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09100134 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7876 BELKNAP DR CONTRACTOR:LIGHTHOUSE ELECTRIC PERMIT NO:09100134 OWNER'S NAME: BARON STEVEN W AND KATI 236 BURNING TREE DR DATE ISSUED: 10/21/2009 4ER'S PHONE: 4084991237 SAN JOSE,CA 95119 PHONE NO:(408)590-7565 LICENSED CONTRACTOR'S DECLARATION f— //. /� r_ r_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class (/`( (.'� Lic.# (0) b J 2 / MECH f— RESIDENTIAL f— COMMERCIAL Contractor 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE&REPLACE METER MAIN ELECTRIC (commencing with Section 7000)of Division 3 of the Business&Professions PANEL Code and that my license is in full force and effect. 1 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:$1600 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 permit is issued. APN Number:36210040.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 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 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM 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 sour regulations pe Cuperti Municipal Code,Section Issuedby:`i "�7 Date•/,�/- 9.18. j _Z</ C)�] Signature Date RE-ROOFS: CJ 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: I,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) I,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. 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 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 Owner r prized a Compensation laws of California. If,after making this certificate of exemption,I eZ' Date:�(1 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.) 1 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 nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION u, and expenses which may accrue against said City in consequence of the grunting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36210040 . 00 DATE ISSUED. . . . . . . : 10/21/2009 RECEIPT #. . . . . . . . . : BS000008987 REFERENCE ID # . . . : 09100134 SITE ADDRESS . . . . . : 7876 BELKNAP DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BARON STEVEN W AND KATI ADDRESS 7876 BELKNAP DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4906 RECEIVED FROM LIGHTHOUSE ELECTRIC CONTRACTOR ALAN FORTIN LIC # 27871 COMPANY LIGHTHOUSE ELECTRIC ADDRESS 236 BURNING TREE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95119 TELEPHONE (408) 590-7565 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 600. 00 1 . 00 0. 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 600 . 00 0 .50 0 . 00 0.50 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 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 BUSLIC FLAT RATE 1 . 00 114 . 00 0. 00 114 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 241 .50 0. 00 241.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 241 .50 --------------- TOTAL RECEIPT 241 . 50 013 CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date- 00 �� - Z/ - 0 � Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes El No HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Owner's Name: Phone#: 1 Contractor: fi�� l�Y �t�,/zrTrt?% Phone: 1--)6 i,�- ie-le-e i zee Fax: Contractor License#: fir,�—o j--7/ Cupertino Business License#: Contact: Phone: Gy �-6 l /-7�/ Fax: Residential Commercial Job Description: Building Permit Info: Bldg ❑ Elect L Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B � - _ 3 Valuation: Square Footage: Project Size: ExpressStandard ❑ 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: C-&-- For --- For hel , contact Build it Green at www.builditereen.org Revised 07/14/09 CITY OF CUPERTINO Cin of GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 so B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-stand alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 M.Indoor Wir Qua rty an Frmshes INPUT Resources Energy !AC�Heafthv 1.Use LowMo-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 LowMo 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 car 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 1116 1 i 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 ! Total Points Available: 1401 130r---'5-71 Total Points Project Received: 01 0 0 G:datalprogs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xis Community Development 10300 Torre Avenue ;E Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .XPEkTINO Building Department JOB ADDRESS: PERMIT # 1X76 &c- OWNER'S NAME: <r c PHONE # GENERAL CONTRACTOR G 1 �� e AX # I am not using any subcontractors: Signature Date 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date