04110060 (2) CITY OF CUPERTINO `�°"waba"v-A5d1.rr s €��az�a t resflts "
BUILDING DIVISION PCRM� CONT.IUOMOR�INFORM ,N
BUILDING ADDRESS: PERMIT NO.
ARGONAUT WINDOW & DOOR 04110060
NtR' AMt. PERMIT ISEUE DATE
PHONE: SANITARY N OL NO.
(408) 996-9679
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOo LICENSED CONTRACTOR'S\D'ECLARATION Job Description
YwF 1 hereby,off no that I on licensed under OOAneolit of Chapter 9(commencing
S;ry with 'on )of Division3of the Bminessaad PrOmasiuns C.dc.and my he.-.is
?�N in fullfom ndelfea ,t'I n-5
sya
Lamm.elaae Lm,x WINDOW REPLACEMENT/STUCCO
n F 0 Dam — 0— Contractor
ARC nF1 SD LABNI0
�i I under Ian m all W se ublic'c da
Jy
Liccn 0 oris I ._ .
OV TER-BUT DE ECLARATION
+j I hereby affirm I am cxcmpt from dim Contractors License law(.r Linc
i0 o following mason.(Scetion 7031.5,Business and Professions Code:Any city or county
acro which retinues a permit to continues.alter improve,demolish.or repair any structure
Fzy prior m its icsuana,ahortqums tWapplimm for such Permitm File a signed statement
< that hu
e is licensed pumuano the provisions of the Contractor's License Law(ChaPmr 9 Sq.Ft.Floor Area Val
¢�� (commencing withSection 7")of Division 3 of Ne B usimas and Proressmna Code)or
i $ Bus he is exempt therefrom and Ilte basis fm the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant o acivil Penalty ofhWatered3 gfpPF iju er0 0 Occupancy Type
are dun five
not Watered dollars 4500).
0 I,as owner of the property,in my employca with wages an their sole compensation.
will do Ne work and dte strucwm is not intended or offered fmss4(Sim.7o .Business
and Professors Code:The Conuactose rs LicenLaw dice:not apply M,n Owner Of Required Inspections
property who buildsor improves Nercon,and who doessuch work himself.,through his -
own employees,provided that such improvements art not intended or.ffered Waste.If.
huilder,One Wilding or den of proving :the withinoneyear of completion.Ne owner-
builder will have Ne burden of proving i Nat he did not Wild o,improve for purpose of
salc1.
❑1,u.weerof the pee.7[P1.Bam exclusively confessions with:)Theed..nlluirS - O
eonnam the canon(Sec.o an weer o.and nywh Professions Code:)The Conuxcmin,Li-
whoc law does not apply c an owner.f property who W olds of improve thereon,and -who contracts for such projedt with acomm�.r(a)licensed pursuer.to the C.nfncfoh
License law.
❑lent cxcmpt under Sec. ,Bin PC for this rtazon
Dat
WORKER'S COMPENSATION DECLARATION
1 heuby affmn under penalty of perjury one of the following dalantiona:
0 1 have and will maintain a Cer ificaeaof Conscm to self insom for Worker's Camper.
nation,az provided for by Secdan 3700 of the Tatar Code.far the pmfmon.of do,
were for which Nis permit is Wound.
0 1 hats and will maintain Workch Compcnaation Wuesnm..ai, retl by Sccuon
37W of the labor Code,for the performance or the wool,for which mi ,mit is issued.
My orkcr Compensation Insurance carrier and Policy nu,Jbe '
Caa/� Poliy No.: RKERS i ..
CERTIFICATE OF EXEM 1111 FROM WDR�KEn0.S'
COMPENSATION INSURANCE (-d S
(This senior need not be min,iread if the Permit is formic hundred dollars(SIM)
or less.)
I certify Nat in the performance of the work for which this Permit is issued,l shall not
employ any Person in any manner so az to become subject to the Workeri Compenaxtion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,aper making Nu Ccnircau,of Exemption,you should
become subject to Ne Worker's Comperactum pnovisions of the tabor Cu c,you must
.J O forthwith comply with such provisions or this permi(shall be deemed revoked.
