10090157 CITY OF CUPERTINO BUILDING PERMIT
C�NTRACTOR:GOLDEN STATE STUCCO PERMIT NO: 10090157
BUILDING ADDRESS: 22001 LINDY LN DATE ISSUED:09/16/2010
5-9 LEISURE ST
OWNER'S NAME: TOM&HEMAL SURRETTE PHONE NO:(925)245-1435
LIVERMORE,CA 94551
PER'S PHONE: 4084371369
LICENSED CONTRACTOR'S DECLARATION LUILDING PERMIT INFO: BLDG ELECT PLUMB r
EE
❑ "2i � 7� `� RESIDENTIAL COMMERCIAL
License Class Lic.# MECH
ZG'1 O
Contractor Date �b JOB DESCRIPTION: APPLYING STUCCO TO EXTERIOR WALLS OFHOME,
I hereby affirm�=d�t�provisions of Chapter 9 OLOR
140T TO EXCEED REFLECTIVE VALUE OF SIXTY ON A FLAT
(commencing with Section 7000)of Division 3 of the Business&Professions ,;URFACE PER R.H.S.STANDARDS
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Valuation:$33000
Section 3700 of the Labor Code,for the performance of the work for which this Sy Ft Ftoor Area:
permit is issued.
APPLICANT CERTIFICATIOAPN Number:35627002
N Occupancy Type:
I certify that I have read this application and state that the above information is
.00
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 save
nitr
upon the above mentioned property for inspection purposes. (We)agree to
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
ertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
with all non point source regulations per the Cup
9.18.
Date:
Dated Issued byY —
Signature
Li OWNER-BUILDER DECLARATION RE FS
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons:
or my employees with wages as their sole compensation installed without first obtaining an inspection,I agree to remove all new materials or
I,as owner of the property,
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Date:
Business&Professions Code) Signature of Applicant:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued.
Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit ieiWued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Health&Safety Code,Sections 25505,25533,and 25534.
lifornia. If,after making this certificate of exemption,
Compensation laws of CaI
become subject to the Worker's Compensation provisions of the Labor Code, .mist O� r r uthorized agent: Date:5
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relat ng for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this elee to save 1 Lender's Name
upon the above mentioned property for inspection purposes.(We)agree
nnify and keep harmless the City of Cupertino against liabilities,judgments. Lender's Address
,,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply
ection ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Slens shall be used as public records.
9.18. 1 understand my p
Date__
Signature Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1k: Lot:
APN 35627002 .00
DATE ISSUED. . . . . . . : 09/16/2010
RECEIPT #. . . . . . . . . BS000011478
REFERENCE ID # . . . : 10090157
SITE ADDRESS . . . . . : 22001 LINDY LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER 'IOM & HEMAL SURRETTE
ADDRESS 22001 LINDY LN
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4836
RECEIVED FROM COLDEN STATE STUCCO
CONTRACTOR . . . . . . . : KIRT HUGGINS LIC # 28932
COMPANY COLDEN STATE STUCCO
ADDRESS E19 LEISURE ST
CITY/STATE/ZIP . . . : LIVERMORE, CA 94551
TELEPHONE ( 925) 245-1435
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------
1BCBSC VALUATION 33, 000. 00 2 . 00 0. 00 2 . 00 0 .00
1BSEISMICR VALUATION 33, 000 . 00 3 .30 0 .00 3 .30 0 .00
1STUCOAPP SQ FEET 4,460. 00 795. 00 0. 00 795. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 800 .30 0 .00 800 .30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ---------------- --------------------
CHECK 800 .30 #4269
----------------
TOTAL RECEIPT 800 .30
CITY OF' CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY: rdw
APN: BP#: *VALUATION: 1$33,000
*PERMIT TYPE: Building Permit PL tN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex I'(�I.iL PENTAMATION 1GENRES
USE: Fl 0O !"'Lr r PERMIT TYPE:
WORK
SCOPE
I1c,h. PCayr Ch,( uJ.h. I'lrrrt t(rerh f.r2c' 1'l,t,?( itc'<l
lfclr_ !'etr�rt 1� : Phur h. F'oww lite:
OTher tt'��4t. lr��7" Dl�ct'Piuu.ar Ir�sr' 011wr 1,/0, bis
dlxii.
