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11110038 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10319 MC KLINTOCK LN CONTRACTOR:SGK HOME SOLUTIONS, PERMIT NO: 11110038 INC. OWNER'S NAME: HYDEN FREDERICK A AND YUAN HUE 3801 CHARTER PARK CT STE B DATE ISSUED: 11/08/2011 rAdkF.R'S PHONE: 4084465730 SAN JOSE,CA 95136 PHONE NO:(oda)264.6964 ❑ LICENSED CONTRACTOR'S DECLARATION /� e� BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r{ License Class_ Lie.#1202*5 r r r MECH RESIDENTIAL COMMERCIAL Contractorglb&— 4. , a o" Date Ivil 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE TWO(2)WINDOWS;NON-STRUCTURAL (commencing with Section 7000)of Division 3 of the Business&Professions 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$5000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number:34215043.00 Occupancy Type: 1 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 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 ]80 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. Issued by: Date: Signature Date_1.{_'g(/_I i OWNF.R-B ILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material berg installed.If a roof is hereby affirm that 1 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 1 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 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(his 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(x)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 Ow are o .*d agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: Q i/ 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 I certify that 1 have read this application and slate 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 in nhfy and keep harmless the City of Cupertino against liabilities,judgments, cnd expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g� .g of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date Licensed Professional VIII v � 3� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• buildina(D cuoerdno.ora •CUPERTINO ❑NEW CONSTRUCTION ❑ ADDIITONTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT N PROJECT ADDRESSAFN{� /.A» 'J /37O t-1 Z OWNER NAME PHONE E-MAIlw IIO STREETADDRESS N CITY. STATE.ZIP I� CONTACT NAME E-MAIL 4,4 STREET ADDRESS .STATE ZIP FAX ❑OWNER ❑ OWNER-BUDDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ A I:Hr ECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO CCOR NAME I ,Q LICENSE NUMBER p 2by1� LICENSE TYPE BUS.LIC p ANY AME V E-MAIL 7 \ FAX . STREET ADDRESS CITY,STA LIP �� PHONE w a G ARCHTTECDETNGINEER.NAME LICENSE NUMBER BUS.LIC p COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE ZIP PHONE DFSCRUMON OF WORK EX677NG USE PROPOSED USE CONSTA.TYPE I tlSTORI:, USE TYPE OCC. SQ.FT. VALUATION(S) O NEW MOOR DEMO TOTAL AREA —3 AREA AREA DEER TAREA BATHROOM XOTCTMN OTHER REMOOELAREA REMODEL AREA REMODEL AREA PORCH AREA DECRAAFATOTAL DEC JPORCH AREA 53NNARPA DETACH ATTACH p DWELLING UNTIB; ISA SECOND UNR YES SBCON'DSTORY YES BEDVG ADDEDt ❑NO ADDITION' []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF LSTHEBLDOAN ❑YES RECEIVED BY: TOTAL VALU N: PLANNIG"PLO ❑NO PLANNING APPROVAL LEITER EICBLRR HOME' OND 75 AK— By naysignature below,[certify to each of the followia I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this application and the information I have provided is c ct I ve reed the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin ding con Cation. I uthoriu representatives of Cupertino to eater the above-identied property for inspection purposes. Signature of ApplicantlAgent: Date: I - SUPP AL ORMAD PIANCHXCXTYPE RovrmcSLEP New SFD or Multifamily dwellings: Apply for Dlitwn permit for Covn,Lsx ❑ BUILDING PLAN REvrBw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ MRESS ❑ PLANNINGPLANREVMW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORM form if any Hazardous Materials are being used as part of this project Cl tARCE ❑ rntauzn Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ❑ SANITARY SEWER Dart= of Building Permit application. MAJOR ❑ ElNYDKO gNTALBZALTH. B/dgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • ADDRESS: 10319 mcklintock In DATE: 11/08/2011 REVIEWED BY: bobs.to APN: BP#: VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD Or DU IBX PENTAMATION USE: p PERMIT TYPE: 1GENRES WORK re lace 2 windows non structural SCOPE 14,/1 t'7.m(;hai. "luP rrGP1 C/rccY, r r 1"Ier, auCia,uA Aku:h, f'eriui:Naze: Plund" P¢e,t a/i'ee: 1-7e:. Perm, a/'4 e: d1rchl7ap, UBuo Pla;nh lryr. .15aCh lmp. Ilea: Plwgh. Ir;.:p, 14Y: f3iec. fn,p. Feer NOTE:This estimate does not Include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). These fees are based on the Prelfaina information available and are onl an estimate. Contact the Dept for addn'l in a. FEE ITEMS (Fee Resohoion 11-053 Eti 7/11111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 2 # Window/Sliding Glass Door Suppl.PC Fee: (j) Reg. © OT 0.0 hrs $0.00 $392.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C,.onsirm!f1on KIx (Imirrstr'rrtiw Fee' Work Without Permit? © Yes 0 No $0.00 G Advanced Plam»ne Fee: $0.00 Select a Non-Residential Q f;ave(1)ocmnanladon l tee. Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item • Bldg Stds Commission Fee' IBCBSC $1.00 ;SUBTOTAL$: $1.50 $392.00 i (,, TOTAL FLEE. $393.50 Revised: 10/01/2011 • CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34215043 . 00 DATE ISSUED. . . . . . . : 11/08/2011 RECEIPT #. . . . . . . . . : BS000015259 REFERENCE ID # . . . : 11110038 SITE ADDRESS . . . . . : 10319 MC KLINTOCK LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HYDEN FREDERICK A AND YUAN HUE ADDRESS . . . . . . . . . . : 10319 MCKLINTOCK LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2677 RECEIVED FROM . . . . : SGK HOME SOLUTIONS CONTRACTOR . . . . . . . : VLADIMIR MERABIAN LIC # 30341 COMPANY . . . . . . . . . . : SGK HOME SOLUTIONS, INC. ADDRESS 3801 CHARTER PARK CT STE B CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 264-6964 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 .00 1. 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 5, 000 .00 0. 50 0. 00 0 .50 0 . 00 1WINREP EACH 8 1.00 392 . 00 0 . 00 392 .00 0.00 ---------- ---------- ---------- ---`------ TOTAL PERMIT 393 .50 0 .00 393 .50 0. 00 • r Lh 7m S � m 0 a0` o ,� m 0 Q f'O � g � Na PO OI a°D cAc $ CX o ° g tpoF � gm Qo m' nD 0 �3m »F 3mmjuD CD �; OG r � �� Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 U P E RTI NO Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 10-31 M c11- k t v� L PERMIT# OWNER'S NAME: f CeA jk4j4" PHONE# 40$ 2104f to 942 GENERAL CONTRACTOR: 6V.- 6wAow BUSINESS LICENSE # ADDRESS:34o1 tQ,.�,, ?ft, G t S.. . —T u gcl13 to CITY/ZIPCODE: *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 SUB ACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors. Lt / SVt e Date Please check applicable subcontractors an co lete 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