09010003 CITY OF CUPERTINO " T
BUILDING DIVISION PERMIT y #r� T � fi
a; s:
PERMIT NO.
BUILDING ADDRESS:
1105 ELMSFORD DR AMERICAN HOME
09010003
PERMIT ISSUE DATE
OWNER'S NAME:
A O. CONTROL NO.
(858) 457-4500
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
0 0 0
Q p p LICENSED CONTRACTOR'S DECLARATION Job Description
m C 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 Codeand my license is
'`4y in full force in tee 7,9e� RMV&RPLC 7 WINDWS;RETRO—FIT SIZEFOR
2 License Class �7 Lle•S
C—a Dam _ Contracto SIZE,LIKE4LIKE
RCHITECCS DEC ATION
-t 1 understand my plans shall be used as public records
�yU
iu.y Licensed Professional
01 OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p Ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county
o
${i which requires a permit to construct,alter,improve,demolish,or repair any structure
y- rn prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
=G rac
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
E Sq.Ft.Floor Area
E r (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $16755
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500). 36206007 . 00
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(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.).
❑1,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 docs 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
License Law.
❑I am exempt under Sec. B tit P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
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 Worker's Compen-
tion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Whave 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 Workees Compensation Insurance carrier and Policy number are:
CartierPolicy No.: .7
CERT KATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 100)
or Icss.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mast
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
7- CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
(Yr the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendees Name
z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
V.H cored.l agree to comply with all city and county ordinances and state laws relating to
Obuilding construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes
f>~ (We)agree to save,indemnify and keep harmless Otc City of Cupertino against *_�w
HrA liabilities,judgments,costs and expenses which may in any way accrue against said City �r
V Z in consequence of the granting of this permit. 06Date /d
�_4 AF;PL!p NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
Sc C REGULATI NS. I
y�� Re-roofs
Signature of Applicant/Contractor Dam Type of Roof
HAZARDOUS MATERIALS D CLOSURE yP
Will the applicant or future building occupant store 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.
0 Yes f o
(f If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0Yes / o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia
d6r-ntly have a tenant.that it is my responsibility to notify the occupant of the
is which must met pri t issmanee of a certificate of Occupancy. Signature of Applicant Date
-CP All roof coverings to be Class'n"or better
Owner or authorize gent Date
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36206007 . 00
DATE ISSUED. . . . . . . : 01/05/2009
RECEIPT #. . . . . . . . . . BS000006894
REFERENCE ID # . . . : 09010003
SITE ADDRESS . . . . . : 1105 ELMSFORD DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CATE THOMAS M AND EDNA P
ADDRESS . . . . . . . . . . : 1105 ELMSFORD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4908
RECEIVED FROM . . . . : EDWARD A GREGORY
CONTRACTOR . . . . . . . : BRADLEY A. SMITH CEO LIC # 29801
COMPANY . . . . . . . . . . : AMERICAN HOME CRAFT INC
ADDRESS . . . . . . . . . . : 6335 FERRIS SQ STE B
CITY/STATE/ZIP . . . : SAN DIEGO, CA 92121
TELEPHONE . . . . . . . . : (858) 457-4500
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- --
1BSEISMICR VALUATION 16, 755 . 00 1 .70 0 . 00 1 .70 0 . 00
1WINREP EACH 8 1 . 00 367 . 00 0 . 00 367 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 368 . 70 0 . 00 368 . 70 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 368.70 VISA
---------------
TOTAL RECEIPT 368. 70
1213012008 17:49 American Home Craft Inc. (FAX)9164817111 P.0031003
RX Date/Time 12130/2008 1122 510 732 9808 P.002
From:AHCI HAYWARD 510 732 9808 12/30/2008 10:36 #686 P.0021002
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CIT1f OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: / I PERMIT # 4
1/0,5- /iMsrd Dr (-)Q o1
OWNER'S NAME: C'a�� PHONE # -- 3 �0
GENERAL CONTRACTOR: ,,, 1-1010n,,= FAX #
l=F y
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
Owner/Contract r Signature Date
CITY OF CUPERTINO
CUPEk ANO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# j, o LS�. (�'� Date: / �- _
LI% ��
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#:
d,1 a Cale Ila
Contractor: Phone: �/ _ 90-
14 m el t'c 4y 11-01",e �/� Fax: !�/6- 11-rif- Z 7 3
Contractor License#: 9 O 70 ?
Cupertino Business License#: `� `1
Contact: M u y Phone: t4 CP
Fax:
Residential Commercial Fj
Job Description: `7 Al d 0�-J --
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/II1/V-A ❑ II/III B, IV-HT,V-B KJ <<
Valuation: 1673,S- Square Footage:
Project Size: Express ❑ 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:
For help, contact Build it Green at www.builditgreen.org
Revised 7/01/08
CITY OF CUPERTINO
Cin OF GENERAL BUILDING APPLICATION
CUPERTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
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
1 ELCPLNCK 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
i 1BSEISMICR Seismic Residential B
1BSEISMIC0 Seismic Commercial B
l TRAVDOC Travel &Documentation B
1 BUSLIC Business License B
5 of 5
lr
M.Indoor Air ua ay and-Fin-res
1.Use Low1No-VOC Pain 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Low/No VOC Adhesives 3 IAQ/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 6IAQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal au Exposed Parfdaboad or MDF 4 IAQ/Health. pts y=yes 0
8.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 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 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 IAQ/Health pts y=yesj 0
S.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
1 ! !
Total Points Available: 1 1401 1301 57
Total Points Project Received:1 1 01 0 0
41 -P res
Gre.W y
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