09050006 CITY OF I PERTINO ��00 �� � +
BUILDING DIVISION PERMIT .
..::.........
..:, ..
PERMIT NO.
BUILDING ADDRESS:
10388 LANSDALE AVE F S CONCRETE SERVICE 09050006
PERMIT ISSUE DATE
OWNER'S NAME:
PAKA I A O. CONTROL NO.
'ONE:
(408) 605-1802
BUILDING PERMIT INFO
ARCHITECr/ENGINEER: BLDG ELECT PLUMB MECH
0 0 (�
a p C LICENSED CONTRACTOR'S DECLARATION Job Description
Wt I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z ie with Section 7000)of Division 3 of the Business and Professions Code.and my license is RMV POOL
H in full force and effect.
v�Z License Class Lie.
E p Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
7yU
Z O H Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractofs License Law for the
a0 following mason.(Section 7031.5,Business and Professions Code:Any city or county
K m Pi which requires a permit to construct,alter.improve,demolish,or repair any structure
prior W its issuance,also requires the applicant for such permit to file a signed statement q Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
EF$ (commencing with Section 7000)of Division 3 of the Business and Profcssinns Code)or 4 9 O 0
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(5500). 3691200-1 . 00
O I,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 docs 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
sal "*-
i
as owner of the property,am exclusively contracting with licensed contractors to
ct the pmject(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 Contractoes
License Law.
O I am exempt u er Sec. &710N�DECLARATION B&P C for this reason
Owner DateORKER'S C IP
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for workers Compcn-
-tion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O 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
(!'his 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.I shall not
employ any person in any manttgr so as to become subject to the Workers'Compensation
Laws of Califoroia Dam 1� t
Applicant �
NOTICE TO APPLICANT:after making 4ks C6rtificatc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
(, .r I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z:) Lender's Address
1 certify that I have rad this application and state that the above information is
O corrccL I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes
d a (we)agree to save,indemnify and keep harmless the City of Cupertino against
0.4 liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date17 S
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURCE REGULATIOf .
C(�,�t,1�•�wr�A sIRe-roofs C7 --
Signature of Applicant/Contractor -� Dhic T� T of]Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Cotte.Chapter 9.12,and the Health and Safety
Code.Section 25532(a)? All roofs Shall be inspected prior to any roofing material being installed.
fi
C3 Yes 2 Ne If a roof i3 installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
it hazardous air contaminantg}s defined by the Bay Area Air Quality Management all new materials for inspection.
.strict? V
[:1 Yes ONO
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant Of the
re�Ow�ncrorau
uirementshick must be met prior to issuance of a Ccruftcate of Occu a"q; Signature of Appl ieant Date
All roof coverings to be Class" "or better
D tc
CITY OF CUPERTINO Oq o t a13
DEMO
CUPEkT1NO PERMIT APPLICATION FORM
APN# f Q Date: I I d
Building Address:
10388 Larsolal,e AvK- , ► qSO 4-
Mailing Address (if different from building addr-Iss):
Owner's Name: Phone:
R�tc�-�srt BC PO&FVA Civ PTA 408 3y3 3�►� I
Contractor: Phone : 4D$ 605 1802—
$ S cor�cro.4e
Fax:
Contractor License #: q 2 S t 1? 2-
Cupertino Business License#:
Contact: F,R Y-E SH, �U PTS Phone: 40$ 3y 7>
Fax:
Residential Ef Sq Footage Commercial ❑ Sq Footage
Job Description:
gew\ove �ool
Valuation: 4, 100
Project Size: Express En--*-Standard ❑ Large ❑ Major❑
Please complete relevant portions of the Gre(n Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMORES Demo-Residential B 1SFDWL-DEM
1DEMOPRES Pool Demo Residential B 1SFP00L-DEM`
1BCBSC Cal Bldg Standards B ALL PERMIT
/ Commission Fee TYPES
1BSEISMICRE Seismic Residential B
Revised 01/07/09
Li 2001
ENTER PROJECT
■ • e t o S5■ o
6 Y � W Gl pz
4.Use Solid Wall Systeme(Indudes Sips,ICFs,i Any NonSgek Frame Assembly)
2.
