The URL can be used to link to this page

12090230CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10614JOHNWAY CONTRACTOR: RENEWAL BY PFRDIITNO: 12090230 ANDERSEN OWNER'S NAME: LEE YAO F AND JEAN C 30800 SANTANA ST DATE, ISSUED: 09262012 OWNER'S PHONE: 4084461897 HAYWARD, CA 94544 PI IONF NO: (510) 400-7470 LICF-NSFI) CON"TRACCTJO�RR'S DECLARATION JOBDESCRIPTION; RF.SIDENTIA . COMMERCIAL❑ License Class Ar -r 1J Lie.H -1 /Z:7UZ, REPLACE 5 WINDOWS LIKE -FOR -LIKE, NON- Contractor /�'�•�_ Date STRUCTURAL I hereby affirm that I am licensed under the provisions of Chapter 9 (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 penally of perjury one of the following two declarations: 1 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 Sq. Ft Floor Area: Valuation: $9800 performance of the work for which this permit is issued. I have and will maintain. Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. AI'N Number: 35918003.00 Occupancy'1)•pe: 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 and county ordinances and state Imus relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city welder upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicam understands and will comply Issued b)_Date with till non -point source regulations per the Cupertino Municipal Code, Section 9.18. (� 1 v( 4--,. A _Y Qf�/fir Rt: ROOFS: Signature - _1 ��A` ,I --r"4 r� �� Date - 1 / C-�/ \�� All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OR'NF-R-BUILIIER DECLARATION Signature of Applicant: Date: hereby affirm that I am exempt from the Contractor's License Law' for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR RE 1-1'ER 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS NIATERIALS DISCLOSURE construct the project (Sce.7044, Business & Professions Code). I hale read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safety Code, Sections 25505, 25533, and 25534. I will 1 hazel}' affirm under penalty of perjury one of the allowing three maintain compliance with the Cupertino Nlunicipal Code, Chapter 9.12 and the declarations: Ilealth & Safety Code, Section 25532(a) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's malrrial. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance vvith the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Ilealth & Safety Code. Sections 25505. 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this CV permit is issued.2 Owner or authorized agent 'k'A-1 Date: 1 certify that in the performance of work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, atter staking this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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 forthwith comply with such provisions or this permit shall be deemed revoked. w'ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANTCERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO I --I n Tar rnwlcTRr v-rrnwl CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333' buildino(Dcupertino.oro /;oq 0.230 1-1 AnnITInN 1S' A I TFRATr1N IT[ n RFVISIONI/nHFI--RRED ORIGINAL PERMIT# JCJ PROJECTADDRESS �J\ 1 h Vhf ML IL,J A[�PNa [�CA1G ``,.�`�I1J PHON(•IQO ^L'1DE-MAIL p OWNER NAME 6_1�� . / STREET ADDRESS 1 0 ( 1 4 � D CITY, S�v1E. ZIP`��u � U I � FAX lVJ l 4/ V\ CONTACT NANI lz - k- �e r� �. PHONE :MAIL Sfo Z 6 3 3 1.7 ,de'r ore \ c01~ STREET AD E55 ,OU ( _ CITY. TE, 7.IP CA M EAx ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER ArENr ❑ NIRACTOR ❑ CONTRACrOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CON RACTORNAN LICENSE NU\IBER •l.