09090012 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21 167 OROGRANDE PL CONTRACTOR:TBD-TO BE PERMIT NO:09090012
DETERMINED
"VNER'S NAME: SHAUPOH WANG DATE ISSUED:09/02/2009
UWNER'S PHONE: 4082178664PHONE NO:
,
M/ LICENSED CONTRACTOR'S DECLARATIONr
GG BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C-7-0 Lic.# Z- r_w
MECH RESIDENTIA COMMERCIAL
Contractor Al It M A2L, Si!Q V lC FS Date Cf" Z"��
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: UPGRADE ELECTRICAL PANEL TO 200
(commencing with Section 7000)of Division 3 of the Business&Professions AMP,ADD A/C AND
Code and that my license is in full force and effect. REPLACE FURNACE
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:$7500
1 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 APN Number:36217009.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certit}that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspe;tion purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ��
granting of this permit. Additionally,the applicant understands and will comply Issuedy' Date: ��
with oil non-point source regulations per the Cupertino Municipal Code,Section
91&
RE-ROOFS:
,lature� Date All roofs shall be inspected prior to any roofing material being installed. 11'a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
Ci OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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&Professions Code)
I,as owner of the property,am exclusively contracting with Licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance.as provided for by the Health&Safety rode,Sections 25505,25533,a.UIL25534.
Section 3700 of the Labor Code,for the performance of the work for which thisq-2-(J
Owner or authorised agent: Date:
permit is issued.
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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions ofthe Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
1 certify that I have rad this application and state that the above information is
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
the above mentioned property for inspection purposes.(We)agree to save
,;mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the i understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with P.11 non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.19
Signature---- - - ------Date—
k Community Development
10300 Torre Avenue
M � - Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
"UPERTINO
BuildinDe artment
JOB ADDRESS: 211(.'1 O r-Dr&^C4 Plc-" PERMIT #
c ri," CM, -q s 01 y 0?1�OWNER'S NAME: 151,1 C,0 Li&'1!2) PHONE # yv pj -7 &-0 3 3
GENERAL CONTRACTOR R Mc,,-7,c e Yv'rc eS FAX# Y"0 2ys - OYb q
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
V ElectricalC Y� c e C l2C+r 1 ( 5 1 c tk s s C—/o
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
X1-2 -a j
Owner/Contrac gi ature Date
CITY OF CUPERTINO
8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36217009 . 00
DATE ISSUED. . . . . . . : 09/02/2009
RECEIPT # . . . . . . . . . : BS000008589
REFERENCE ID # . . . : 09090012
SITE ADDRESS 21167 OROGRANDE PL
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SHAUPOH WANG
ADDRESS . . . . . . . . . . : 21167 OROGRANDE PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4151
RECEIVED FROM . . . . : DANIEL RIQUEROS
CONTRACTOR TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 7, 500 . 00 1 . 00 0 . 00 1 . 00 0 .00
1BSEISMICR VALUATION 7, 500 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 .00
1MPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 . 00
1MRRAA UNITS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0. 00 42 . 00 0 .00
1TRAVDOC FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 274 .80 0 . 00 274 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 274 . 80 VISA
---------------
TOTAL RECEIPT 274 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
CITY OF CUPERTINO
FURNACE/AC
CUPEI�TINO PERMIT APPLICATION FORM
6g6ci 00 IZ
APN # Date:
Fl bo ci •Ov Cl- Z-09
Building Address:
2-l � (,1 Cru ,r \C .e 1?lC,u
Owner's Name: Phone#:
Contractor: Phone#: yc)F� -7 -3b v333
A11Z L!�o tcLZ Fax#: 1406 24s 04814
Contractor License#: Cupertino Business License#:
-� 3252-?
Contact: Phone#: q05 3 o9 _-7 89 y
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Fax #: Yug Zy5 - vy6 q
Building Permit Info: /
Elec Plumb []'✓ Mech qa7—
Residential Commercial ❑
Job Description:
For Resicrential Installations:
Attic ❑ 1st floor 2°d 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):
C�C� Lec-1 n Cc.,l (u C k(,In(Ck I
Strapped ❑ On Platform H Bonded New Location 0--- Replacement
Project Size: Express ❑ Standard.21 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
a FURNACE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1 MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,ab sorption 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.
1 MCSUSHTR Commercial Install/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 piping system of 5 or P
more per outlet.
1 MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit.
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICO Commercial Seismic B
1 MRR.AA 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 heater,recessed wall htr, or
floor mounted unit heater.
CITY OF CUPERTINO
FURNACE/AC
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description 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
1BSEISMICO Seismic Commercial B
1 PGASCOM Commerical for ea gas piping System P
1-4 outlets
1PGASRES Residential for ea gas piping system P
of 1-4 Outlets
1 BPGAS For each gas piping system of 5 or P
more per outlet. Comm/Resid
IBREMAIRHAN Residential A/C units<= IOk CFM B
1 MRRAA Residential Mech Repair/alt/add M
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
I TYPES
/ 1BSEISMICR Seismic Residential B
1 EPERMITFEE Electric Permit E
I 1 MPERMITFEE Mechanical Permit M
1 PPERMITFEE Plumbing Permit P
l TRAVDOC Travel Documentation B
1BUSLIC Business License B
INPUT Resources Energy IAQ/Health
M.indoor Air Quality andFrnrshes
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 D
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
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 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
1 1
Total Points Available: 401 130 57
Total Points Project Received: 01 0 0
7 -2 -0?
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