Z " CONSTRUCTION LENDING AGENCY
'v'—t I hereby affirm Nat there is a construction lending agency for the Performance of
xNe work fur which this permit is issmd(Sec.3097,Civ.C.)
{LIQ Lenders NamegL _`.,_,_,
Z) z lenders Adtlrrss
U d 1 anify that I have read this application and sum Nat the about informauun is �.
I,, correct.I agree to comply with all city and county ordinances and sum laws relating to ----
Q U Wilding consuuction.and hereby wtharix mpro em,tim of Nu city to enter upon the
Ck1 above-mentioned Propeny(or inspection purposes.
F4 (We)agum to save.indemnify and kcal,harmless NC City.1 Cupenio,against /
h liabilida,judgments.cosy andaperoa which may in any way attiuc against said City
U in consequence of the gaming of Ni{permit.
'—' APPLICANT N ERS NDS ND WTLLtOMPLY WITH ALL NON-POINT Issued by: Date j
5
UL
RCE
L PIONS
C /
Re-roofs
>Part fAp i y uacmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will pCutertu,futoni building e,Chaptstore er 9.12,
handle Hcard.usm,teety
as defined by the Cupertino Municipal Code.CTap¢r 9.11,antl the Health and Safety
ode.Section 25532(01I�/ u All roofs shall be inspected prior to any roofing material being installed.
C3 Yea fhN
Will the applicant or future building oceupant use
equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants az dcfincd by the Bay Area Air Quality Management
Disuict? all new materials for inspection.
❑Yes Nu
Ihavcread Nehasad,m ,grialsuquimmenuundcr Chapmr6.95of Ne-Califon
ria Hen Salary ade,Simtiona 115.15533 and 25534,1 understand Naz if the building
docs not cuor a n,na tit is s 'vihilitymnoufy Ne.aupantorthe
msni /t,./ ni mat .t n. c r Ccdr.am.racupany. Signature of Applicant Date
wne,.a; m tied ag Da¢ All roof coverings to be Class "B"or better
0
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng: Sub: Blk: Lot :
APN 34245015 . 00
DATE ISSUED. . . . . . . : 11/10/2004
RECEIPT # . . . . . . . . . : 27720
REFERENCE ID # . . . : 04110060
SITE ADDRESS . . . . . : 10375 MELISSA CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER LARRY WONG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SARATOGA CA, 95070-5107
RECEIVED FROM . . . . : ARGONAUT WINDOW
CONTRACTOR MARTIN ETTEMA LIC # 22820
COMPANY ARGONAUT WINDOW & DOOR
ADDRESS 10624 S DEANZA BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
• TELEPHONE . . . . . . . . : (408) 996-9670
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- - - - ---------- ----- - -- - - ---------- --- - ------ ----------
BENERGY PERMIT FEE 288 . 36 138 . 41 0 . 00 138 . 41 0 . 00
BPERMFEE VALUATION 21, 000 . 00 288 . 36 0 . 00 288 . 36 0 . 00
BSEISMICRE VALUATION 21 , 000 . 00 2 . 10 0 . 00 2 . 10 0 . 00
BPLANCHK PERMIT FEE 288 . 36 384 . 82 0 . 00 384 . 82 0 . 00
TOTAL PERMIT
813 . 69 0 . 00 813 . 69 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-- -- -------- - ---- ------- ----- - -
CHECK 813 . 69 3224
TOTAL RECEIPT 813 . 69
•
SCG CITY OF CUPERTINO� b
CI
PERMIT APPLICATION FORM
• CUPEkTINO
APN # Z[-2, x yl/ Date:
Jv \
