08010042 •
CITY OF CUPERTINO arse n " ens a E"� ' ' ' `
BUILDING DIVISION PERMIT Cdll� PRACTOIONFOR_MATIQ1V�d .
.,! PERMIT NO.
BUILto�R9
D o✓ ELKNAP CT _ WU CHIN T AND MEI—LUN 08010042 ,.r
•
OWNER'S NAME: PERMIT ISSUE DATE
WU CHIN T ANDMEI—LUN 1203 BELKNAP CT • 01/08/2008
,NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: •
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 C C 0
186 LICENSED CONTRACTOR'S DECLARATION Job Description
ler❑ I hereby affirm Nall am licensed under provisions of Chapter 9(commencing
:Zed wird Section 70gBofDivision 3oftheBusinessand Professions Cade,andmylicense is WNDW RPLCMT LIKE4LIKE,KTCHN,BTH RMDL NON STRCTRL
<<n in full fame and effect.
i J_q License Class Lic.II
)-el Dam Contractor
qq ARCHITECTS DECLARATION
i3:,4 I understand my plans shall be used as public records
iyp
'a H Licensed Professional
12 S OWNER-BUILDER DECLARATION
0 I hereby a(lirm that I am exempt from the Contractors License Law for the
-o 0 following mason.(Section 7(D 1.3,Business and Professions Code:Any city or county
i$f which requires a permit to construct.alter,improve,demolish,or repair any structure - ' '
_zi prior to its issuance,also requires the applicant fortech permit to file a signed statement
a-,o that he is licensed provisions of ontracessammnselaw(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or $25000-
,..R
$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 70313 by any applicant fa a permit subjects the applicant to a civil penalty ofyT.7 Number Occupancy e
not more than live hundred dollars(5500).
3621 0 019:`t/Y7 P Y P ,
0 I.as owner of the property,or my employees with wages as thew sale compensation,
will do Ne work,and Nesuuclure is not Intended or offered for sale(Sec.704A,Busies! q Re oared Inspections /
and Professions Cade:The Contractors License Law does net apply to an owner of P
propeny who builds or improves thereon,and who doses such work bimselforthrough his .
own employees,provided that such improvements are not intended oroffered 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.).
[if'i,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Cade:)The Contractors Li- '
cense Law does not apply to an owner of property who bulbs or improves thereon,and
who contracts for such projects with a contraetor(s)licensed pursuant to the Contractors
License Law.
❑1 am exempt under Sec ,B&P C for this mason
Owner (/VJ yt—L.yDam O//v'8/�'
WORKER'S COMPENSATIO DECLARATION "..
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-Insure fee Waiters Compen-
an,as provided for by Section 3700 of the Labor Code.for the performance of the
wort for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as inquired by Section
3700 of the Labor Code,far the performance of the work for which this permit is issued. •
My Worker's Compensation Insurance coria and Policy number ale:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE •
(This section need not be completed If the permit Is for one hundreddollars($100)
or less.) .
I certify thn in the performance of the work for which this permit is issued,I shall not •
employ any person in any mapner so as to me subject la the Warton ons li
!awl of California.Dau.2' c y cop Q/ a /�I
ApplicantwsofV1vLk•V esob !!( /
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker'!Compensation provisions of the Labor Code,you must
.J Q forthwith comply with such provisions or this permit shall be deemed revoked. •
z " CONSTRUCTION LENDING AGENCY
F+ I hereby affirm that there is a construction lending agency for the performance of
C4 the Wit fur which this permit is issued(Sec.3097,Civ.C.)
Lg.,Q Lender's Name .
OLender's Address
C)O I certify that I have read this application and state that the above information is •
w-. F correct.I agree to comply with all city and county ordinances and state laws relating to
building construction.and hereby authorise representatives of this city to enter upon the
`v
,, LO ahave-mentioned property for inspection purposes.
a, (We)agree to save,indemnify and keep harmless the City of Cupenino against
r 0) liabilities,judgments,costsand expenses which may in any way accrue against said City , Wi
C)L in consequence of the granting of Nis permit.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: re £a lore Date L"- 6
SOURCE EGULATION .