b.Walls D _
c.Rods 0 2 2
S.Reduce Pollution Entering the Home from the Garage
a.Tightly Seal the Air Barrier between Garage and Living Arca __
0 1
b.Install Garage Exhaust Fan OR Build a Detached Garage D
6.Design Energy Heels on Trusses(75%of Attic Insulation Height at Outside Edge of Exterior Walll D 1 t
7.Design Roof Trusses to Accommodate Ductwork 0 1 ! }
IL Use Recycled-Content Steel Studs for 90%of interior Wall Framing 0
9.Thermal Mass Wails:516-Inch Drywall on All Interior Walls or Walls Weighing more than 40 Iblcu.t L 0
10.Install Overhangs and Gutters
a.Minimum 16-Inch Overhangs and Gutters __ _•__ ;_�:—�,__
b.Minimum 24-Inch Overhangs and Gutters
Toles Pi-rots Available In Structural Building Frame and Envelope=36 0
B.EXTRORFI $H
asure
1.Use Recycled-Content(No Virgin Plastic)or FSC-CerllOed Wood Decking 0 f I 2 s
2 Install a Roln Screen Wall System D 2
3.Use Durable and Noncombustible Siding Materials D ; 1
4.Select Durable and Noncombustible Roofing Materials 0 2
Total Points Available In Exterior Finish= 0
F PDmtS Avellab�E'R� I9aSurB+r
1.Install Insulation with 75%Recycled Content
a.Wails andlor Room 0 ( 1 I
. b.Calingt 1 h
2 Install Insulation got Is Low-Emitting(Certified Section 0135D)
a.Walls and/or Floors �.- _• 1_ _-..
b.Callings
I 3.Inspect Quality of insulation Installation before Applying Drywall
Total Points Available In Insulation= 0
G.PLUMBING ` Poiriis AJalabfe Peraultiasure.
1.Distribute Domestic Hot Water Efficiently(Maximum 7 Points)
■ a.Insulate Hot Water Pipes tram Water Healer 10 Kitchen
�.1--4 --- -
0
b.Insulate AD Hot Water Pipes _ _-_— ` --.--i,—_ ^•--•_.; -
c.Use Engineered Parallel Piping ��•~ -- _._ __ _ _ _-_ 1-._
d.Use Engineered Parallel Piping with Demand Controlled Circulation Loop 0
e.Use Skudured Plumbing with Demand Controlled Circulation Loop
I.Use Central Core Plumbing 0 _- 1 T{ - —{ 1 2
t Install Only High Efficiency Toilets(Dual-Flush orO.29 gIM 0 4
Total Points Available In Plumbing=Total 1 0
H.HEA371VG,VENTII IcaTTON do i,IIt CONDITftO11IINGF `�,t, w?� x �. i,pointi Aaaliabte Par Mt asitia n
w.:
1.Design and Install HVAC System to ACOA Manual J,D,and S Recommendations 0 } 4
Z Install Scaled Combustion Units
a.Furnaces
2
b.Water Heaters
3.Install Zoned,Hydrenic Radiant Heating with Slab Edge Insulation D 1 1 I
4•Install High Efficency Air Conditioning with Environmentally Responsible Refrigerants 0 1 ( f
5.Design and Install Effective Ductwork
a.Install HVAC Unit and Ductwork within Conditioned 5 ce
b.Use Duct Mastic on All Duct Joints and Sawn y D
■ c.Install Ductwork under Attic Insulation(Burled Duds) l --
d.Pressure Balance the Ductwork System ..-o._
a.Protect Duds during Construction and Clean AN Ducts before Occupancy
G Install High Efficiency HVAC Filter(MERV S+) 0 t 1 I
f 1 t
■
T.Dont Install Fireplace or Install Sealed Gas Fireplaces with Efficiency Rating Not Lees Than 601. D
using CSA Standards + I r
A.Install Effeetive Exhaust Systems In Bathrooms and Kitchens
■ a.Install ENERGY STAR Bathmcm Faris Vented to the Outside
b.AN Bathroom Fens Are on Timer or Humidistal
c.Install Kitchen Range Hood Vended to the Outside --
9.Install Mechanical Ventilation System for Cooling(Maximum 4 Points)
■ a.Install ENERGY STAR Coling Fans it Light Kgs In Living Areas d Bedrooms
b.Install While House Fan with Variable Speeds 0^ Y 1 1
■ _—
0 2DD7 Build It Green Single Family GreenF point Cheddist 2007 Version Page 3 of 7
y ' Community Development
10300 Torre Avenue
e ;3 Cupertino CA 95014
Telephone(408)777-3228
C1TY OF Fax(408)777-3333
-,UPERTINO
Building Department
JOB ADDRESS: PERMIT #
t o3 g g Lowes" Ave, Oq C 5 00 v
OWNER'S NAME: PHONE # a 60 ^ o
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com Clete 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
_ y Zoo 9
Owner/ on actor Signature Date