7044,Business&Professions Code). hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE leclarations: have and will maintain a Certificate of Consent to self-insure for Worker's I have rea I the hazardous materials requirements under Chapter 6.95 of the ;ompensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& have and will maintain Worker's Compensation Insurance,as provided for by Safety Co Ie,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air iection 3700 of the Labor Code,for the performance of the work for which this contamin:Lnts as defined by the Bay Area Air Quality Management District I will rermit is issued. maintain :ompliance with the Cupertino Municipal Code,Chapter 9.12 and the certify that in the performance of the work for which this permit is issued,I shall Health&Safety Co Sections 25505,25533,and 25534. rot employ any person in any manner so as to become subject to the Worker's ompensation laws of California. If,after making this certificate of exemption,I Ow r or author' d ager wx �recome subject to the Worker's Compensation provisions of the Labor Code,I must Date: (� 'orthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby a firm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) -orrect.I agree to comply with all city and county ordinances and state laws relating Lender's Same �o building construction,and hereby authorize representatives of this city to enter apon the above mentioned property for inspection purposes.(We)agree to save Lender's 4ddress nify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understa id my plans shall be used as public records. 9.18. Licensed Professional Signature Date \ t C I -Z .. ITY OF CUPERTINO CUFF OF GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: Building Address: r 0-VK l oc two h1l. Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes LJ No HOA: (Exterior work only) Yes ❑ No I& If yes,pro-dde letter from HOA Owner's Name: Phone#: WN b Lee- C/D° �0 Contractor: n� . / Phone: 7. As l0 [Fax: S�c� 3 Contractor License#: Cupertino Business License#: Contact: Phone: Fax: Residential Commercial Job Description: /o/ l be�` �� U// 0 W AJ Intl Building Permit Info: Bldg Elect ❑ Plumb I:1 Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IPIII/V-A ❑ II/III B, IV-HT,V-B [�� •► _ Valuation: Square Footage: I A Ob -0'0 Project Size: Express �tandard ❑ 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. `oints Achieved: for help, contact Build it Green at www.builditgreen.org Revised 07/14/09 s CITY OF CUPERTINO FEE ESTIMATOR-BUILIIING DIVISION F1ADDRESS: DATE REVIEWED BY: APN: BP#: VALUATION: $3,900 PERMIT TYPE: Building Permit PLAN CHECE TYPE: Alteration/Addition/Repair OVER THE APPLICATION 1CHIMNEY PRIMARY SFD or Duplex COUNTER? © 'ales � No TYPE USE: Yes EIE 'T1ktIAL Q"Y�s N° MECHANICAL Q > es . �Q x � y a O O 3 � TYPE OF 7_FF(R AREA PC FEES PC FEE ID BP FEES BP FEE ID OCCUPANCY TYPE: CONSTR. s .ft. TOTALS: 0 $0.00'j '.. $0.00 ' OTE: These ees are based on the preliminaryinformation available and are onl an estimate. Contact the De t or addn'l info. �' MISC ITEMS FEE ITEMS (Fee Resolution 09-051 F.tf 7/1.,092 FEE QTY/FEE Plan Check Fee: $0.00 1 # Chimney/Chimney Repair Suppl. PC Fee: � Reg. 0 OT 0.0 hrs $0.00 $507.00 I Ct11MNEYR Chimney Repair PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. ®OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: Yes Q No $0.00 Q Work Without Permit? 0 Yes � No $0.00 $0.00 Select a Non-Residential 0 Planning,Fee: Building or Structure 0 Strong Motion Fee. I BSEISMICR $0.50 Select an Administrative Item Bid- Stds Commission Fee: 1BCBSC $1.00 SUB p' iLS: $1.50 $507.00 i.. t OTAL FEE- $508.50 Revised: 7/27/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECENT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34229013 . )0 DATE ISSUED. . . . . . . : 08/03/201) RECEIPT #. . . . . . . . . : BS000011053 REFERENCE ID # . . . : 10080021 SITE ADDRESS . . . . . : 10444 LOC{WOOD DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . . MING LEE ADDRESS . . . . . . . . . . : 10444 LOC{WOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GREEN QUEST CONTRACTOR . . . . . . . : TBD - TO 3E DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO 3E DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -------- -- ---------- ---------- ---------- 1BCBSC VALUATION 3, 900 . 00 1 . )0 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 3, 900 . 00 0 . 50 0. 00 0. 50 0 .00 1CHIMNEYRE EACH 1. 00 507. )0 0 .00 507. 00 0 . 00 -------- -- ---------- ---------- ---------- TOTAL PERMIT 508 . 50 0 . 00 508. 50 0 .00 METHOD OF PAYMENT AMOUNT REF3RENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 508 .50 VISA --------------- TOTAL RECEIPT 508 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -- ------ ---------------------------- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 517 FINAL CHIMNEY NOW Air QualitY and Finishes 0 1.Use Low/N"OC.Paint 1 IAQJHeal h pts y=Yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAOJHeal ch pts y=yes7 0 3.Use LowND VOC Adhesives 31AQJHea th pts y=yes 'P Y--Yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resourc, is es 5.Use Engineered Sheet Goods with no added Urea 0 Formaldehyde 6 IA(yHea th pts Y--yes P Y-Y D 6.Use Exterior Grade Plywood for Interior Uses 1 lAQlHeelth is Y=Yes 7 Seal ,or IADF 4 IAQJHee Ith is = es ___. .. . D B.Use FSC Certified Materials for Interior Finish 4 Resourc a pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resourc a pts Y=yes 0 10.Install Whole House Vacuum System 3 IAQ1He31th pts y--yes ' 1 D N.Flooring 1.Select FSC Certified Wood Flooring B Resourc 3 pts Y--YesD 0 2.Use Bapi4yReneusahle Flooring Materials 4 Resourc 3 pts y=Yes 0 3.Use Recycled Content Ceramic Tiles 4 Resourc3 pts Y--yes 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/He dth pts y=yes 0 D 5.Use Exposed Concrete as Finished Floor 4 Resourc3 pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts Y--Yes Total Points Available: 140 130 57 Total Points Project Received: 01 01 0 G:&Wprogs/greenbuildingg ridelineslremodelerslgreenpointsfinal212D4proteoted.xis Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ID Loc UJOOR PERMIT# a d 0 � OWNER'S NAME: PHONE# GENERAL CONTRACTOR: ,1�{or,�„1C,e BUSINESS LICENSE# ADDRESS: o vn� i 2 • O CITY/ZIPCODE: *Our municipal code requires all businesses 4orking in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY SUBCONTRACTOI:S ION(S) WILL BE H HAVE OBTAINED ACITY OF GUNTIL THE ENERAL CONTRACTOR AND AL CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Date Signature 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 )<O—,O, Masonry Painting/Wallpaper Paving Plastering E] Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner Contractor Signature Date