0/ 08/0 8 Re-roofs
Signature of Applicone/Contractor Dim
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant nom or handle hazardous material '
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 23532(07 All roofs shall be inspected prior to any roofing material being installed.()Yes ElNo
Will the applicant or future building occupant use qv pnsem or degas which If a roof is installed without first obtaining.an inspection,I agree to remove •
'hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
,ria?
D Yes MN)
I have mad the haaardtan materials requirements underChapter 6.95 of the Califor-
nia
alifs- � '/' �'�}\� o ��py
does noN&entl yhaveea tenant.
uun it'a my swu5ilitI to notify
understand building 0(71, -0.,....` e;37 \ [� //04.0.8-
does
�Q'O/O V
duranot &Sacyhave.sectionthatith553 responsibility423534unratifytheaifthe of the I
requirements yihich mut he met 'or to issuance of a Certificate of Occupancy./ Signature of Applicant Date
( 0/! " g All roof coverings to be Class"B"or better
Owner or authorized agent Date' _
•
CITY OF CUPERTINO
0 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN • 36210019 . 00
DATE ISSUED • 01/08/2008
RECEIPT # • BS000003640
REFERENCE ID # . . . : 08010042 -
SITE ADDRESS • 1203 BELKNAP CT
SUBDIVISION
CITY • CUPERTINO
IMPACT AREA
OWNER • WU CHIN T AND MEI-LUN
ADDRESS • 1203 BELKNAP CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4904
RECEIVED FROM • CHIN-TE WU
CONTRACTOR LIC # *OWNER*
COMPANY • WU CHIN T AND MEI-LUN
ADDRESS • 1203 BELKNAP CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4904
TELEPHONE
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
1BSEISMICR VALUATION 25, 000: 00 2 .50 0. 00 2 .50 0. 00
1REMRESBAT SQ FEET 135. 00 429 . 00 0. 00 429 .00 0. 00
1REMRESKIT SQ FEET 114. 00 . ' 429 . 00 0. 00 429 . 00 0. 00
1STPLNCK HOURS 2 . 00 244 . 00 0. 00 244 .00 0. 00
1WINREP EACH 8 1. 00 367 . 00 0. 00 367 . 00 0. 00
TOTAL PERMIT : 1471 .50 0 . 00 1471. 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CHECK 1, 471. 50 #154
TOTAL RECEIPT : 1,471. 50
•
o ge ooy-;\
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERJINO PERMIT APPLICATION FORM
APN# Date:
Building c;11 0019 .
Address: c
/ 2 v,3 /�zGkv/fF' 7 , C cJ� Z�-7,'-�/v c"9. `jviCZ
Mailing Address (if different from building address):
Sia- t3- /91 19/Jus/Tr'
Owner's Name: Phone# :
Contractor: Phone#:
0/B '
Fax #:
Contractor License#:
Cupertino Business License#: -
Contact: Phone#:
OLS
Fax#:
Building Permit Info: SF-D /z4-lawn 6 aivin re..,oci-c.I non c r-of bo etc,c Ye-1
�r l ci k i'Net .nh y. � % ,cJ,o 'x.a-1 a ot..r t
Bldg. [C- Elect. ❑ Plumb. Mech. Er Hillside ❑
•Job Description:
Addition (adding sq footage):
What is being remodeled? (� M043w repc.
i 6 a wti.• a \',lae fr-f' tip_ —
.. I.. 4Glno.• h S ' "ree 'o da-l' ,( S' �v f gt,r el
•
Remodel Includes Re-Roof: Yes ❑ Noes list number of squares
Remodel Includes Structural: Yes ❑ No [�y
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen // 4 .5'9i-1- Bath / 3 S"5 9ft Other .
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N 9--3
Valua$on,;..G o2 Please check this box if the project is a
second-story addition ❑
Green Building Check list must be completed and Green Building Points Achieved: if
attached to the plans.
