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11120050 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7779 ROBINDELL WAY CONTRACTOR:SEARS HOME PERMPTNO: 11120050 IMPROVEMENT OWNER'S NAME: SANDRA LEWIS 1024 FLORIDA CENTRAL PKWY DATE: ISSUED: 12/07/2011 ER's PHONE: 4087258206 LONG WOOD, FL 32750 PHONE NO:(925)245-2000 I.ICFNSF,D CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLEC ELECT PLUMB License ClassJ%CG CZO C; Lic.W 7 Z 1 3 7 9 r r r d1EC11 RESIDENTIAL COMMERCIAL Contractor I 12— 7 1 1 hereby affirm t m�iae sed under the provisions or Chapter 9 X013 DESCRIP"PION: RGI'RO-PIT S WINDOWS IN DEDIi00M&MAS'I'GR DA'I'I I (commenci it run 7000)of Division 3 of the Business&Professions Code 1 my license is in full force end 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 Arco: Valuation:$6801 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 AI'N Number:36221022.00 Occupancy Type:permit is issued. APPLICANT CISRTIFICATION 1 certify that I have read this application and state that the above in ormation is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,mid hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FR011� LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, hJ`\J f costs,and expenses which may accrue against said City in consequence of the Issued b ! —I I granting of this permit. Additionally,the applicant understands and will comply y: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date--!-?--:/ 7 I NI roofs shall be inspected prior to any roofing material being installed. Fa roof is installed without fist obtaining an inspection,I agree to remove all new materials for inspection. 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 BE:TFER I,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(Sce.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to IIA7.ARDOUS 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 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 I 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 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 Iteallh&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this2 permit is issued, Owner or authorized agcn • Date: 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,alter making this certificate of exemption,I C ��STRUCHONENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby atTum 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 APPIICANTCFRTIFICATION Lender's Address I certify that I have read(his 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 U on the above mentioned property for inspection purpoSeS.(We)agree to Save ARCHITECT'S DECLARATION mnify and keep harmless the City of Cupertino against liabilities,judgments, is,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 all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM • COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36221022 . 00 DATE ISSUED. . . . . . . : 12/07/2011 RECEIPT # . . . . . . . . . : BS000015511 REFERENCE ID # . . . : 11120050 SITE ADDRESS . . . . . : 7779 ROBINDELL WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SANDRA LEWIS ADDRESS . . . . . . . . . . : 7779 ROBINDELL WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JEFF RAINEY CONTRACTOR . . . . . . . : ALFRED W NYMAN JR - ASST SEC LIC # 23097 COMPANY . . . . . . . . . . : SEARS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 1024 FLORIDA CENTRAL PKWY CITY/STATE/ZIP . . . : LONGWOOD, FL 32750 TELEPHONE . . . . . . . . : (925) 245-2000 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6 , 601 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 801 . 00 0 . 68 0 . 00 0 . 68 0 . 00 1WINREP EACH 8 5 . 00 392 . 00 0 . 00 392 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 393 . 68 0 . 00 393 . 68 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 393 . 68 VISA --------------- TOTAL RECEIPT 393 . 