12080203 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10100171RWOOD DR CONT'RACT'OR:I10LDER INC DBA ABLE PERMITNO: 12080203
CLASS
OWNER'SNAME: ENDISCII DENIS H AND SUSANNE: 850ALD0 AVE DATE ISSUED:08202012
OW'NI,R'SNIONE: 4089738615 SANTA Cl,%RA.CA 95054 PHONE NO:(408)496-9960
Cl LICENSED CONI'RAC"FOR'S DECLARA'T'ION BUILDINGPERb11T INFO: BLDG r ELECT r PLUMB r
License Class Lie.N d 90 r r, r
p1ECIE RESIDENTIAL CO MERCIAL
Contncmr Date h///�
hereby affirm t tat I am licensed under the provisions of Cha liter JOB DESCRIP'T'ION: REPLACE9 EXISTING WINDOWS WITH NEW LIKE FOR
(coil]nencing with Section 7000)of Ilivision 3 of the Business S Professions LIKE
Code and till ore license is in full force and effect.
hereby affirm under penalty of perjury ane of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,its provided for by Section 3700 of the Labor Code,for the
performance ofthe work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:58565
Section 3700 of the Labor Code,for the perfammance of die work for which this
permit is issued. -
APN Number:34233036.00 OccupmrgyType:
APPLICAN I'CF.RTI FICAT'ION
I 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 slate laws relating
to building construction,and hereby authorize representatives ofthis city to enter 13EIIN11T EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes, (We)agree to save
indemnify'and keep harmless the City ofcupertino againstliabdities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST C LEI) INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
With all non-point source regulations per the Cupertino Municipal Code,Section ( (-
9.18. Q y� Issued by: \ Date:6 �f
Signature Date " O 44
❑ OWNER-BI11LDEIR DECLARATION RE ROOFS:
All roofs shall be inspected prior to any'roofing material being installed.If a roof is
hereby affirm that I am exempt from the Contractor's License Low for one of installed without first obtaining an inspection,I agree to remove all new materials for
the futlow'ing bvo reasons: . inspection.
1,as owner of the property,or my employees with mages as their sole compensation,
will do the work,and the stucture is not intended or offered for sale(Sec.7044, .Signature of Applicant: Date:
Business S Professions Code)
I,as owner ohhe property,tan exclusively contracting with licensed contractors to
construct the project(Sec.7044,(business fi Professions Code). ALT.ROOF COVERINGS TO BE CLASS"A"OR Bl ITER
1 hereby affirm under penalty of perjury one of the following three
declarations: IIA%ARDOUS MATERLU S DISCLOSURE
I have and will maintain a Certificate ofConset to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided forby Section 3700 of the Labor Cade,for the California I Iea11h S Safety Code,Sections 25505.25533,and 25534. 1 will maintain
performance ofthe work for which this permit is issued, compliance with the Cupertino Jlmnicipal Code,Chapter 9.12 and the Realrh S
I have and will maintain Worker's Compensation Insurance,.a provided for by Safety Code,Section 25532(x)should 1 store or handle hazardous material.