•**For Office Use Only***
Over-the-Counter ❑
•
CITY OF CUPERTINO
ii ADDITION/REMODEL
CUI% INO FEE SCHEDULE
s
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
PLLONGRNGR Long Range PL
Planning/Residential
1R3INSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat. B
•
Inspection
1R3REPPLNC Dwellings Repeat Plan B
Check •
1R3HINSP Dwellings Hillside B
inspection
1R3HPLNCK Dwellings Hillside B
plan check
1R3HREINSP Dwellings Hillside B •
Repeat Inspection •
IR3HREPLNC Dwellings Hillside B
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B •
Materials Inspection
1R3ALTPLNC ' Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Disposal System
1PRSEWER Sewers P
1BPSPRINK Lawn P
Sprinkler/Backflow
1BPWSVCS Main Water Service P
1BSEISMICRE SeismicResidential B
DECKS 1R3SFDADD OR
1R3SFDREM
1DECKWOOD Deck(Wood)-Each B
(Each) • •
1DECKRAIL Deck Railing-Each B
(Each)
•
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
GARAGES 1R3SFDADD OR
1R3SFDREM
1GARDTW<=1K Wood Frame up to B
1,000 SF
1GARDTM<=1K Masonry up to 1,000 B
SF
BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
•
1PATIOWOOD Wood Frame up to.300 B
SF •
1PATIOMETAL Metal Frame up to 300 B
SF
IPATIOOTHER Other Frame up to 300 B
SF
PATIO'S CLOSED 1R3SFDADD OR
1R3SFDREM
•
1PATIOENCLW Enclosed Wood up to B
300 SF
1PATIOENCLM Enclosed Metal up to •
B
300 SF
1PATIOENCLO Other Enclosed Patio - B
up to 300 SF
ICOVPORCH Porch Covered-Each B
(Each)
1REROOFRES Residential Re-roof B
Each 100 SF
REMODELS 1R3SFDREM
t/ 1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
1 . 300 SF check)
/ 3S 1REMRESBAT Bath Remodel up to B «
300 SF
1REMREOTH Other Remodel up to B «
300 SF
REMODEL PLNCK
• .1 1STPLNCK(1-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTER PLAN CICS.
3of3
CITY OF CUPERTINO ,
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft _
WINDOW/SLIDING 1R3SFDREM
GLASS DOOR
1 WINREP Replacement windows B
(ea 8 windows)
1WINNEWNSTR New Window (non- B
structural)
IWINMEWSTR ' New Window B
(Structural Shear
Wall/Masonry)
1 WINBAYSTR Bay Window B
(Structural)
SKYLIGHTS 1R3SFDREM
1SKYL<10 SF Skylight less than 10 sf •
B
1SKYL>10SF Skylight greater than B.
10 sf or structural
1 STAIRS Stairs-first flight/ea B
addt'l •
1BUSLIC Business License B'
•
4 of 3
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
0 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.
INPUT Resources Energy AD/Health
Ite
1.Recycle Job Site Construction&Demolition Waste
65%=1 point;75%= 2 points;80%=4 points up to 4 Resource pts 0
'2.Salvage Reusable Building Materials 4 Resource pts y=yes 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 Stormwater Practices 2 Resource pts y=yes 0
1 7.Protect Water Quality with Landscape Design 2 Resource pts y=yes 0
B.Design Resource-Efficient Landscapes and Gardens 4 Resource pts y=yes 0 .
9.Reuse Materials/Use Recycled Content Materials
• for Landscape Areas 2 Resource pts y=yes 0
10.Install High-Efficiency Irrigation Systems 2 Resource pts y=yes 0
11.Provide for On-Site Water Catchment/Retention 2 Resource pts y=yes 0
. • 0 . 0 ,0
B.Foundation
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 0
2.Use Recycled Content Aggregate 2 Resource pts y=yes . 0
3.Insulate Foundation/Slab before backfill 3 Energy pts y=yes_ 0
•
0 0 0
C.Structural Frame .
