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10040090 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7921 BELKNAP DR CONTRACTOR:LAGUNA MADISON INC. PERMIT NO: 10040090 OWNER'S NAME: FLETCHER HOMER L AND JACQUELYN 3030 OSGOOD CT DATE ISSUED:0411412010 OWNER'S PHONE: 4082579106 FREMONT,CA 94539 PlIONE NO:(510)353-1600 ❑ LICENSED CONTRACTOR'S DECLARATION G 1 � F_ r r —1 r— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class I Lic R b J 1 *8 0 r r r NN MECH RESIDENTIAL COMMERCIAL Contractor 4'V'—,, Date `1-14—I D 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: DUEL PAYNE REPLACEMENT WINDOWS LIKE FOR LIKE (commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL 5 WINDOWS&I PATIO DOOR'BEDROOM Code and that my license is in full force and effect. TO MEET EGRESS REQUIREMENTS 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 Section 3700 of the Labor Cade,for the performance of the work for which this Sq.Ft Floor Area: Valuation:55500 permit is issued. APPLICANT CERTIFICATION APNNumber:36208041.00 Occupancy Type: I certify that I have read this application and state that the above information is correct. I agree to comply with all city and cowry ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regu ions per the Cupertino Municipal Code,Section 9.18, Signature Date'-\—t 1-1—f 0 Issued b � Date: h ❑ OWNER-BUILDER DECLARATION RE-ROOFS: hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection,1 agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Cade). 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 Compensation,as provided for by Section 3700 of the Labor Code,for the 1 hnve read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,1 shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505.25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or eu/�ori d C forthwith comply with such provisions or this permit shall be deemed revoked. Date: c{ f+" CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's correct. 1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,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 re clarions per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date `i'1'a_t b Licensed Professional a 4 d � a J NC Li LA p ' ` C 3 40 LA �_ O - 0 M APPROVED IN ACC DANCE WITH THE,CITY OF el" L.A CUPE NONQ2E-1EaAND ORDINANCES !1l'''� J11 r DATE SILT E This set of plan rid Hicatbns MUST --- be Iton theQb at a] times and it is unhtwtuNp In e, y ch ges or alterations n�----'' yardet with "wrine Permission from t BuilGirig De artmer . C' of Cupertino. Th st r o1 this p n and spe ,ieations S NOT .heir in perme of to be an approval of the anon of any provisions of any City Ordinance ur State Law U M k °- Cr r PROCEDURES-FOR'REQUEST FOR MODIFICATION OF CODE OR ALTERNATEWATERIAL OR METHOD OF CONSTRUCTION COMMUNITY DEVELOPMENT',DEPARTMENT• BUILDING DIVISION CUPERTINO 10300TORRE'AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333•buildingQcupertino.oro PURPOSE: The Building Official may approve modifications to the requirements of referenced codes and staridardsxwhere special individual reasons exist that make strict compliance impractical. This authority-.allows°demonstration of equivalent protection for the health, accessibility, life and-fire safety and-structural requirements by meeting the intent and purpose of the code: The Building Official-may also permit the use of an alternate material, design or method of construction for innovative ideas or technological advances not specifically regulated in the code. This authority allows approvals of alternatives that are equivalent to code accepted methods(for nine areas:m quality, strength, effectiveness, fire resistance, durability and-safety. J PROCEDURE: The project design professional will need to complete and submit the related Department form`with all supporting documentation. The designer may submit the request before, with or,after any application or approval for the related construction permit. After submission, Department staff will review the request for clarity and completeness of information and-determine if any testing is required to substantiate the request. Department staff,wilfthen notify the project design professional when the application is complete for processing,or testing is required. After the applicatiomis considered complete, Department staff will complete their review and make an,initial determination whether to approve or deny the request. After this review, the project design,professional may request an informal conference with the staff reviewer to discuss the;decision.If unsatisfied, the project design professional may request a decision