Building Address: Mailing Address (it di f Brent rm building address):
/0-37- L SS X Q-T- Q up I=27lAM Q, 9 S-V (
Owner's Name: Phone#:
-A42&q W f7 N Gi ¢a8• Z 5-3 • g i, m
Contractor: License #:
,4aN,4vr /kC. G 0 +7
Contact: Phone: 468.63 f.4-3-FS- Cupertino Business License#:
7-YL IFF WI KF—k Fax: zlo8''3-7PO 9
Building Permit Info:
Bld Elect ❑ Plumb ❑ Mech ❑
Job Description: �
Residential A W/N40Wt( r-'<ACPHiS.vr S7-V--( 0 Cofm c a�
Sq.Ft. Floor Area: $ q.Ft.: /
Cost of Project:
�I 66 Occupancy
-11660, Group
Type of Construction: Please check this box if the project is a
second-stor addition: ❑
Project Size: Standard Large ❑ M�[:]
Quandt Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax -Resi/Mobile BUILDING
BELEC1000 flee 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD I Energy Add Multi BUILDING
BINVESTIGA Investi anon fee BUILDING
z77�
1 of
SM *CITY OF CUPERTINCO
CITY OF PERMIT APPLICATION FORM
CUPEI�TINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE PbIg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
�}
CITY OF CUPERTINA
°TY°F PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM -Temporary Bldg Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elee Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
E C x4 G
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CITU Of -2'' .{i+Yw•_1.�T4-,`��y.arv--.,.,� !.^a+�Tx i<v�"', �" 'l '�^xF 'iz. +i.5:ca +k .a�'``t�^ Y ",x`a';- . +_ ���
CUPERTINO
Assessor's Parcel Number:
Name of owner. i�NOV 0 9 2004
Project address. BY'—�--
Contact person. Phone.
Fax. (�1 (� (�nn�/�
Net square footage of lot. " ` U moII � �I-I' `II J�% �b
"ti . .w
" Exi stip e Proposed
Square footage: First floor: /,3 S:-Z1 3 SZ3
Second floor: g `/2 '�'72
Garage: 6 3 $ 6 7 9
TOTAL: L 3'L 2 2 3 2-14
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? G N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done? ! 2-
Brief description of work. RENO V& RF_7'41 cr- W/NAaV/S - DO d�S
2tdt°vE 4RFP4C9 5:7VC-044T7kyl'
Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2001 CMC (YEN)
2001 CPC (Y -N)2001 NEC (Y - N) FRbv TM�pity,�0
Effective 11/1/02
,peciticadonsVt is a114
�: sS Ga°.��at all times and
tna 'an y as on aftereitnm
�`y Lut syr lien c�pe�po
_ r City °t and specncCedon9
lttleto be at,
b L tz,- j si Platt�n to Pe[Mrt or two
01 altv POD,
• f ane
Plan Review Process Work Book Page-8-Revised 4/28/04
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT " - ;p.0}O,NTRA.CTQRxiNF,OORMA'CIQN - - -
BUILDING ADDRESS: PERMIT NO.
ARGONAUT WINDOW & DOOR 04110060
O N R'S AfvPERMIT ISSUE DATE
NE:
SANITARY OL NO.
ARCHITEC'VENGINEER: BUILDING PERMR INFO
.. _ BLDG ELECr PLUMB MECH
uoo LICENSED CON'rRACIOR'S DECLARATION
YmF I hereby drum that I am ficanxd ander p.,W ns of Chapmr Y(commencing Job Description
<Zt�f with )of DivWon]of We BualnesaZal PfafetslansCode.and myliceaxb _
^�N in full fa delta. I'' I-
f ucer�x- %I /fie. uc.a WINDOW REPLACEMENT/STUCCO
'Fp Dam - m- 4 '1�Conlra� rAf
I uncle an m ARC all x D li c Ods
JyU
;�� Licen d fes' 1 .
