10120009 JCC:: Lww.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1507 ASTER LN CONTRACTOR:MILLER JAMES G PERMIT NO: 10120009
OWNER'S NAME: MILLER JAMES G 1507 ASTER LN DATE ISSUED: 12/02/2010
O NER'S PHONE: 4082530436 CUPERTINO CA,CA 95014-5214 PHONE NO:
L LICENSED CONTRACTOR'S DECLARATION I
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH[_ RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:UPGRADE ELECTRICAL PANEL-200AMP
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have 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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1350
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
permit is issued. APN Number:36624006.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I 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 1 AYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DA M LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date:
9.18.
Signature Date
RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,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 not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner 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 Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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 for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the 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 is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 Worker's Ow r or auth ize e`: q
Compensation laws of California. If,after making this certificate of exemption,I 1' Date: �c. l 0
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 revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm 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.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I 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
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
c,,..c,and expenses which may accrue against said City in consequence of the
ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
all non-point source regulations per the Cupertino Municipal Code,Section
9.18, _a o, / , ee. auiu
Licensed Professional
Signature YhOh `� Dated N
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 1507 aster In. DATE: 12/02/2010 REVIEWED BY: bobs.
APNc BP##: *VALUATION: 1$1,350
R*PERMITTYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex �: PENTAMATION 1REAP2
USE: p � PERMIT TYPE:
WORK
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 100 Amps $42
TOTALS: $42.00
Elec.Plan Check0.0 1 hrs $0.00
Elec.Permit Fee: IEPERMIT
.......... Li
Other Elec.Insp. 0.0 hrs $42.00
NOTE. Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info,
FEE ITEMS (Fee Resohitio71 09-051 Elf.7%1%/0) FEE QTY/FEE MISC ITEMS
Plan C-licc:h !'cc:
F-71
PME Plan Check: $0.00
Per'l,FiF Fc>c:
`ll til, 1"sp,_`t, >
PME Unit Fee: $42.00
PME Permit Fee: $42.00
`fjt, Ptttt`tar:t,t 7'{��
7
Work Without Permit? 0 Yes No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50
Revised: 11/08/2010
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228- FAX(408)777-3333-buildinga-cupertino.org
CUPERTINO
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS JO S APN BP#
OWNER NAMES OWNER ADDRESS
J AMS s 4=_ 1�1c�: �S—a 9 . s Ti—te_ LAtjc
DESCRIPTION OF WORK: P"(a-
too A M P ,2 2ou A tAp
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you,the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
ilder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
4p2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
t e construction and are not hiring a licensed Contractor to assume this responsibility.
3. 1 understand as an"Owner-Builder' I am the responsible party of record on the permit. I understand that I may
otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
J4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
n mbers on permits and contracts.
5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
tal value of my construction is at least five hundred dollars($500), including labor and materials, I may be
considered an"employer' under state and federal law.
6. 1 understand if I am considered an"employer"under state and federal law, I must register with the state and
ed ral government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to
employment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
t7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
dential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
ensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
an financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
ects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04/14/10
9. 1 understand I may obtain more information regarding my obligations as an"employer"from the Internal
R venue Service,the United States Small Business Administration,the California Department of Benefit Payments,
nd the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State
License Board(CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed
contractors.
tth
10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
e party legally and financially responsible for proposed construction activity at the site address listed above.
11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
applicable laws and requirements that govern Owner-Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions,',deletions, or changes to any of the
i ormation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
u contract with someone who does not have a license,the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property,you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers'compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
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.)
Lender Name: Lender Address:
Before a building permit can be issued,this form must be completed and signed by the property owner and
returned to the agency responsible for' suing the permit. Note:A copy of the property owner's driver's license,
form notarization, or other verification ceptable to the city may be required to be presented when the permit is issued
to verify the property owner's sin e.
