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07050049 CITY OF CUPERTINO BUILDING DIVISION' PERMIT ��10 NS• PERMIT NO. BUILD Ny�DdRESS: � CRESTLINE DR TBD - TO BE DETERMINED 07050049 PERMIT ISSUE DATE OWNER'S NAME: EVELYN & ALF MODINE 05/08/2007 SANITARY NO. CONTROL NO. )NE: BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH i p Q LICENSED CONTRACTOR'S DECLARATION Job Description V r- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ?z M with Section 7000)of Division 3 of the Business and Professions Code,and my license is KITCHEN RE MODEL NON STRUCTURAL-ADD GAS LINE h y in full force and cff v�Z Licenao Cl Lic•>< �,o Date Contractor ARCHITECTS DECLARATION j a< 1 understand my plans shall be used as public records )WU U.F Licensed Professional o a OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Z y he applicant for such permit to file a signed statement prior to its issuance,also requires tValuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area 5 O O O 0 4 F (commencing with Section 7000)of Division 3 of t he Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of p Number Occupancy Type not more than five hundred dollars($500). 3 6 2 2 4 0 4 2 , 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is trot intended or offered torsade(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of 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.). O I,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- cense 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 L' nse Law. I am exempt under See. B&P C for s reason E ANITARY Own WORKER'S COMPENSATION DECLARATIO �d C 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 Workces Compen- tion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 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 (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any 22 brume subject to the Workers'Compcnsauon Laws of Calif Applicant, NOTICE TOA PLIC :If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z , CONSTRUCTION LENDING AGENCY Fr 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.C.) W Q Lender's Name az Lender's Address U Q 1 certify that 1 have read this application and state that the above information is LL. h r correct.I agree to comply with all city and county ordinances and state laws relating to O U building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against ►�- to liabilities,judgmens,costs and expenses which may in any way accrue against said City V z �inconsequcnco of th granting of this permit. + �+ PLICA U RSTANDS AND WILL COMPLY WITH ALL N-POINT Issued by: Date �--• c,-7 U IONS. Q Re-roofs Signature of Applicant/Contractor Date Type Of Roof G� HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstorc 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. ❑Ycs �Vo Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes �Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have tenant.that it is my responsibility to notify the occupant of the rcquircmcns ich ; met prior t4 issuance of a Cc tificale of OC Signature of A)plicant Date �— � �� All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36224042 . 00 DATE ISSUED. . . . . . . : 05/08/2007 RECEIPT # . . . . . . . . . BS000001232 REFERENCE ID # . . . 07050049 SITE ADDRESS 1180 CRESTLINE DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : EVELYN & ALF MODINE ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5035 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOLNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 540 .00 259.20 0.00 259.20 0. 00 BPERMFEE VALUATION 50, 000 .00 E40.00 0 .00 540 .00 0 . 00 BPFIXTURE UNITS 1.00 9. 00 0 .00 9. 00 0.00 BPGAS OULETS 1 .00 5.40 0 .00 5 .40 0 . 00 BREMFIXT NO. FIXTURES 7 .00 8.40 0 .00 8 .40 0 . 00 BREMRECEPT NO. OUTLETS 6 .00 7.20 0 .00 7 .20 0. 00 BSEISMICRE VALUATION 50, 000 . 00 5.00 0 .00 5 . 00 0.00 EPERMITFEE FLAT RATE 1 . 00 38.37 0 .00 38 .37 0.00 PPERMITFEE FLAT RATE 1 .00 38.37 0 . 00 38 .37 0. 00 ----- ----- ---------- ---------- ---------- TOTAL PERMIT 510 . 94 0 .00 910 . 94 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- ------------------ CHECK 910 . 94 1490-EWEN CONST --------------- TOTAL RECEIPT 910. 94 awCITY OF CUPERTINO WYOF PERMIT APPLICATION FORM CUPEkTINO APN# Ll Date: Building Address•• Mailing Address (if different from building address): /l/S U Sy��-,�,v�' ,1��f2r/ti'Z�) Owner's Name: Phone c SELn/' .4n1� A-F /�ODi,✓� ��vz�'3-�'� � Contractor: License#: Co tact: :IF on Cupertino Business License#: x ��'�i'�/ Building Permit Info: Bldg ❑ Elect Plumb Od Mech ❑ Job Description: C_�`- CCl cl Residential ,�j i2'�Y�'�/ ��L- j1 f Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: .sa eve R -7 Type of Construction: Please check this box if the project is a second-storyaddition: El Project Size: Standard Large ❑ Major [] Qua_nt_ity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> �.M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. T 3.x for BQ Zone BUILDING BCONSTAXH Hot-,I and Motel BUILDING BCONSTAXR Constar—Resi/Mobile BUILDING BELEC1000 Elec 6)OV<= I OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Ener4y Add Multi BUILDING BINVESTIGA Inv(:stigation fee BUILDING 1 of 3 CITY OF CUPERTINO 1W TT PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Misc(;llaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind W<<ste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Clieck Add Multi BUILDING BPLANCKREP Plan Cl.eck Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S-)rinklerBackflo PLUMBING BPSTORM Storra/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Iter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL ` 7 BREMFIXT Ligf.ting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fr mace> 1 OK btu MECHANICAL BREMHEAT Heat-.r Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mi,,c Apparatus ELECTRICAL BREMNRAPP Rem Nc n-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power E-evice/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remod,;l Res Appliance ELECTRICAL 2 of 3 CITY OF CU:PERTINO ;rr F PERMIT APPLICATION FORM CUPEkTINO 2uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remode. Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICR.E Seismic Fee Res BUILDING BSPECIAL Spec ial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary BldgPermit BUILDING BTEMPSVCS Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec P�rmit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fe sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Lo ig Range Residential PLANNING ZADDCHG Adc.ress Change BUILDING 3 of 3 i - L:. C571 7, POW - CRY - CUPEkTINO Assessor's Parcel Number: Name of Owner- pr wner- Project address. Phone. Contact person. �"1`=' Fax. Net square footage of lot. Existin), Proposed Square footage: First floor: Second floor: Garage: �---- TOTAL: b 20 foot clear space; inside the garage?Y N Are there at least two 10 foot y privacy protection planting required for the project? �' Is p Y On what floor(s) is work being done? Brief description of work. A- Code editions: 2001 CBC 2001 CFC �-N)2001 CMC (Y-N) �T-�2001 NEC (�-N)2001 CPC - PPRCj V, �({�, J ED ��URDAIVCC Wt e C� Effective 1 lNo COo�s� tE trayo MAY l 7 . OR )p i E %00 t�lr�'AHCFS � � � PY slctryL This set`-"-�,— PE, i,op , ;7,1 Pecrfi,alt; ail t;n ions MUS lO, ir`,11ie� Or 81 teratic pe;ni5^ion n ;. ron Ir;e Wtan?i,ir„ v of Gif t.no. f 'ltrA,!t lVQ; be << by A'an and cpec+ficaticn APProvai of `'d to 1�all it the violation of , or to be al 7t any City Ortllnarice or Scare t s�Nl ovis►n, Page-B-Revised 4'28/04 Plan Review Process Work Book C� � L Oct J x ,. v io Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'UPEKTINO Building Department All Cupertino building permits must meet,:ertain conditions related to maintaining environmental quality and public peace and safety. The two most common conditions are described below. STORMWATER POLLUTION CONTROL State law requires that Cupertino, 12 other S licon Valley cities, Santa Clara County and the Santa Clara Valley Water District control :;tormwater pollution. Educating local residents and businesses and enforcing storrr water pollution control laws are key parts of the City's compliance efforts. Stormwater pollution prevention: It's up to us In northern Santa Clara Valley, storm drains low directly to local creeks and San Francisco Bay, with no treatment. Stormwat(�r pollution is a serious problem for wildlife dependent on our waterways, for people living near streams and baylands, and for the local water supply. Common sources of stormwater pollution include: • Dripped oil, fuel, and antifreeze from vehicles and heavy equipment; • Construction debris, including dirt, concrete and paint; • Landscaping runoff containing pesticices or weed killers; and • Any material dumped or spilled into si reets or storm drains The property owner and the contractor share ultimate responsibility for activities occurring at a construction site and will be hod responsible for any environmental damage caused by subcontractors or employees. For more information on construction-related stormwater requirements, see the Stormwater Quality Regulations section of tha City of Cupertino web site at: http://www.cupertino.org/city goverr ment/departments and offices/ environmental services COMMUNITY NOISE CONTROL The basic noise control requirements for con!:truction sites are as follows: • Typical construction work hours are: - Weekdays - 7 a.m. to 8 p.m. - Weekends - 9 a.m. to 6 p.m. • Construction other than street construction is prohibited on holidays. • Residential daytime noise levels from complaint site - 60 dBA • Nonresidential daytime noise levels frim complaint site - 65 dBA For more information on noise control, please see Chapter 10.48 of the Cupertino Municipal Code, which can be accessed at http://www.amlegal.com/cupertin.o ca/ Greg Casteel Building Official r. II�ETIAL PR�JC � nisNEs ®' RSI� �' CUPEkTINO Assessor's Parcel Number: Name of owner- _ =✓ `''�� !'f CJ Project address. 84 Phone. Contact person. Fax. 9 r_ Net square footage of lot. Existin ; Proposed Square footage: First floor: Second floor: Garage: — TOTAL: Are there at least two 10 foot by 20 foot clear space: inside the garage?y N Is pnvacy pro planting lanting required for the project? Z' On what floor(s) is work being done? f,T Brief description of work. K �' -N}2001 CMC (Y-N) Code editions: 2001 CBC �-�2001 CFC (�-N)2001 CPC 2001 NEC- Effective 11/1/02c'�l Mpy 07407, S�SS4 R CO Pj• age-8-Revised 4/28/04 Plan Review Process Work Book P oi-,. . f vq TIN Z l �' (V