68 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildingClZcuoertino.org NEW CONSTRUCTION ❑ ADDITION IJALTERATION/TI ❑ REVISION/DEFERRED ORIGINALPERMITk PROJECT ADDRESS 7'7 79 2DYI�1�E11 I APN# 0,� 2 �] OWNERNAME A 1-PRA \�� 1 /J PHONO Z� 4q2O/ EMAIL v��l STREET ADDRESS 7779 ��1� �/ . I CITY, STATE,Q&JPtJZZIP J0 C 10 5O/ FAX CONTACT NAME / / / (� PHONE EMAIL STREET ADDRESS CITY,STATE.ZIP FA% ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT /"1 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I IZ LICENSE NUM LICENSE TYPE BUS.LICK (� DJr` EZ Z e6 Gr'7 COMPANY= I� !��rj�'��� ��— 309 HoAAE IyVf'PfM-,A1tA1") E-MAIL F -SSI 'NTfS STREET ADD SS CI Y.STATE,ZIP P ON l� �z Pirso F-D ��RA r��o G/I 9 43 of Vii-,9_3c9 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME EMAIL FAX r CITY,STATE,ZIP PHONE ORK I1lT�, I N J —,—c i Rv F-I'f IJ I LbaJ 1,,J r--f.J17 . Ai D ZC Utft/J6c EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES OFFICE O/jE V ALUATIQN IS) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECKAREA TOTAL DECKIPORCH AREA GARAGEAREA: ❑ DETACH ❑ ATTACH a DN'ELLINGONITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEING ADDED? ❑NO ADDITION? ❑ND �I /'� ,/� PRE-APPLICATION OYES IPYFS.PROVIDECOPYOP PLANNEWSNAW RECEIVEDBY:(`/ 7� TOTAL VALUATION PLANNING APPLu I PLANNNG APPROVAL LI bb OOGG By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: I I Z.Z./I SUPPLEMENTAL INFOR N IRED I- PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwelli pply for demolition permit for n ❑ existing building(s). Demolition permit is required prior to issuance of building ,❑ OVER-THE-COUNTER BUILDING PLAN REVIEW permit for new building. I'❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS Nm if any Hazardous Materials are being used as part of this project. ❑ LARGE 11 FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to 11 LARGE 1:1 SANITARY D RY SEWER DISTRICT of Building Permit application. ❑ F.NVIRONLENTALHEALTH B1dgApp_20//.doc revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • ADDRESS: 7779 Robindell Way DATE: 12107/2011 REVIEWED BY: RDW APN: BP#: *VALUATION: $6,801 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK Retro-fit 5 windows in bedrooms and m/bath. SCOPE "i t1e,h PI.w Cho. Phauh.Plan Check Lir :Wec:fi. Perntit I'le Plunih. Pemit Fee: Ziac Pennh Fee: • Otht" .1lrch.h�slz 0111er Pluuih 1e.rp, Other/Jer.. Inrp. Li ,h/ch. Imp. Fee: Plumb. Imp.Fe,: Liter.Lnsn. Pee. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc. . These fees are based on the prelinina In ormatlon available and are only an esdinale. Contact the Dent for addn7 info. FEE ITEMS Jee Resohition 11-053 L'lf, 7/1%11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl. PC Fee: 1E) Reg. Q OT 0.01 Ins $0.00 $392.00 1WINREP 7 Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. lnsp. Fee:Q Reg. Q OT O,p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction To.% Adminislrative Fete Q Work Without Permit? O Yes (D No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Docurnenlation Feev, Building or Structure StronE Motion Fee: IBSEISMICR $0.68 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.68 $392.00 TOTAL FEE: $393.68 Revised: 10/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 U P E RTI N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 7 swp PERMIT# 11 f OC>S 0 OWNER'S NAME: S IJ COO PHONE# 101 -72-, 2e6 GENERAL CONTRACTOR: E IM fflt�POEVT BUSINESS LICENSE# ?Z-1 7 ADDRESS:12.60 PC?— PA-50 gp CITY/ZIPCODE: EW70 3 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAI A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Z/�/ Sign Date' Please check applicable subcontractor plete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Ah 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 Own tractor Signature Date WE abed 6CKOE89M 90:Ll 90-U-toz V � N o �n � � d N � Q — o � 0 z 71 r, J � N � � X x m { S � zl � a3 13 20 o oo o v_ Y rya O � pt6 � CZ v m � �J � Z� N 000 vg2m -0 o, '1 m iw � o go o ` o O Fop sk Zm b' inn ��OaE ,m 31y0 m = 1 0 59 Sl R� CD =- K 0 tc O o 5wn a'. cr (gym cn mom c m Q (b CD Z g O a p' OD J 4� lh A W N ... p b w V O\ try N r+ A � 1ID � �ij i kril lit r4 • [�7 11 Ile � a � g n o N m U lb o V O u O = O<; N C a �. ° 6 o i y � p 0 0 0 O o a °o 3 ' w DC7 o � o { 5. 3ID � r -� o rr o m lI rA ' C Received on 11/9/2011 9: 53:29 PM 00 39Vd SdIHS 6EVE0E09T61 90:91 TTOZ/90/ZT