'1'.Substitute Solid Sawn Lumber with Engineered Lumber 3 Resource 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 I-Joists 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 0
11.Use Reclaimed Lumber for Non Structural Applications 3 Resource pts y=yes 0 •
;12.Use OSB -
a.Subfloors 1 Resource pt y=yes 0
b.Sheathing 1 Resource pt y=yes 0
• _ U U .. 0
INPUT Besomces Energy IAO/Health
�. xter or ns
1.Use Sustainable Decking Materials
a.Recycled content 3 Resource pts y=yes- 0
b.FSC Certified Wood 3 Resource pts y=yes_ 0
2.Use Treated Wood That Does Not Contain Chromium/Arsenic 1 IAO/Health pt y=yes_ 0
3.Install House Wrap under Siding 1 IAL/Health pt y=yes- 0
4.Use Fiber-Cement Siding Materials 1 Resource pt y=yes 0
•
0 0 0
E.Plumbing
•1.Install Water Heater Jacket 1 Energy pt y=yes 0
2.Insulate Hot and Cold Water Pipes 2 Energy pts y=yes 0
3.Retrofit all Faucets and Showerheads with Floiv Reducers
a.Faucets(1 point each,up to 2 points) Up to 2 Resource pts. 2, 0 •
b.Showerheads(1 point each,up to 2 points) Up to 2 Resource pts. 0
4.Replace Toilest with Ultra-Low Flush Toilets
(1 point each,up to 3 points) Up to 3 Resource pts. 0
5.Install Chlorine Filter on Showerhead 1 IAO/Health pt y=yes 0
• 6.Convert Gas to Tankless Water Heater 4 Energy pts y=yes 0
7.Install Water.Filtration Units at Faucets
(2 points each,up to 4 points) Up to 4 IAO/Health pts. 0
8.Install On-Demand Hot Water Circulation Pump 4 Resource pts y=yes 0
0 0 0
h.electrical
1.Install Compact Fluorescent Light Bulbs(CFLs)
(6 bulbs=2 points,10 bulbs=3 points, 12 bulbs=4 points) Up to 4 Energy pts. 0
2.Install IC-AT Recessed Fixtures with CFLs(1 point each,up to •
5 points) Up to 5 Energy pts. 0
3.Install Lighting Controls(1 point per fixture,up to 4 points) Up to 4 Energy pts. 0
4.Install High Efficiency Ceiling Fans with CFLs
(1 point each,up to 4 points) Up to 4 Energy pts. 0
0 0 0
G.Appliances
1.Install Energy Star Dishwasher 1 Energy pt y=yes ri 0 •
2.Install Washing Machine with Water and Energy
Conservation Features 1 Energy pt y=yes 0
3.Install Energy Star Refrigerator 1 Energy pt y=yes_ 0
4.Install Built-In Recycling Center 3 Resource pts y=yes_ 0
U U U
H.Insulation
1.Upgrade Insulation to Exceed Title 24 Requirements
a.Walls 2 Energy pts y=yes 0
b.Ceilings 2 Energy pts y=yes 0
2,Install Floor Insulation over Crawl Space 4 Energy pts y=yes 0
.3.Install Recycled-Content,Fiberglass Insulation with
No Added Formaldehyde 3 IALI/Health pts y=yes 0
4.Use Advanced Infiltration Reduction Practices 2 Energy pts y=yes 0
5.Use Cellulose Insulation
a.Walls •
4 Resource pts . y=yes 0
b.Ceilings 4 Resource pts y=yes 0 •
•6.Alternative Insulation Products(Cotton,spray-foam)
a.Walls 4 Resource pts y=yes 0
o.uellings 4 Resource pts y=yes 0
•
0 0 0
•
INPUT Resources Energy IAD/Health
.IT n•owe
1.Install Energy-Efficient Windows
a.Double-Paned i 1 Energy pt y=yes / 0
• b.Low-Emissivity(Low-E) 2 Energy pts y=yes c.
c.Low.Conduct v ty Frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
0 0 0
J.Heating Ventilation and Air Conditioning
1.'Use Duct Mastic on All Duct Joints 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside • 1 IAQ/Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2IAOMealth pts y=yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes D
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0 .