3 O\ ER- UI DE ECLARATION
.� y I Wmhy olrfm 1 am e.. in from tW Contamofs License Law for llc
0 o following mason.(Section 7031.5,Business and Professions Code:Any city or county
x m which wifuines a permit to comomet.After,improve.demo)lah,at mpair any acetum
AA
prior in its iatamum.shot oxine ithe applitanl for such permit to Neo signed namment
�< that he is licensed pursuant to the provisions of the COmmcmr's Umnx law(Chapmr 9 Sq.Ft. Floor Area Y 1
H$ (commencing with Section 7")of Division 3 of tm Business and Professions Code)w /
dw he is eampt tmmfrom and We basis for Um alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not roam that,five hundred dollars($M 3 4V4t*4# O 0 c,up ype
1,u owns of the properly,army employers with wages u Ilmv sole compenutlon, `C1
will do t e work end tm stuctarc u notinmMed uoRemA rosea(Sec.yOa4,Busirost a
and Professions Cade:The Commences Liceme Law docs not apply in an owner of _ Required Inspections JC
property who builds or improves 0 tar on.and who doessuch workhimselfortloaugh his
Own employers,provided matauch improvements me not intended uolfesed for sale If. -
however.We building or improvement is sold within one year of completion,the ownor-
W ilde'will lave We burden of proving that he did not Mid or improve for purpose of
sok.).
❑1,u Owner of be property,am exclusively contracting with lhainsed contaco rs to
constmcl the project(Sec 90".Business and Prosiblons Cada)Tim Com acbri U.
cerise taw docs not apply to an owner of property,who Wilds or improvrs Wmon,and
who contacts for such projects with acontrauOKs)licemed pursuant to We Contractors
License law.
❑l am tempt under Sec. ,B k P C far this mason -
Owar Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of We following declarations:
737W.f
have and will maintain aCenitcam of Consent to self-insum for WoracesCompen-
n,u provided for by Section 3'!00 of the LAW,Code,for the performance of the
k for which this permit is iuucd.
love and will maintain Warkels Compensation Imuana,.y}_tt��syyrea by Section
the tabor Code,far Ue performmce of Ne woh for whic�.thiypermit is issued.
orker Campemation Imumnce carrier and Policy n�
UI PolicyNo.CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE }e
' IG-f'CS
Mos inion need not W complemdiftha hundred
permit is foranc hundred dNlars(510(1)
nr lens)
I mri fy Out in the performance of We work for which this permit is issued.I shall not
employ any Pinson many manner sec as in become subject to thc Wo wW Compcwtion
Laws of Celifomiw Dam
Applicant
NOTICE TO APPLICANT:If,afar making thb Ccniram of Excmplian.you should -- -
Wcome subject m the Worker's Compensation previsions of W tabor Code,you must
.,O foMwim amply with such provisinm Of this immot.hail be deemed revoked.Z'.. CONMUCiON LENDING AGENCY
F"�' l hemby affirm Nat than is a construction lendingfar the performance of
a.)
2' the work for which Nis permit b iuucd(Sec.3097,Cl,C.)
6w. Q lender's Name
:D z Lcnderi Address ...�•�—
U Q 1 cenify Nat I have rend Nis application and sum Nat the above informatiun is ^
:L f"' correct.1 agree to comply wit all city and county ordinances and saw laws relating an
0U Wilding construction.and hereby authorim mproxnlatircs of this city to cnmr upon the
above-mentioned property for inspection purpmes -
y (We)agree an ave,indemnify and Imp harmless We City of Cupertino against
liabilita,judgments,costs and expenses which may in any way seem against said City
UZ in consequence of did granting of permit.
'-' APPLICANT N ER NDS p WILL OMPLY WITH ALL NON-POINT Issued b
S URCE R IONS ( L_\,
\ y Date I /
�1
—� Re-roofs /
m A m H FOCUS MATERIALS DISCLOSURE Dam Type of Roof
Will pplicant or future Wilding occupant nom or handle ha�ous material r
As
derncd by tm Cupertino Municipal Code,Cbapmr 9.13,and We Health and Safety
Code.Section sss3z(a)+ All roofs shall be inspected prior to any roofing material being installed.
Yu
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
'mit hanrdous air contaminants u dc0ncd by the Bay Area Air Quality Managemem all new materials for inspection.
District?
❑Yes No
I have mad the banrdous nab requirements under Chapter 6.95ofthe CAirm-
niaflalth&Safety ode,Semons 5,25533an 25534.1un&nm,dlbmirthc Wilding
Ones not curt w y nano t it u ra mihility 0 nodfy tW occupant of thc
to mea h f Certi0camofOcapancy. Signature of Applicant Date
I/iO-YI All roof coverings to be Class"B"or better
wnu'or N iced Dam
t