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09100158 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11406 LINDY PL CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100158 OWNER'S NAME: KELLY HIRANO DATE ISSUED: 10/23/2009 ER'S PHONE: 4084801669 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG .ELECT PLUMB License Class (f- I t7 Lic.# rT-3-1 U 2 2. MECH RESIDENTIAL COMMERCIAL Contractor C J<7rr• Date -->L--E./z-3 /v y I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE EXISTING ALUMINUM WIRE TO (commencing with Section 7000)of Division 3 of the Business&Professions COPPER WIRE, Code and that my license is in full force and effect. RELOCATE SOME SWITCH BOXES,REPLACE BATHROOM FANS 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$8500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35624011.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued7 ...-pp- Date* Signature Date d[f l Z.3) 041 ` Ei OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by 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 contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I mush Date: �Z� forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.1 agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address i nify and keep harmless the City of Cupertino against liabilities,judgments, 1-1 and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35624011 .00 DATE ISSUED. . . . . . . : 10/23/2009 RECEIPT #. . . . . . . . . : BS000009017 REFERENCE ID # . . . : 09100158 SITE ADDRESS . . . . . : 11406 LINDY PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER KELLY HIRANO ADDRESS . . . . . . . . . . : 11406 LINDY PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4814 RECEIVED FROM . . . . : YCK ELECTRIC 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BAPPLOTHE NO OF APPLIAN 1.00 63 .00 0. 00 63 . 00 0 . 00 1BCBSC VALUATION 8, 500. 00 1 .00 0 .00 1 . 00 0 . 00 1BREMFIXT NO. FIXTURES 1 . 00 63 . 00 0. 00 63 . 00 0 . 00 1BREMRECEP NO. OUTLETS 1. 00 42 . 00 0 . 00 42 . 00 0 .00 1BSEISMICR VALUATION 8, 500 . 00 0 . 90 0 . 00 0 . 90 0 .00 1BUSLIC FLAT RATE 1. 00 114 . 00 0 . 00 114 . 00 0 .00 1EPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE 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 409.90 0 . 00 409 . 90 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 409 .90 --------------- TOTAL RECEIPT 409 . 90 CITY OF CUPERTINO CITY Of CUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN# U { , �� Date: 4-1 Z-3 Building Address: 114-06 >_sNDY PL , rctPc), -t—iao Mailing Address (if different from building addr ss): Are Hazardous Materials being used as part of this project? Yes El No HOA: Exterior work only) Yes ❑ NoIf es, provide letter from HOA Owner's Name: Phone#: e IKA Jul o / d Contractor: Phonq.- 1�)—0.3 3 i Fax: Contractor License#: o L Cupertino Business License#: Contact: Phone: Fax: Residential EZ Commercial Job Description: AL Building/Permit Info: Bldg ❑ Elect tom' Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, 1-B ❑ II/III/V-AF] II/III B, IV-HT, V-B E3-- —'3 Valuation: Square Footage: uU . = Project Size: Express Standard ❑ Large ❑ Ma'or ❑ 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: For help, contact Build it Green at www.buildit reen.or Revised 07/14/09 S` mCITYOF CUPERTINO CITY 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 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK 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 r 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 1 TRAVDOC Travel & Documentation B ( 1 BUSLIC Business License B Ili=tit 12-P_ C P a1-t fn 5of5 M.indoor Air Quality and Finishes 1.Use Low/No-'VOC Paint 1 IAQ/Health pts y--yes 0 2.Use Low VOC,Neater-Based Wood Finishes 2 IAQ/Health pts y--yes 0 3.Use Low/t4o VOC Adhesives 3 IAOJHealth pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes 0 S.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Ssal a lEwwd!!a l r Qr MDF _ 41A0/Health-oto= es _ 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes D 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes p 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 D 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 D 1 1 i Total Points Available.] 1401 130 57 Total Points Project Received: 0 0 0 c L3U � G:datalprogslgreenbuiliOngguidelines1remodelerslgreenpointsfinal212.MproteDled.xls RESIDENTIAL, PRO ��ER SHEET Assessor's Parcel Number: Name of owners (( y 1--� "r tel.►' Project address. ( U a L 21`1 ) _ �-�- `-�I�r TY-) y Contact person. `Lc, n Phone. C csi2) Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: / TOTAL: -e there at least two 10 foot by 20 foot clear spaces inside the g N Is privacy protection planting required for the project? Y aN ` On what floor(s) is work being done? Brief description of work. ITIp kn e L it i 12e_ ,;,6 vrn s>r t ot, 1� l . 3 —Tr t 13�.-fG,f4 u "k, S. Code editions:2008 CBC (Y -N)2008 CFC UV N)2008 CMC (Y-N) 2008 CPC r!�L N)2008 NEC (Y-N) IN ACCORDANCEAPPROVED WITHTHE CITY OF Effective 1/1/08 CUPERTINO CODES AND ORDINANCES DATE-- SIGNEff This set of plans and specifications MUST be kept On the job at all times and it is unlawful to make any changes or alterations on same without wntten permission from the Building Department. City of Cupertino. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law Plan Review Process Work Book Page-8-Revised 1/1/08 Community Development s 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTIN0 Building Department JOB ADD�ESS: PERMIT# �ry J v d L.ZN 1) L-" u t,-� -/ V OWNER'S NAME: PHONE #4-19— Z1274i —10' 1 GENERAL CONTRACTO : FAX # 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