12090161 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8151 PARK VILLA CIR CONTRACTOR:ARGONAUT WINDOW& PERMITNO: 12090161
DOOR,INC
ON�NER'S NANI E: MARTIN.WILLIAM I 1901,5 BASCOM AVE SfE 800 DATE ISSIIED:09/192012
OWNER'S PHONE: 6509065838 CAMPBELL,CA 95008 PHONE NO:(408j,3784018
❑ LICENSED CONTRAC`fOR''S DECLARATION BUILDING PERMIT INFO: BLDG (✓ ELECT r PLUMB
License Class I"ic.H' B Zq 6 (�(rT NIECII RESIDENTIAL.(- r COMMERCIAL r1
p
Contraclot- Aa.aNA- Wi(44AWDate ! 1°l /
1 hereby affirm that I am licensed under the provisions of Chapter 9 dots DESCRIPTION: REMOVE AND REPLACE(5)WINDOWS AND(1)PATIO
(commencing with Section 7000)of Division 3 of the Rusiness S Professions DOOR
Code and that my license is in full force and effect.
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$14000
Section 3700 of the Labor Code,for die performance of the work for which this
permit is issued.
.\I'N Number:35610043.00 Occnpaaev'1'ype:
APPLICANT CERTIFICATION
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 state Imes relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,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 CALLED 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. Issued by:, %Fi$1/✓ /tfGC7 Dote:
Sign r. Date
OWNER-BUILDER DF.CLARA"PION 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 Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages its their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Dale:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors lo'
construct the project(Sec.7044,Business&Professions Code). AL1-R0017 COVF,RINGS"f0 RE CLASS"A"OR[DATER
1 hereby afinn under penalty of perjury one of the following three
BAZARDOUSMATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided far by Section 3700 of the Labor Code,for the California Ilealth&Safety Code,Sections 25505.25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the[health&
I have mid will maintain Worker's Compensation Insurance,as provided for by 'Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emir hazardous air
contaminants as defined by the Ray Area Air Quality Managemnn District I 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 Health&Safety Code,Sec'ons 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,1 (caner a t oriz it
become subject to the Worker's Compensation provisions of the Labor Code,I m st ' - D tea _l Z
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRf1Cl'ION LENDING AGENCY
APPLICANT CERTI FICA9ION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and stale that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above menlioried property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the .\I2CIII'1'FCT'S DECLARATION
of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Dale
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 8151 Park Villa Circle DATE: 09/19/2012 REVIEWED Bl': Sean
A PN: I BP#: 'VALUA'T'ION: $14,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRINIARY PEN"GIMATION 1GENRES
USE: SFD Of Duplex PERMITTI'PE:
WORK Remove and replace 5 windows and 1patio door.
SCOPE
,Neth. Plan Check Plumb. Plan Check Flea Plan Check
Meeh. Permit Fee: Plumb.Permit Fee: flcc. Permit Fee:
Other Mech.Insp. Other Plumb Insp. Other Flee. hrsp.
Meth.hasp. Fee, Plumb. bull). Fed: face.Drop. Fee:
NOTE: This esiinmte does not includejees clue to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District,etc. . Thesefees are based on tire prelindnan information available and are only an estimate. Contact the Dept for add n7 info.
FEE ITEMS (Fee Resolnion I1-053 Elf 71111 U FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 6 # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $400.00 /fl'INREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. FeeQ Reg. Q OT O,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee.: O
Work Without Permit? O Yes Q No $0.00 G
Advanced Planning Fee: $0.00 Select Non-Residential 0
Building or Structure Q
Travel Docun eniation Fees: i
Strong Motion Fee: 1BSEISAIICR $1.40 Select an Administrative Item
131dg Sids Commission Fee: 1BCBSC $1.00
SUBTOTALS: $2.40 $400.001 TOTAL FEE: $402.40
Revised: 07/01/2012
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildino(5cuoertino.orD
❑NEW CONSTRUCTION ❑ ADDITION TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROIECT ADDRESS I%RY\ VILLA- C[ CLF— ANN
OWNER NAME (, " PHONE EMAIL (/
'3I LL 77 so 90(l s82g na 4cr s k�o.�
STREET ADDRESS775'1 PA-t\K ILLA OXCL� CrrY.S ATE.ZIP O Ch /'SO FAx
CONTACT NAME -..U PHO N SVS E-MAIL 1 LF-Q ,W t •V/11•�Q
CITY,ST ZI FA^'
7�oESS 6'S. . co Jc SfE %60 � �} Sbo
STREETg LSg eSS
❑OWNER ❑ OWNER-BUI DER ❑ OWN/ER AGENT XKONIRACtOR ❑CONERACTORAGENT ❑ ARCHITECT 11ENGINEERR C1R ❑ DEVELOPER TENANT
CONTRACT R2„6oKAv� A6,P, &oq(2. 1NC' LICENSE NUMBER LICENSETYPEL G� BUS.LICK �T of 07�D
CONIPANYNAME / E-MTI
AIL F x b
r LERW A-RGo�d1,V. co 08 (ogq o,5'i'
STREEF ADDRESS 134_&C0)_1 AL/F_ 51571-00CIT', ZI C�� PHONy4&e �^ 4�
ARCfBTECTI LICENSE NUMBER BUS
COMPANY NAME FAX
SI"REET ADDRESS CITY,STATE,ZIP
DESCRIPTION OF WORK
E S W %IA"S I 1770 JL6011 • @ 7
S S'12-es. lA7rRl0 E)crIIF9102 R1 K IST7
EXISTING USE PROPOSED USE CONSTR.TYPE dSTO IES
fi7 USE TYPE OCC SQ.FT. VALUATION(S)
E[ISTG NEW FLOOR DEMO TOTAL
AREA AREA ARM NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL ARM
PORCHAREA DECK AREA TOTALDECKfPORCIIAREA GARAGEAREA; DETACH
❑ATTACH
nDW'EWNG UNriS: EING ADDED. �O ABES U TIONLNT'OR\ DYES
PRE-APPLICATION ❑ IF 1'FS.PROVIDE COPY OF IS THE BLUCAN LJ YES RECEIVED BY: TOTAL VALUATIO '
PLANNING APPL if .•0 /"r1PLANNING APPROVAL EICHLER HOME? '1O
Z-4 15�90
By my signature below,l certify'to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. 1 hive read this
application and the information 1 have pm ided is correct. I ve read the Description of Work and verify it is accurate. I agree to comply with WI applicable local
ordinances and state laws relay to u' w tion. auth re esentatires of Cupertino to enter the above-identified rape for inspection purposes.
Signature ofApplicandA in / Date:
SUPPE'NIT,NTA12 rNIORMAJDON REQUIRED Plan cuEc%TYrE _ _ROIrrlsr.SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building DCER:ruEcoun V_B(j11,DiSf.PLAN RE\'IE\V
permit for new building. ❑ EXPRESS -❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure O STANDARD- ❑ PUBLIC WORKS
form if my Hazardous Materials are being used as pan of this project. -.
❑-1.,\RC.E. ❑FINE UF:PT-
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑;.,AIA.Iiiu.. -. ❑ SANITARY SEWER nLcrRlcr
submittal of Building Permit application. -
❑ EN\'1HONMENTAL HEALTH
Bldg l pp_20l Ldoc revised 06/21111
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