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09080026 CITY OF CUPERTIN � BUILDING PERMIT Bli1LI)iNG ADDRESS: 20189 APPLE "I'REE LN ��ONTRACTOR: JOHN MCCUNE PERMIT NO: 09080026 ��ONSTRUCTION !�' '�"'�.R'S NAME: REPETTI STEVEN J AND PRISCILLA +5 LAS COLINAS LN DATE ISSUED: 08/06/2009 U'i. .� r:K'S PHONE: 4082555365 iAN JOSE, CA 95119 PHONE NO: (408) 227-2700 ❑ LICENSED CONTRACTOR'S DECLARATION gUILDING PERMIT INFO: BLDG �. ELECT�LUMB� License Class Lic. # �� T 0 ��( � t � - � y �� MECH RES[DENTIAL COMMERCIAL Contractor • J�1� �Q �V/�'� Date�� 1 hereby aftirm that I am licensed under the provisions of Chapter 9 IOB DESCRIPTION:NIOVE FURNACE/AC ADD TANKLESS WATER (commencing with Section 7000) of Division 3 oT the Business & Professions E�EATER Code and that my license is in full force and effect. 1 hereby aflirm under penalty of perjury one of the following hvo declarations: 1 ha��e and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performa�ice of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $1000 I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this �>ermit is issued. APN Number: 31633096.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating pERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter � upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemni;y and keep harmiess the City of Cupertino against liabilities, judgments 180 DAYS FROM LAST CALLED INSPECTION 1costs, and expenses which may accrue against said City in consequence of the I granting of this permit. Additionally, the applicant understands and will comply � with all non-poin so regulations per [he Cupertino Municipal Code, Section Issued b - i� Date: 9.�s /� �� `" d= G:�.� Si� '�:re : � L: RE-ROOFS: ❑ OWNER-BUILDER DECLARATION .All roofs shall be inspected prior to any roofing material being installed. lf a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for I hereby� afTirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: l, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work, and the structure is no[ intended or offered for sale (Sec.7044, _ Business & Professions Code) l, as o�+mer of the property, am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Codel. 1 hereby aftirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure fot Worker's California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & performance of the work f'or which this permit is issued. Safety Code, Section 25532(a) should 1 store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should 1 use equipment or devices which emit hazardous air Section 3700 of the Labor Code, for [he performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit �s issued. Health & Safety Code, Sections 25505, 25533, and 25534. I certify !hat 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 Worker's r a or' agent: � q/� Compensation laws o1�Califomia. If, after making this certificate of exemption, 1 Date: v0. become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed reveked. CONSTRUCTION LENDING AGENCY 1 hereby aftirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) 1 certifv that 1 have read this application and state that the above information is Lender's Name correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter Lender's Address �r � above mentioned property for inspection purposes. (We) agree to save � i :rj and keep hannless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION cus�s, and expenses which may accrue against said City in consequence of the grantint cf this permit. Additionally, the applicant understands and will comply 1 understand my plans shall be used as public records. with all non-point sou�ce regulations per the Cupertino Municipal Code, Section 9 � g Licensed Professional Signature __ Date__ ' � �� . . � CITY O�' CUPERTINO � � FURl�dACE/AC CUPE(�TINO PERMIT APPI�ICATION FORM APN # � Date: � ��(�33v�9�� 6 � Building Add ess: � �- � N-�P�� `T�ZCF �� . Ow '�s Name: Phone #: ,�� . �-.� ` �/ � r�. TT -�� Contractor: Phone #: (� � '..�.�J ,�2�v� � .�" � Q �V.� �C� '^� ��(�� Fax #: `C� ,�� v�7a S'f Contractor License #: Cupertino Business License #: 6 `f� I� �'AP�'US�� Contact: Phone #: � /� � �� I��1 7� `J �r� Fax #: Building Permit Info: Elect � Plumb �"� Mech � Residential � Commercial Job Description: �� F�� .r. : ri.