7.Install Whole House Fan i 4 Energy pts y=yes 0
8.Install Sealed Combustion Units
a.Furnaces 3IALI/Health pts y=yes 0
b.Water Heaters 31AQ/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes • 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes i 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stovesfinserts 1 IAQ/Health pt y=yes • 0
• b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 41AQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAD/Health pts y=yes 0
17.Install Separate Garage,Exhaust Fan 3 IAQ/Health pts y=yes 0
0 0 0
K.Renewable Energy and Roofing -
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes_ 0
2.Install Solar Water Heating System 10 Energy pts •y=yes 0
3.Pre-W re for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 points) Up to 18 Energy pts 0 •
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
• 7.Install Radiant-Birder 3 Energy pts y=yes 0
•
0 0 0
L.Natural Heating and Cooling .
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
0 0 0
•
IIJPU7 Resources Energy IA011iealth
�. n•oor • r qua tyan• nis es •
1.Use Low/No-VOC Paint 1 IAOMealth pts y=yes 0
2,Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y=yes 0
3.Use Low/No VOC Adhesives 31Ao/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 6 IA0/Health pts•y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAOMealth pts y=yes 0 •
7.Seal all Exposed Particleboard or MDF 4 IA0/Health pts y=yes 0
B.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 0
10.Install Whole House Vacuum System 3 IAO/Health pts y=yes 0
0 0 0
N.Flooring
1.Select FSC Certified Wood Flooring 6 Resource pts y=yes f 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAO/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 •
0 0 0
Total Points Available: /S ( 1401 1301 571
Total Points Project Received: 01 01 0 •
G:datatpmaerpreenbulldmppuldellneehemodele Wgreenpointsfnal2.1 ao4protected.ds
•
•
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CUPE(�TINO
Assessor's Parcel Number:
Name of owner. /`7 i G (JA-) Ac)L J
C cif Z� 7,Yo
Project address. / 203 /3 �Z/l.t/R�% G T i , �c titaid
Contact person. /7di37-/r'7 //U,9;✓f- Phone. (act) 736` 9 SL-- S
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor: f �_
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage2-- N
• Is privacy protection planting required for the project? Y N
On what floor(s) is work being done? /
Brief description of work. //rJ�4/-b v kiS � ' -reb/e"" 2 23/9-.721( 0?o n-
%IBn n e"1- ---' c..0.1 )42-1,;n f
Wri an zcA e> a,-2 9.
Code editions:2001 CBC Qom-N)2001 CFC N)2001 CMC l-N)1
2001 CPC al N)2001 NEC (Y-N) o
16)
APPl CM Ob
HE
Effective 11/1/02CC RDANRO H ORDINA CES
Ctri
UPERTINO CODES AND
Mg. MUST
.441111r
s ecifications
i1GN£U o1 p arl; and P and it is un p
chis set on the lob at all bma ar alterations In �
ne kept ale anY chan8e5ermission Iron: ICEIVED 1�
lawful tom 'iritten P d} O
an same wdhou t City of CuPspecth JAN p 7
ne building DeP ^, and sPacth be
2088
5
of his plan ertnrt or to be ar. �
fhe stamping Id to P tovrsron JI
• iHALL MT the veolauoa of nylIgo
,°prove\ he vfOnce or ��
• a aav Cit'
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I, Community Development
10300 Torre Avenue
Cupertino CA 95014
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Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEKTINO
Building Department
JOB ADDRESS: PERMIT # og 0 o �a
/2-6 5 r3 421(-onc-x
OWNER'S NAME: /tit rh L L-- 4 PHONE # 3 t'gam(SeG
GENERAL CONTRACTOR: 0(f) FAX#
I am not using any subcontractors:
Signature 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
• 0(/0 aloe
Owner/Contractor Signature Date