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09050045 CITY OF CUPERTINO ���T pT BUILDING DIVISION PERMIT1� PERMIT NO. BUILDING ADDRESS: ARGONAUT 19141 MEIGGS LN PERbIIT ISSUE DATE OWNER'S NAME: S A CONTROL NO. 'NNE: (4 0 8) 378-4018 BUILDING PERMIT INFO ARCHiTECTIENGINEER: BLDG ELECT PLUMB MECH Q 0 Z p ZO LICENSED CONTRACTOR'S DECLARATION Job Description v I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)oI'Division3oftheBusiness and Professions Code,And mylicense's WINDOW REPLCMNT LIKE4LIKE NON—STRCTRL; ,BDRMS TO y in full force and effect. -Z License Class Le•N o Date Contractor MEET EGRESS DECLARATION I understand my plans shall be used as public retards ? ttum U V Q y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county a which requires a permit to construct,alter,improve.demolish,or repair any structure rn prior to its issuance.also requires the applicant for such permit to file a signed statement 3q.Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 8 6 5 3 x!�� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 5.. that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(s5otp. 37537001 . 00 0 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,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,Provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). I,as owner of the property,am exclusively contracting with Gcenaed convactes i- �truct the project(Sex.7044.Business and Professions who builds Ives tractonsand. cense Law does not apply to an owner or property Pm who contracts f _ itch projects with a contractor(s)licensed pursuant to the Contractor's License I. B lk P C fo th• reason 00%, lam mptun See. Owner Date WORZ SATION DECLARATION I hereby affirm under penalty of perjury ohne of the following declarations: have and will maintain a Certificate of Consent to self-insure for Worker's Compen- _aon,as provided for by Section 3700 of the Labor Code,for the performance Of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Mis secuom rec4beclom ted if the permit is for one hundred dollars(5100) or Ices)1 certify that in the perfwork for s permit is issued.I shall not employ any person in anWo rs'Compensation Laws of California.Da Applicant NOTICE TO APPLICANT:if,after making this Ccrtifica of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,You must ,J z forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY Fie I hereby affirm that there is a construction lending agency for the performance of 5 the work for which this permit is issued(Sic.3097,Civ.C.) W Q Lender's Name 0 Z lender's Address U 0 1 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 0 V building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes a (We)agree to save,indemnify and keep harmless the City of Cupertino against CA liabilities,jnafiIRSTANDS costs and expenses which may in any way accrue against said City U Z in consegtrgranting of this perm t Date APPLICA A D LL COMPLY WITH ALL -P INT Issued b.�: SOURCE E ONS. ?� Re-roofs .�� Signature f rcant/cennncto ie T of RoofHAZARDOUS MA ALS DISCLOSURE t Type Will the applicant or future building occupant store or handle h• ous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cede.Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed. 0Yes P�Ne If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which L hazardous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection. uict? ❑Ya ftNo 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health afc Code,Sections 25505. 33 and 25534.1 understand that if the building does not urrend have a tenant that it y responsibility to notify the occupan f the Date require ench must W trance of a Certificate of Occup cY• ` Signatui a of Applicant Lug GZG All roof coverings to be Class''`or better Owner authorized agent ate no CC)o a—FCITY OF CUPERTINO CUPEf�TiNO GENERAI. BUILDING PERMIT APPLICATION FORM Date: APN # Building Address: C(4 IQe_L, u:. Cry 5© Mailing Address (if different from build address): Owner's Name: ti Phone#: C40y sc:`j_�%� ell,fir` lw� JQX�� HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Phone: Sot1ctWy (tic J`) C3 H2 C1 Fax: (t"9,) � 6`ou l "I Contractor License#: Cupertino Business License#: Contact: � Phone �V e) S to 1 —G'A`L � tzvt P �����. Fax: Residential Commercial Job Description: A v , s S Building Permit Info: Bldg L- Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ©— Valuation: _ Square Footage: Project Size: ExpressE4---Standard ❑ Larges ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicat,le, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditQreen.or Revised 02/05/09 ai(� -1 1 , CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 2 1 WINREP Replacers.ent windows/sliding glass B door (ea 3 windows) IWINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M IPLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone IBC Cal Bld;; Standards Commission Fee B ALL PERMIT TYPES I BSEISMICR Seismic Residential B IBSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1 BUSLIC Business License B 5 of 5 41`e N q X Y 0 n � .3 x x a m o � N , ' - N x , 00 N 9LMLJ � . 00; 7 '` - x � ry !-,:Zl y 1 ZOn9 .� MAY CID, ._ LOP Ica, (TIN Tb nn �o M oe ,y y le- cp AN Qtj ki �, �� eco , kpA'A ov SQ OLd Colas w � S •3 '� VJ Q � •, V''• 1 , x I i p -d " x e x o� 09 1 F • � V x � , � ►,� � � foo � � � � � , tN � -til 0 �` S .� NA•�� oN �, Mass c�NN4,`S ul -1�. 5p i oXVN 46 s Community Development S,', 10300 Torre Avenue �.; �s1.;; Cupertino CA 95014 Telephone(408)777-3228 CIV Of Fax(408)777-3333 ',UPEkTINO Building De artment JOB ADD SS: PERMIT # t�f o t Y OWNER'S N O tj (Ae PHONE # Ka 56 -41 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: ture ate Signa Please check applicable subcontractors and complete the followin information: SUBCONTRACTOR BUSI14ESS 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 tRockner/Con ctor Signature Date