�r � � For Residential Installations: Attic � lst floor [] 2 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 ❑ Co t of Project: Type of Construction (Usage Class): � � l� / Strapped ❑ On Platform Bond�d New Location Replacement ❑ Project Size: Express Standard ❑ Large [] Major ❑ Valuation: Green Building: Please complete relevant portio�i of the Green Building Checklist & attach it to the application or if applicable, incl ude in plan set & the sheet index. �_ Revised O1/07/09 r :�, CITY OF C UPERTINO .��` FURNA.CE/AC CUPEI�TINO FEE SC��EDULE Quantity Fee ID Fee Description Fee Permit Type Group FURNACE FURN/AC 1 MCRAA Commercial-Rep<<ir/Alteration/Add to M ea heating appliar.ce,refrigeration unit, cooling unit,absoiption unit,or ea heating,cooling,at�sorption or evaporative cooli�ig system,incl installation of cor. trols regulated by this code. 1MCREPALT Commercial for tlie repair of alt/add to M ea heating appliar�ce,refrigeration unit,cooling unit; �AV boxes, absorption unit oY ea heathing, cooling absorption,or eva�orative cooling sys, incl install of conxols regulated by this code. 1MCSUSHTR Commercial Instz.11/Relocate ea M suspended heater.recessed wall htr, or floor mounted unit heater. 1PGASCOM Commerical for ea gas piping System P 1-4 outlets 1BPGAS For each gas pipi:ig system of 5 or P more per outlet. 1MCAPPVNT Commercial for t1e install/relocate/ or M replacement of e�. appliance vent installed & not incl in an appliance permit. 1BCBSC Cal Bldg Standar3s Commission Fee B ALL PERMIT TYPES 1BSEISMICO Commercial Seismic B 1MRRAA Residential Repa.r/Alteration/Add to - M ea heating applialce,refrigeration unit, cooling unit,absorption unit,or ea heating,cooling,absorption or evaporative cooling system,incl installation of co:itrols regulated by this code. 1MRSUSHTR Residential Insta:l/Relocate ea M suspended heater,recessed wall htr, or floor mounted urit heater. CITY OF C UPERTINO � T ' ` � � FURN�.CE/AC . CUPE(�TINO FEE SCl3EDULE Quantity Fee ID Fee Descriptior� Fee Permit Type Grou AIR FURN/AC CONDITIONING 1 BCAIRHAN Commercial A/C Units <= l Ok CFM B 1MCRA.A Commercial Mech Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for E;a gas piping System P 1-4 outlets 1PGASRES Residential for e;i gas piping system P of 1-4 Outlets 1 BPGAS For each gas pi ping system of 5 or P more er outlet. �omm/Resid 1 BREMAIRHAN Residential A/C units <= l Ok CFM B 1MRRAA Residential Mec:i Repair/alt/add M 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT r TYPES 1 BSEISMICR Seismic Resider.tial B � 1 EPERMITFEE Electric Permit E L M � 1MPERMITFEE Mechanical Per.nit 1 PPERMITFEE Plumbing Perm �t P 1TRAVDOC Travel Documentation B 1BUSLIC Business Licen�;e B � �� T� ' � . M. In oor Air ua iry an Fm�shes 1, lise�l.+vwMo-YOG Pair�t 1 IAQ/Health pts y=yes � 2. Use Low VOC, Water-Based Wood Fnishes 2 IAQ/Health pts y=yes � 3. Use Low/�lo �O� Adhesives 3 IA(�/Health pts y=yes � 4. Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5. Use Engineered Sheet Go�ds with no added Urea Formaldehyde 61AQ/Health pts y=yes � 6. Use Exterior Grade Plywood for interior Uses 1 IAQ/Health pts y=yes � 7, Saa1 a11 �possd�arhdeboarc� oc �F 41AQ/Heaith. pts y=yes o 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 IAC�1Health pts y=yes � . 1 i 1 N. Flooring 1. Select FSC Certified Wood Flooring �3 Resource pts y=yes 0 2. Use Rapic�y Renewable Flooring Materials �� Resource pts y=yes 0 3. Use Recycled Content Ceramic Tiles �3 Resource pts y=yes 0 4. Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes � 5. Use E�cposed Concrete as Finished Flo�r � Resource pts y=yes 0 6. Install Recycled Content Carpet with Low VOCs � Resource pts y—yes 0 . 1 1 ! Total Pomts Available: 140 130 57 Total Points Pro'ect Received: � 0 0 0 G:data/prog�lgre :nbuildngguidelines/remodelzrs/greenpointsfina12.12.D4protected.xis � � �� b � Community Development �"°��-, ' 10300 Torre Avenue _ ��- .` Cupertino CA 95014 Telephone (408) 777-3228 C(TY OF Fax (408) 777-3333 „UPE�TINO Buildin De artment JOB ADDRESS: PERMIT # of ��- �12�� o'�- � OWNER'S NAME: �..�'`T'J PHONE #" d d 2 �' c� v GENERAL CONTRACTOR: I ry�,�1 e CU� � FAX # 1.�� .2 7�� o I am not using any subcontractors: Si;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTIZACTOR BUSIrdESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing p � Heating e,Z /y� �.g�' 1,N G Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing � � j�j` �'_U�,Qtn j Roofing Septic Tank Sheet Metal Sheet Rock T' �' � � � A ner/ Contractor Signature Date