Inv), FCC: Phrruh. Ire �z Fe1<I<r.Irrzh,tie'
NOTE. Thesefees are based on the preliminary information o rvailable and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resohitiori 09-051 E,ff.7%1!10) FEF QTY/FEE MISC ITEMS
Plan Check Fee: $().00 4,460 s.f. Restucco
Suppl. PC Fee: E) Reg. 0 OT FTO I hrs $().00 $795.00 ISTUCOAPP
PME Plan Check: $0.00
Permit Fee: $(1.00
Suppl. Insp. Fee.e Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $(1.00
PME Permit Fee: $(.00
C`0rs1t'1!('ci0n Kff
Acoustical Fee: 0 Yes 0 No $C.00
Work Without Permit? Q Yes E) No $C.00
Planning Fee: $C.00 Select a Non-Residential Q
11-ovcl 0outflac niatioll 1•'ee8: Building or Structure
i
Strong:Motion Fee: IBSEISMICR $2.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $r.30 $795.00 TOTAL FEE: $800.30
Revised: 9/14/2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ ,'-;,UBCONTRACTOR LIST
JOB ADDRESS: Z 2 L ^ Q PERMIT#
OWNER'S NAME: � �vl S V N t PHONE# Cr? C% 98y
GENERAL CONTRACTOR: BUSINESS LICENSE# 757
ADDRESS: -r ` �z.�� CITY/ZIPCODE: 2 4
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.94�5s /
NO BUILDING FINAL OR FINAL OCCUPANC V INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON'T'RACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: Date
ignat re
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
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Yes ? No ®i
s
Required
Prereq 1 Storage&Collection of Recyclf = i 1
Credit 1.1 Building Reuse:Maintain 25%of -xisting Walls,Floors&Roof 1
Credit 1.2 Building Reuse:Maintain 50%of =xisting Walls,Floors&Roof 1
Credit 1.3 Building Reuse:Maintain 75%of interior Non-Structural Elements 1
Credit 2.1 Construction Waste Managemer t: Divert 50%from Disposal 1
Credit 2.2 Construction Waste Managemer t:Divert 75%from Disposal 1
Credit 3 Materials Reuse: 1% 1
cot sumer+'/Z pre-consumer)
Credit 4.1 Recycled Content: 10%(post- 1
Credit 4.2 Recycled Content:20%(post-coi isumer+1/z pre-consumer) 1
Credit 5.1 Regional Materials: 10%Extracted,Processed&Manufactured Regionall 1
Credit 5.2 Regional Materials:20%Extracted,Processed&Manufactured Regionall 1
Credit s Certified Wood
Yes ? No m s
ess s
Required
Prereq 1 Minimum IAQ Performance Required
Prereq 2 Environmental Tobacco Smoke(ETS)Control 1
Credit 1 Outdoor Air Delivery Monitorinll 1
Credit 2 Increased Ventilation 1
Plan:During Construction
Credit 3 Construction IAQ Management 1
Credit 4.1 Low-Emitting Materials:Adhesi les&Sealants 1
Credit 4.2 Low-Emitting Materials: Paints &Coatings 1
Credit 4.3 Low-Emitting Materials:Carpet Systems
Credit 4.4 Low-Emitting Materials:Composite Wood&Agrifiber Products 1
FEHCredit 5 Indoor Chemical&Pollutant Source Control 1
Credit s Controllability of Systems:The rmal Comfort 1
Credit 7 Thermal Comfort:Design
Credit 8.1 Daylight&Views:Daylight 750/( of Spacesfft 1
Credit 8.2 Daylight&Views:Views for 90'/0 of Spaces
Ves ? No MNNNNMNENN=°`e
1
Credit 1.1 Innovation in Design:Provide 3peciftc Title 1
Credit 1.2 Innovation in Design:Provide ipeciffc Title 1
Credit 1.3 Innovation in Design:Provide Specific Title 1
Credit 1.4 Innovation in Design:Provide Specific TitleHfl 1
Credit 2 LEED®Accredited Professional
Yes ? No
• • !
Certified: 23 to 27 points, silver: 28 to 33 points, G)Id: 34 to 44 points, Platinum: 45 to 61 points
CITY OF
CITY OF C UPERTINO
Is GENERAL BUILDING APPLICATION
FEE SCHEDULE
CUPERTINO
Fee Description Fee Permit Type
Quantity/Sf Fee ID Group IGENRES or
IGENCOM
ISTUCOAP Stucco Applications(up
to 400 sf) B
Lt L �0 additional stucco a lication B
1 WINREP Replacem,-nt windows/sliding glass
door ea.S windows B
I WINMEWSTR New Window-structural shear
wall/mason includes lan ck fee
1 EPERMITFEE
Electrical Permit Fee E
1 MPERMITFEE
Mechani,;al Permit Fee M
1 PPERMITFEE Plumbin;;Permit Fee
P
1 ELCPLNCK Stand A lone Electric Pln Ck(hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck(hrly) M
I PLMBLNCK Stand Alone Plumbing Pln Ck(hrly)
P
I STPLNCK43 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter hourl •stand alone
B ALL PERMIT'
1 BCBSC Cal Bl Ig Standards Commission Fee TYPES
B
I BSEISMICR Seism is Residential
113SEISMIC0 Seismic Commercial
B
ITRAVDOC Travc-1&Documentation
B
1 BUSLIC Business License
B
5of5
OF PLOT PLANS
CITYCHECKED BY
F0 CITY OF CUPERTINO DA -�o
GENERAL BUILDING PLS; ._
CUP'ERTINO PERMIT APPLICATION FORM
t3A'1'E_
APN # � 0 � Date:
Building Address:
;I V1
Mailing Address (if different from building add ess): R �S
I
k--eI s V S�', �-t t�-c v W-4)r-
-A4
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's Name: Phone#:
� �-I�e rn�-I �� r Y�� t> 0
Tom
Phone: Z "tV--14
3S
Contractor: S11C C U -z ti s-�y 3 6
=License
Fax: �l r S`7
6-i-�`1 �- L{U8 -S��l - 3�r 7 t
Contact: Phone:
K1Y' �- � xS-- �Lrt- ry3S
Residential Commercial
Job Description: O f n G yy�
�} pl yl� sfv< <.o 4-oE �� r� o� wti ins
r�L-001, N c)-T -to
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type: (2 -
V-A
` _V-A ❑ II/III B, IV-HT, V-B [L].J R-e Si d-e-
Valuation: Square Footage: L/V &0
3 , vUU —
ProjectSize: Ex ress(Standard ❑ Lat e❑ Ma'or ❑
Green Building: Please complete relevant porton of the Green Building/LEED Checklist& attach it
to the application or if applicable,include in plan sett& the sheet index.
Points Achieved: (]
For help,contact Build it Green at www.buildit reen.or
Revised 07/14/09