from•.thetBuiIding Official, whose decision is administratively final. Fire Marshal approval,is required in;some circumstances where the request involves modification from Fire Code requirements. Separate approval from the Fire Marshal will be required iWthese cases prior to the approval of the request by the Building Official. CEIVED APR 14 NIB AliProc 2010.doc revised 03/24/10 ALTERNATE MATERIALS AND METHODS / MODIFICATION FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•:CUPERTINO, CA 95014-3255 (408)777-3228 FAX(408)777-3333• buildinalaDcuoertino.org CUPERTINO ❑ REQUEST FOR MODIFICATION OF.CODE (CBC 104.10) REQUEST FOR ALTERNATE MATERIAL, DESIGN OR METHOD OF CONSTRUCTION(CBC 104.11, CFC 111.2.4) To apply for this request,complete sections 1.2.&3 ink ortype) SITE - APN DATE'`- ADDRESS 1 � "`77 v Owner.R.o..lmt-.r.....(._��..(gtl.5...11e .f..........:..................._...........I..._.......... PC#: .._._..........__............... Type: ..................................... Address ..q. ..Z..�..._... ... C' ,G t'1>A P r ._........_.............. 1 _ •,1.....1........................ ..�.................... Permit#:............................... Stories: ........................_....... Email..............................................................Phoneyog�z.5.-,1..-..q. o..�o PLN#: ................................... occupancy:............................ ......................Title.. .ems........... Dept./Div................................ Floor Area:............................. J . y.�T.�l.l S>j Job Status: ............................ Occ.Load: ............................. Address.3.ol.Q......E?._5...9afl.SL.L.?..:_.....1...('.�.Q.k2 .....S..C........... J Use of Bldg:_........................ Emaill..........................._................................. ..... 2 REQUEST: For code modifications,please state the applicable code requirement and the extent of relief desired. For alternate requests,state the type of system ro osed and design methods. Submit plans If necessary to illustrate request. Additional sheets or data may be attached. o� a .),c, i S o p � `r 0f' e X r i'y ' X 'T GCS W W . C-p c S; W ' ul d SLfQ u..S a OI VF Covel- !S C' 3 JUSTIFICATIONIFINDINGS OF.EQUIVALENCY: For code modifications,applicant shall demonstrate that Code Section(s): special,individual reasons exist that make compliance with the strict letter of the ordinance impractical and that equivalency is provided. For alternate requests,applicant shall demonstrate suitability,strength,effectiveness,fire resistance durability,safety and sanitation that is equivalent to the code for a similar use. Attach additional sheets if necessary. Petitioners / �� Reviewed Si nature: .................................................. Position:I;.1.r1... ...�'....... Date:................... By:.................................................. Date:.................. 1 The Request is: ❑ GRANTED ❑ DENIED I Dept.Comments: CONDITIONS OF APPROVAL: No.of Items: .................................... Fee Due:5.....__........._.................... Dale Paid: ................................__. Receipt No.: .........._. ....._............ .. Processed by: ................................ BuildingOfficial:...._..__...........................:.........................................Print:........................ ...........__._......__.................. ....._..Date:........_.._.._._..._........ FireMarshal:........... .........__.............. ..Print: ................................. ............................Date:...._.......................... DEPARTMENT ACTION: After determination,copies to:1)applicant, 2)permit file Ahform_2010.doc rerised 04106110 S-in CITY OF CUPERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Building Address: -\ Z _I kYIG 12 r Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes Ll No HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Owner's Name: 1 Phone#: W n yneI-r 1— (e Lhei 0*) ) 5 Contractor: &-u1.(_A (Y11' bIS0 Phone: 6I-) LSy- i1P 0 M n , w Fax: bio Contractor License#: .,� S \ 8d 3 Cupertino Business License#: � a— Contact: � 1 L Phone: S �) b S �- \J 0 v ( Q �� F'n Fax: Cs11- �ii �I�1S Residential Commercial II t Job Description: a V e IPU Yrs c a(-e m-Cn1 W) n O f L; k� nor sArv(,A. - co 5 w ', ndows 4 ) PCA, , d ,J, X ,7 i' Q �c SS r e v " JYN rJ.1 Building Perm/it Info: Bldg L9/ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, I-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B ❑�_ —.� Valuation: U�C Square Footage: Project Size: Ex ressStandard ❑ 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.buflditgreen.org Revised 07/14/09