Property Owner's Signature: Date: o
- - - - - - - -
(NOTE. The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
Owner BuilderForn:_1010.doc revised 04/14/10
INPUT Resnmes FneTgyATHealth
,Win ows
1.Install Energy Efficient Windows
.a.Double-Parsed 1 Energy pt y=yes 0
b.Low-Emissnrity(Low-E) 2 Energy pts y=yes 0
c.Low.Conductivity frames 2 Energy pts y=yes 0
2.Install Low Heat Transmission Glazing 1 Energy pt y=yes 0
1 1 1
J.Heating Ventilation and Air Conditioning
1.Use Duct Mastic an All Duct Joints 2 Energy pts y=yes 0
2.Install Ductwork within Conditioned Space 3 Energy pts y=yes 0
3.Vent Range Hood to the Outside 1 IAO./Health pt y=yes 0
4.Clean all Ducts Before Occupancy 2 IAQ/Health pts y=yes 0
5.Install Solar Attic Fan 2 Energy pts y=yes 0
6.Install Attic Ventilation Systems 1 Energy pt y=yes 0
7.Install Whole House Fan 4 Energy pts y--yes 0
8.Install Sealed Combustion Units
a.Furnaces 3 IAQ/Health pts y=yes 0
b.Water Heaters 3 IAQ/Health pts y=yes 0
9.Replace Wall-Mounted Electric and Gas Heaters with
Through-the-Wall Heat Pumps 3 Energy pts y=yes 0
10.Install 13 SEER/11 EER or higher AC with a TXV 3 Energy pts y=yes 0
11.Install AC with Non-HCFC Refrigerants 2 Resource pts y=yes 0
12.Install 90%Annual Fuel Utilization Efficiency(AFUE)Furnace 2 Energy pts y=yes 0
13.Retrofit Wood Burning Fireplaces
a.Install EPA certified wood stoves/inserts 1 IAQ/Health pt y=yes 0
b. Install/Replace Dampers 1 Energy pt y=yes 0
c.Install Airtight Doors 1 Energy pt y=yes 0
14.Install Zoned,Hydronic Radiant Heating 3 Energy pts y=yes 0
15.Install High Efficiency Filter 4 IAQ/Health pts y=yes 0
16.Install Heat Recovery Ventilation Unit(HRV) 5 IAQ/Health pts y=yes 0
17.Install Separate Garage Exhaust Fan 3 IAQ/Health pts y=yesl I 0
1 1 1
K.Renewable Energy and Roofing
1.Pre-Plumb for Solar Water Heating 4 Energy pts y=yes 0
2.Install Solar Water Heating System 10 Energy pts y=yes 0
3.Pre-Wire for Future Photovoltaic(PV)Installation 4 Energy pts y=yes 0
4.Install Photovoltaic(PV)System
(1.2 kw=6 points,2.4 kw=12 points,3.6 kw=18 Up to 18 Energy pts 0
6.Select Safe and Durable Roofing Materials 1 Resource pt y=yes 0
7.Install Radiant Barrier 3 Energy pts y=yes 0
1 1 1
L.Natural Heating and Cooling
1.Incorporate Passive Solar Heating 5 Energy pts y=yes 0
2.Install Overhangs or Awnings over South Facing Windows 3 Energy pts y=yes 0
3.Plant Deciduous Trees on the West and South Sides 3 Energy pts y=yes 0
t 1 i
M.Indoor Air Qualityand Finishes INPUT FiesDurres Energy 1AQ!Heafth!T
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 61AQ/Health pts y--yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes
7.Seal all Exposed Particleboard or MDF 4 IAQ/Healft 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[AQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B 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
1 0
1 1
Total Points Available: 1 1401 130E---5-71
Total Points Project Received: 1 0 0
G:data/progs/greenbuiirfingguidelines/remodelers/greenpointsfinai2l2.G4protected ids
CITY OF CUPERTINO
CUFEKTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
Building Address:
t5o`7 �S•�� ���c Cv�e�.Tt��� �. ��ot�i
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes D No
HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA
Owner's Name. Phone#:
Contractor: Phone: ` L
c� jC O r3 Fax:
Contractor License#:
Cupertino Business License
Contact: CrV�es f+ 1Fax:
esidential VCommercials..
Job Description: r1 ,� '�
260 'p4 IT
Building Permit Info:
' Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type: 11� —
1-A, 1-B ❑ UIHI/V-A ❑ II/III B, IV-HT, V-B
Valuation: Square Footage:
41350 l
Project Size: Ex ess [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:
-)r help, contact Build it Green at www.buflditueen.org
i
Revised 07/14/09