The URL can be used to link to this page

12060049 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20803 STEVENS CREEK BLVD CONTRACTOR:I1AR BROOF NORTIiERN PERMIT NO: 12060049 CALIFORNIA OWNER'S NAME: DIANETAYLOR 23067BERNIiARD"r ST DATE ISSUED:06/08/2012 OWNER'S PHONE: 4085959596 HAYWARD.CA 94545 PHONE NO:(510)887-8500 ❑ LICENSED CONTRACTOR'S DECLARATION dOBDESCRIPTIONRESIDENrIALLJ CO\IMF.RCL\L❑ License Class I.ic.q R'I/ :3 (� REPLACE DOOR WITH PANIC HARDWARE AND �� TEMPERED Contractor-A-4-3" Date 6A/� �" _ _0' 12 WINDOW I hereby affirm that I sera licensed under the provisions of Chapter 9 t� (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 cenilicate of consent to self-insure for Worker's Compensation,as provided for by Scction 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: \'alualiun:$3950 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,f'or the performance of the work for which this .\PN Number:32632042.00 oeeapaney'fypr: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct I agree to comply with all city arid county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mcmioned property for inspection purposes. (We)agree to save 180 DAY FROM LAST CALLED INSPE T ON. indemnify and keep harmless the City of Cupertino against liabil hies,judgments, costs,and expenses which may a•crue against said City in consequence of the Z granting of this permit. Addili ally,the applicant understands and will comply Issued by: -t G Dale: with all non-point s ree regi. lions per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to imy rooting material being instal led, If a roof is installed wilhoW first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date I hereby affirm that 1 am exemptfrom the Contractor's License Lew for one of the following Iw'o reasons: AL1.ROOF COVERINGS TO BE:CLASS"A"OR BETTER h as owner of the property,or my employees with wages as their sole compensation, will do the work,aid the structure is not intended or offered for sale(Sec 7044, Business&Professions Code) 1,as owner of the property,ran exclusively contracting with licensed contractors to IL\%ARDOI IS MATERIALS DISCLOSURE: construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth&Safely Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. AJdilionally,should I use equipment or devices which emit hazardous Compensmion,as provided for by Section3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Qualily Management District 1 performance of the work for whichthis permit is issued. will maintain compliance with the Cupe lino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Secti s 255 5 5$33,and 25534. Section 3700 of the Labor Code•for the performance of the work for which this Owner or euthorizrJ agent: Daly. permit is issued I certify that in the performance of the work for which this permit is issued I shall not employ any person in any'nhanncr so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGE:NCV become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of fonhveith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify thin 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 building construction,mid hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes.(We)agree to save _ indenmify and keep harmless the City of Cupertino against liabilities,judgments, ARCIII 1'ECI"S DF.CLARA7lON costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records, gn inting of this permit.Additionally,the applicant understands and will comply with all noo-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Dale CITY OF CUPERTINO 4 ITEMSOF 4 PERMIT .RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32632042 . 00 DATE ISSUED. . . . . . . : 06/08/2012 RECEIPT #. . . . . . . . . : BS000017025 REFERENCE ID # . . . : 12060049 SITE ADDRESS . . . . . : 20803 STEVENS CREEK BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DIANE TAYLOR ADDRESS . . . . . . . . . . : 5539 W BLUFF AVE CITY/STATE/ZIP . . . : FRESNO, CA 93722 RECEIVED FROM . . . . : HAR BRO WEST CONTRACTOR . . . . . . . : FRANKLIN, JIM LIC # 20709 COMPANY HAR BRO OF NORTHERN CALIFORNIA ADDRESS . . . . . . . . . . : 23067 BERNHARDT ST CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE . . . . . . . . : (510) 887-8500 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 950.00 1. 00 0. 