Section 3700 ofthe Labor Code,for the performance of the work for which this AdditionalR,should I use equipment or devices which emit hazardous air
contaminants its defined by the Bay Area Air Quality Management District 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued.I shall I lcalrb S Safety Code.Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owner ar a r ed agent:
become subject to the Worker's Compensation provisions of the labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDINGAGENCY
APPLICANT CIIRTIFICAT'ION I hereby affirm that there is a construction lending agency for the performance of work's
I CCrll I)'that p have read this application and soh:than the ebaYC InfOlmi1l10x IS for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city anmd county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon die above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify,and keep harmless the Cit'of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said Cit'in consequence ofthe
granting of this permit.Additionally,the applicant understands and will comply ARCI11TECI"S DFCL RATION
with all non-point source regulations per the Cupertino Municipal Code,Section I undersumd my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
GENERAL PERMIT APPLICATION E P
COMMUNITY DEVELOPMENT DER AR I t ENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 950173255
CUPERTINO � I
(408)7T7-3228 • FAX(408)T-77-3333• buildingOcuoertino.orG
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PLUNSING ❑MECY_4:VCAL E]Et ECZCA.L D hf'iSCi_La.Nc0US
PRO��ADDRSB ,Qt o0 n(ZWool /� � � I .��.t a - .33 -03
O`A'NR NAME ?HONE / I `MAL
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STRE-ADDRESS I CITY. STATE,ZIP
FAX
CONTACT NAME L - PHONE I MPL�
SFRETTADORES /�•� C,=,STAT'_, ZIP FAX
❑Ow?M ❑ OwNER'SUDDER ❑ OWNER AGENT, CONTRA(7OR ❑CONRACORAGc , ❑ AR== ❑ DEVt'....OPR ❑TENANT
CO OR NAMEQ JC-r215E MIME / UCZA )Fc TY7� BUS.LIC 0
COMPANY NAME I EE..MMA'IM FAXN(B
STRET ADDRES�� ACO() I J;,= cl nu- C.+ 9sa I PEO T - ?9.OQ
ARG~ffi ENGDr=-2 NAME I LICrENSc NUMHR I BUS.LIC A
CONeANY NAMEI E-MAIL I FAX
STREET ADDRESS I =.STATE ZIP PHONE
USE OF ❑sm v DUPLEX ❑ MUL7.FAMEY I PROIECT N WILOL ND ❑ YES I PROTECT N ❑.YS IS THE BLDG AN ❑ YS
S=ING: ❑CowaxtAL URBAN DrrERFACE ARTA ❑ NO FLOOD ZONE ❑NO ElQ HOME? ❑NO
DESCRIPTION OF WORKr. /�, /
/iC - V/1/ A n17 2J
TOTAL VALUATION: �(0 I RECEIVED BY: �f By my signature:below,I cern-.1 to each of the following: I am the ptnpe,j owner or amborized agent to act on the propery owner's behalf. I have rad this
application and the information. I have provided is C=CL I have read Che Description of Work and verify it is accurate. I agree a comply with all applicable local
ordinances and sate laws relating W building c I authorize represeaadves of Cuperdc-_:c a^t the above-idgEtt���aper.for inspection purposes.
Signan.^e ofAppl cant/AgmC Date:_ EPV11
SUPPLEN ENTAL Ir TFORNL-'�T'ON REQUaED OFFICE USE ONLY
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RECEIVED
AU6 20 2012
BY:
CITY OF CUPERTINO _
2 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10100 Firwood Dr. DATE: 08/20/2012 REVIEWED BY:
APN: RP#: 'VALUATION: $0
*PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration / Repair
PRIMARY 2nd Unit? Yes No REM
PE
0 NTAMATION 1
USE: SFD or Duplex OTC? 0 Yes
('No PEI2MTt"TYPE:
WORK a lace 9 existing windows with new, like for like
SCOPE
OCCUPANCYTYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES RP FEE ID
CONSTR. (s.f.)
R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00
I
i
TOTALS: 0 $0.00 $0.00
MECH, HOURLY O Yes (j) No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes (F)No
Mech. Ilan Check Plumb.Plan Check F-lec.Plan Check
Aleeh,Permit Fee: Plumb.Permit Fee: rlec.Permit Fee:
Other,[tech. Insp. Other Plumb Insp. Other Elec.Itsp. El
.Neck.lasp.Fee: Plumb, br..p.rte: Flce.Insp.Fee:
NOTE': This estimate doer not include fees clue to other Departments(i.e: Planning, Public Works, Fire,SanitarySewer District,School
District,etc.). These feav are haled on the prefintinan information available and are only an estimate. Contact the De I or addm7 info.
FEE ITEMS (Fee Resolution 11-053 F_lZ 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 9 # Window/Sliding Glass Door
Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 $533.00 1tvINRFP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee@ Reg. 0 OT 1 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tut':
A(iininisirative/'ee: 0
Work Without Permit? 0 Yes 0 No $0.00 ' E)
Advanced Planning, Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
Trorel Dactanerdallon Fees: �
Strong,Motion Fee: $0.00 Select an Administrative Item
131cte Stds Commission Fee: $0.00
SUBTOTALS: 1 $0.00 ' $533.001 TOTAL FEE: $533.00
Revised: 07/01/2012