09060029 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �1NTR,� QRI�#ERI�N; `
BUILDING ADDRESS: PERMIT NO.
20724 GARDEN GATE DR ARGONAUT WIND09060029
OWNER'S NAME: PERMIT ISSUE DATE
lani
PHO — S A CONTROL NO.
(408) 378-4018
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job DCSCilptlOn
m I hereby arm that I am licensed under provisions of Chapter 9(commencing
Zaffirm
with Section 7000)of Division 3 of the Business and Professions Code,and my license is
° a. in full force and effect. 3 REPLCMNT WINDOWS FOR BKRM
D%? License Class Lic•S
Fa Date Contractor (SUN—RN) : 1-48X48 (TEMPERD) 2— 96X48 3 — 96X48 (BY
„t ARCHITECTS DECLARATION
d I understand my plans shall be used as public records DOOR&TEMPERD)
�yU
`Oy Licensed Professional
rn OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following mason.(Section 7031.5,Business and Professions Code:Any city or county
K 9 which requires a permit to construct,alter,improve,demolish,or repair any structure
Z14 prior to its issuance,also requires the applicant for such permit to rile a signed statement
_G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or 4 0 3 0
y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than fire hundred dollars(s500). 32633014 . 00
❑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(Sec.7044,Business ns Required Inspections
and Professions Code:The Contractors License Law does not apply to an owner of q P
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.).
Ias owner of the property,am exclusively contracting with licensed contractors to
Ci,
truct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law. 11
❑I am exempt under ,B&P C for this reason
Owner Date �i 6
RKER' ATION DECLARATION/
01
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Workers COmpen-
.ion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I 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 Workers Compensation Insurance carrier and Policy number arc:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars($100)
or Icss)
I certify that in the performance 0f work for which this pc 't is i umcd.I shall not
employ any person in any man 6 bcc�omc atbject orkc ompensation
Laws of California.
AppBr ant
NOTICE TO APPLI ,after making this Cc .tar of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z2 CONSTRUCTION LENDING AGENCY
HrA 1 hereby affirm that there is a construction lending agency for the performance of
(Y,5 the work for which this permit is issued(Sec.3097.Civ.C.)
aQ Lentlers Name
]Z Landers Address
V 0 I certify that I have read this application and state that the above information is
LL" conrcL I agree to comply with all city and county ordinances and state laws relating to
0 V building constntction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way scenic against said City
U Z in consequence of the granting of this permit.
m"m APPLICANT DERST AND WILL LY WITH NON-POINT Issued by: Date =�
SOURC REG �� _
°q Re-roofs
Sign DtA plicant/Contrac r I Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes )n No
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
mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
istrict?
❑Yes ]No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&S y Codc,Sections 25505,25533 .1 un at if the building
does not curccn have am.that it;s m ilit aetffy the occupant of the
requi I.nts 'c� be met prior to' of a 'ncatc of Occup er. Signature of Applicant Date
Ow 6rauthorixc gc t
6171'Dae All roof coverings to be Class'`'or better
` CITY OF C.UP ERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date:
32 C - 33
Building Address: / ,1
20-72%`1 6rnrAeW Vc-A'e- 1J/ . Q- erA -iexSOL �(
Mailing Address (if different from building address): 1
Owner's Name: Phone#:
NrA nnBERA-ros Itog
HOA: (Exterior work only) Yes ❑ No CK `t o g Z-S2 — 1 v 6
If yes, provide letter from HOA
Contractor: Phone:
N r v� c- ., -,%.,A %- /00, v W t U oo r x-10 & — 3-7 6
Fax:
Contractor License#: is g g o 5 E
Cupertino Business License#: .14ILB 2 0
Contact: Phone:
((, 9 -
i�Avt �=ur�
Fax:CqO 3
Residential ❑X Commercial
Job Description: ll
3 IZe�1 Cew,e ✓1'1- w.V%,4a ..j lt
`I FS -A y g C re
2 , ci6 -A `18
3 • ci G x b y c��a. �Te,,,���ere d
Building Permit Info:
Bldg C--"" Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
J
I-A, I-B E] II/III/V-A ElII/III B, IV-HT, V-B P
Valuation: Square Footage:
yo�o
Project Size: Express ® Standard ❑ Large Major ❑
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: 6 f e'r V'�Kc1<�.w X 3 = $
For help, contact Build it Green at www.builditgreen.or
Revised 02/05/09
CITY OF CUPERTINO
Cin of GENERAL BUILDING APPLICATION
CUPEkTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco A,)plications (up to 400 sf) B
additions stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR 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
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
I BSEISMICR Seismic",Zesidential B
1 BSEISMICO Seismic Commercial B
1 TRAVDOC Travel & Documentation B
IBUSLIC Business License B
5 of 5
3-0"N %..%Misr fz, YN
w;�dow re �lo►cevwe � i ( like- 1 + 1e.� � �
QQdN°✓�f `^.��2 'r 2 Care !J Re ��,.•lrC✓,%P_ ti � )
1..14
V o®a
1,Noy4
F\
woaZ1
t
C
N
t
AdOO dOSS3SSd
1avA0�} ��a6 S3tiX 9b
It+oo0 ; t