00 1 .00 0. 00 1BSEISMICO VALUATION 3, 950.00 0. 83 0. 00 0 .83 0. 00 1BUSLIC FLAT RATE 1..00 119. 00 0. 00 119 .00 .0. 00 1WINREP EACH 8 1.00 392. 00 0 . 00 392 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 512.83 0. 00 512 .83 0 .00 METHOD OF PAYMENT AMOUNT ' REFERENCE NUMBER ----------------- --------------- ----- CREDIT CARD 512 . 83 visa --------------- TOTAL RECEIPT 512. 83 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20803 Stevens Creek Blvd DATE: 06/08/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $3,950 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY Commercial Building PENTAMATION 1GENCOM USE: PERMIT TYPE: WORK Re lacement of door with panic hardware and tempered window. SCOPE tj,,j,. /'(nn r'hr:k Plumb. Plzen ChceA lour. Phm Chr,k lirclr_ l'r,nIII Fir: Phunh, N"'Or I", lJdr. I'drrnir 14-r: I Ifi r.1/rrh.hili' Oho 1'11nnh Imp. Uihrr Uo. Lnp. U.,h, bMyi. F'rr_ 1'hmrh. 1,7o/J. Fer: Li," hep. / NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc. . These fees are based on file prelimina information available and are only an estimate. Contact the De t or adtln'l info. FEE ITEMS (Fcc, Resulalion 11-051 Eft: 711/111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl. PC Fee: Q Reg. O OT FO.01 hrs $0.00 $392.00 ItVINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 l`nnso 11clion I-In. 11,hiliiii..nam" /cc. Q Work Without Permit? Yes Q No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential O Ino cl I M(Imwnlamm Fees. Building or Structure Shona Motion Pee: IBSEISMICO $0.83 Select an Administrative Item 131(12, Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.83 $392.00 TOTAL FEE: $393.83 Revised: 06/05/2012 r Community Development t 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CRY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMTT# Lvov 3 SC,13 2-b(PUYq G OWNER'S NAME: G)IGn\-e —TA—k LRZ _ PHONE # GENERAL CONTRACTOR # Le I I am not using any subcontractors ejz, ` g Si Date Please check a licable'subcontractors and complete 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ,X- �/✓LGA L. er ctor Signature a Date CONSTRUCTION PERMIT APPLICATION 6P /B COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �O CU PERTINO (408)777-3228• FAX(408)777-3333•building(DDcupertino.orG \// ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROfECI ADDRESS S. S AFNA n w y f a OWNER NAME �n ^ PHONE � �G 1_ �(/E-MAIL STREET ADD!'g /�F C7TY ATE IIP I lP �i FAX frA CONTACT NAME PHONE E- [. a, STREETADDRESS ,�/ CrfY ATE IIP FAX ❑OWNER ❑ OWNER-BUGDM ❑ OWNERAGENT LL CO croit ❑CONTRACTORAGENT ❑ ARCHITECT ❑FNGWEER ❑ DEVELOPER ❑TENANT CONIRALTOR NAME " 5 "CENSE TYPE BUS.LIC A '0'a' BAeo COMPANY NAME E- f F G .f 0% STREET ADDRESSCITY, A IIP ONE ARCHMECTIENGWEER NAME "CENSE NUMBER BUS."C A COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE,IIP PHONE DESCRIPTION OF WOR% 1 G USE PROPOSEDE CONS R.TYPE A STORIES AN /}/ e USE TYPE OCC. SQPT. VALUATION(S) AREA NEW FlAOR DEMO TOTAL / A / AREA MEA AREA NOT BATHROOM KITCHEN REVtODEI.AREA REMODEL REMODELAREA PORCHMEA = TOTALDECK/PORCH AREA GARAOEAREA DETACH ATTACH A DWELL ISA SECOND UNIT YEs - SECONM STORYYES BEING ADDED? NO ADDITION, �N0 PRE APPLICATIONYFS LYES,PROVIDE COPY OF ISTHEBLDGAN YES RECEIVE BY: - TAL VALUATION; PLANNPTG MPLp 0 PLANNPIG APPROVAL LETTER EICHLER Ham? 0 6 By my signan,..below.I certify to each of the following: am die athe property owner or authorized agent to act on the pmperty owner's behalf. I have read this application and the information I have provideA is correct I have read the Description of Work and verify it is accurate. 1 agree to comply wick all applicable local ordinances and state laws relating to buil ' onsrruc I authorize representatives of Cupertino to enter the above-idemi d pmperty r inspection purposes. Signature ofAppGcant/AgenD ✓r.. Date: ' SUPPLEMENTAL INFORMATION REQUIRED PLANCHECKTYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for )R OVER-THE-COUNTER Bttv.Dtivc Ptar REvmw existing building(s). Demolition permit is required prior to issuance of building j_ permit for new building. ❑ EXPRESS a ANnmc PIAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS T—=if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIXE Derr Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVTRONMENTALBEALTH Bldgdpp_201 Ldoc revised 06/21111