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09050030 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � k� � « .:>. .. ... ..:. BUILDING ADDRESS: PERMIT NO. 890 SEPTEMBER DR A PER:PE OWNER'S NAME:rT�L7 r 7 r1� PERMIT ISSUE DATE 1914 11TY��1ri LTT TD SNE: SA '2089CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH REPLC FURNC, ADD A.0 & ADD uoa LICENSED CONTRACTOR'S DECLARATION MINI ;SPLIT FOR UPSTAMf3Description U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and cif, Li Cl as L� Lic.M F p Da Contractor ','j ARCHITECTS DECLARATION -r I understand my plans shall be used as public records , � U �p y Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's Lfccnse Law for tic ,:in O following mason.(Section 7031.5,Business and Professions Code:Any city or county t$� which requires a permit to construct,alter,improve,demolish,or repair any structure Zyy prior to its issuance,also requires the applicant for such permit to rile a signed statement g c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation Y t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or f R$ 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 APN Number Occupancy Type not mom than five hundred dollars($500). ❑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 Contractors License Law dors not apply to an owner of q p property who builds or improves themon,and who does such work himself or through his own employees,provided that such improvements am 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 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 License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insum for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance caner and Policy number are: Cartier eAdU rdra L-%-Wo'r'4 Poh y CN,ao.A �,n o--Lcsy(- -L— CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) Of less) 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 must ,J 0 forthwith comply with such provisions or this permit shall be deemed mvokcd. z CONSTRUCTION LENDING AGENCY [~i CA I hereby affirm that there is a construction lending agency for the performance or �E the work for which this permit is issued(Sec.3097,Civ.C.) OW.r Q Lenders Name ]z Lenders Address U 0 1 certify that I have mad this application and state that the above information is V. correct.l agree to comply with all city and county ordinances and state laws relating to OU building construction,and hereby authorize representatives of this city c enter upon the U above-mentioned property for inspection purposes CL (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in anyway accrue against said City ^7 V Z in consequence of the granting of this permit. Date J ( � ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SO REGULA S. Re-roofs Sign f Applicant/Co=tor 1 Date HAZARDOUS MATERIALS DISCLOSURE Type of koof 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)? B All roof:;shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or forum building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. ,,strict? ❑Yes gnu 1 have read the ha=,dous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand rstand that if due building does not currenghust a tenant,that it is my responsibility to notify the occupant of the 0 1rem rats wbe rior to issuance of a Certificate of occupancy. SignatuP:of Applicant Date s '6 All roof coverings to be Class"Jq``or better Ow r o authorised agent Dae CITY OF CUPERTINO FURNACE/AC CUPEkTINO PERMIT APPLICATION FORM APN # �� � � L � .. � � Date: Building Address: a , Owner's Name: Phone#:t1 U g M246.0- is -(o2-rA Contractor: Phone#: YO C _ E-6 r _9J zfy- 14 4Fax#: d C- (m[- ?� Contractor License#: Cupertino Business License#: lJ Contact: Phone#: Cl/0 y_eQ-.745;� rl(vl_ Fax #: O Building Permit Info: ElectlzkPlumb Mech Residential Commercial Job Description: ✓' h� c� Aj A , C i i r rr For IkesidentialInstallations: Attic ❑ I` floor 12� 2nd floor Adhere to minimum setback requirement [.]� For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): Strapped D On Platform Bonded New Location Replacement Project Size: Express El Standard ❑ Large ❑ Major❑ _ Valuation: Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set & the sheet index. _ Revised 01/07/09 CITY OF CUPERTINO FURl�ACE/AC COF CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1MCRAA Commercial-Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,ab:orption unit,or ea heating,cooling absorption or evaporative cooling system,incl installation of controls regulated by this code. 1 MCREPALT Commercial for the repair of alt/add to M ea heating appliance,refrigeration unit,cooling unit,VAV boxes, absorption unit or ea heathing, cooling absorption,or evaporative cooling sys, incl install of controls regulated by this code. 1MCSUSHTR Commercial In:tall/Relocate ea M suspended heater,recessed wall htr, or floor mounted L nit heater. 1 PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas piping system of 5 or P more per outlet. 1MCAPPVNT Commercial for the install/relocate/ or M replacement of,:a appliance vent installed & not-ncl in an appliance permit. 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repair/Alteration/Add to M ea heating appliance,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling:absorption or _ evaporative cooling system,incl installation of controls regulated by this code. 1MRSUSHTR Residential Install/Relocate ea M suspended heatcr,recessed wall htr, or floor mounted unit heater. CITY OF CUPERTINO FURNACE/AC CUPEf�TINO FEE SCEIEDULE Quantity Fee ID Fee Descriptiwi Fee Permit Type Group AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units<= l Ok CFM B 1 MCRAA Commercial Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Seismic Comme:-cial B 1PGASCOM Commerical for -M gas piping System P 1-4 outlets 1 PGASRES Residential for e i gas piping system P of 1-4 Outlets IBPGAS For each gas piping system of 5 or P more per outlet. Comm/Resid I BREMAIRHAN Residential A/C units <= l Ok CFM B IMRRAA Residential Meclh Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B ' IEPERMITFEE Electric Permit E 1MPERMITFEE Mechanical Perrait M 1 IPPERMITFEE Plumbing Permit P 1 — 1 TRAVDOC Travel Documentation B 1BUSLIC Business Licens:, B INPUT Resources • 1ADIHealth M.Indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 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 all Exposed Particleboard or MDF 4 IAQ/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 IAQ/Health pts y=yes 0 1 i 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=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 i 1 1 Total Points Available: 1 1401 130 57 Total Points Project Received:1 1 01 01 0 G:data/progs/gre:nbuildngguidelines/remodelers/greenpointsflna12.12.D4protected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 .s_a Telephone(408)777-3228 CITY OF Fax(408)777-3333 -.UPEf�TINO Building Department JOB ADDRESS: PERMIT # 2 0 -z n r-� 45-e--,�r� OWNER'S NAME: ` PHONE # q0 GENERAL CONTRACTOR: A FAX # Y 09- I S -I am not using any subcontractors: &? S ignature Date Please check applicable subcontractors and coir. lete the following information: SUBCONTRACTOR BUSI:vESS 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/Contractor Signature Date