�Z / LICENSE TYP%,( ``�t BUS, LIC# COMPANY NAME C�_-MAIL FAX STREET ADDRESS�n(��,` IG�q C`, CITY,STATE,ZIP C* 4ysyy PHONE T/0Zb (J 3 �17e J ` NNAME ARCHITECTIENGINEE`RR ^W� AC LICENSE NU\IBER BUS. LIC A COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE. ZIP PHONE DESCRIPTION OF WORK I �LI �t �CLi —73—� T. G JlYlCM�� 'CAn/0 all �Iuc Ns A-0 o>" -fit^ C s EXISTING USE PROPOSMUSE 5f, R- CON4rR. TYPE wV I MSTOgIES I USE TYPE: OCC. SQ.FT. VALUATIONS) CLISTG NEW FLOOR DEMO TOTAL AREA AREA AAF.\ NETAREA BATHROOM KITCHEN OILER REMODEL AREA RLMODEL AREA REMODEL AREA PORCII AREA DECK AREA TOTAL DECKIPORCHAREA GARAGE AREA: DUACH [:]ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY OYES REIN'G ADDED? BNo ADDITION? t5NO PRE -APPLICATION ❑YES IF YES. PROVIDE COPY OF PLANNING APPROVAL LETTER IS 1111: RLIG AN OYES F.ICIII.F.R IIUME^ .rINO RECEIVED BY: LL TOT LqVAQL'{1ATION: PIANNINGAPPL# &NO _/1f / VOO, GU By my signature below, 1 certify to each of the following: I am the property Owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply With all applicable local ordinances and state laws relatin�g,(to building constrt¢tiol . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Agent: �?St /A^ Date: gtzV I ei _ Signature of ApplicanV7 SUPPLEMENTAL INI'ORMATION REQUIRED PI-N.N CHUCK11111, ROvnsc SLIP ®o-rur:couN n;B Ituu.DlNc rl.,\N REvlt:e' New S17D or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLICwuusS _ form if any Hazardous Materials are being used as part of this project. O ❑ LARGE FIRE DKP'1' _ Copy of Planning Approval Letter or Mceting with Planning prior to ❑ .\1•\wu ❑ 5AN'I'R\R1'SE-rAt. submittal of Building Permit application. IIF,%L II ❑ F.S\'IRO\,,\I I:NTA1. 11 .\LTTE RldgApp_2011.doc revised 06121/11 r" CITY OF CUPERTINO rRE FEE ESTIMATOR—BUILDING DIVISION /L`ADDRESS: 10614 john way DATE: 09126/2012 REVIEWED BY: bob s. MAPN: Plumb. Permit Fee: BP#: 'VALUATION: $9,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Elce. Insp. Fee: PENTAMATION 1GENRES PERMIT T)'PE: WORK re lace 5 windows non structural for sfd. 71 SCOPE $0.00 NOTE: This estimate doev not include fees clue to otter Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These feev are based on the nrelindnarr information m,ailahle and are only an etintala Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-053 EfT 7 11) Alech. Plan Check Plumb. Plan Cheek Flee. Plan Check Mech. Penult Fee: Plumb. Permit Fee: F.lec. Permit Fee: Other Alech. lnxp. Other Plumb Insp. Other Elec. Imps .1✓e.ch. Insp. Pee: Plumb. hasp. Fee: Elce. Insp. Fee: NOTE: This estimate doev not include fees clue to otter Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These feev are based on the nrelindnarr information m,ailahle and are only an etintala Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-053 EfT 7 11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $400.00 Window / Sliding Glass Door 1lvhvREP Replacement Suppl. PC Fee: Q Reg. Q OT 0.0 Thrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT F0,p hrs $0.00 PMH Unit Fee: $0.00 PME Permit Fee: $0.00 Comvnvtction Tux: ddininistrative Fee: 0 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 Travel /Jnc anentation Fees: Strong Motion Fee: IBSEISMICR $0.98 Select an Administrative Item 131de Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.98 $400.00 TOTAL FEE: $401.98 Revised: 07/01/2012 Renewal; byAndersen. - WINDOW REPLACEMENT an Andersen Company PROJECT DATE _J I � (r� t �.:• I I - �- �- --- -- - - r I- 0 ),xU I - - �--- - — L _ ani/ I I I 1 I I I ice.! 1._- i_ I B`'nafRs a riNo- I _ 1 SEP 2 s; i epanm!nt f I I fi __ 1 REviE I 2012 I I r` ReVi� rWEDF - Df - - i i 1 -4- 2- -i SE' 26 2012 L � � I I I moi__ i • �T I