12090205 CITY OF CUPERTINO 13UILDING PERMIT
BUILDING ADDRESS: 18825 PENDERGAST AVE CON'TRAC'I'OR:ARGONAUT WINDOW& PERMITNO: 12090205
DOOR,INC
OWNERS NAMF,: SHEILA R 11M IIFYUURSf 1901 S BASCOM AVE SI'E 800 DATE ISSUED:09242012
OWNER'SPIIONE: 4088353489 CAM I'll ELL.CA 95008 mtONF.NO:(408)378-4018
❑
LICENSED CO\1'RACI'ORS UECL,\RKPIONBUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic.q r r r
�M ECII RESIDENTIAL COM i\IERCL\L
Contractor Date
—
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB 1)ESCRI PTION:Rf:PI.ACI'7 WINDOWS WITII TRANSOMS LIKE I'OR LIKE
(commencing with Section 7000)of Division 3 of the Business S Professions
Code-,Ind that my license is in full force and effect.
I herchy affirm order penalty of perjury one of the following too declaratioro:
1 have and will maintain a certificate of consent to sell--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. Valuation:$7000
1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.It FloorArca:
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:37533022.00 OccupancyType:
nrrl,la\N'r cER•1•IFIcnT1oN
I certify that I have read this application and state that the above information is
correct.)agree to comply with all city and counq•ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indeninil'y and keep harmless the City ol'Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of de
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued b ': � Date:
9.18.
Signature Dare
RE-ROOFS:
❑ OWNER-IR111.UER DECLARATION All roots shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
1 hereby affirm that 1 am exempt front the Contractor's License Lao for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages a their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BE'FITR
construct the project(Sec.7044,Business&Professions Code).
hereby affirm under penalty of perjureone of the following three 11.\%ARDOUS\L\'1'ERIA S DISCLOSURE
declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and willmaintain a Certificate of Consent 10 self-insure(0r Worker's California I Iexhh&Safely Code.Sections 25505,'_5533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the I.abor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12:Ind the I Iculth&
performance of the work for which this permit is issued. Safety Code.Section 25532(x)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally.should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of rhe work for which this contaminants as defined by the line Area Air Quality Management.District I will
P maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
permit is issued. Ilcallh&Safety Cade,Sections 25505,25533.and 25534.
I certify that in the pedornance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's Owner or authorize ag I:
Compensation laws of California, If,after making this certificate of exemption,I
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. CONS'IRl7Cl'ION LENDING AGENCI'
I hereby a0 iris that there is it construction lending agency for the performance of\cork's
APPLICANT CI'DITIFICATION for which this permit is issued(Sec.3097,Cie C.)
I cenify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city tend county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indenmily and keep harmless the City 01'Cupcnino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the AItCI I1'1'ECI"5 DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-paint source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signaumue C/ Dame
U
Sol/Iv&Z?�
GENERAL PERMIT APPLICATION '57/7/tv Irl E I
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 m ' A
CUPERTINO (408)777-3228 • FAX(408)777-3333 • building(a cuoerino.oro J
/WNVO.S-
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECTADDRESS I APNi 3 25 ,3, pad
18}325 ?F-.QErvr Af 'N'e GJ P%yi?.NU
OWNER NAME `` PHONE E-MAIL
j-1 (- -(�-1Jris i IC'-IJY) `635-34-8 I-1•: hrsv& 5bc lob,1. t4-
STREETADDRESS CITY, STATE,ZIP FAX
So K•, C-JPEwT.NL CtA g5oIy
CONTACT NAME PHONE E-MAIL
50..,..t C-
STREETADDRESS - CITY.STATE, ZIP FAX -
11 OWNER ❑ OwNER-BUCDER ❑ owNER AGENT ❑ COATRACTOR ❑CONTRACTOR AGENT ❑ MCFDTECT ❑ENGDInUt. ❑ DEVELOPER ❑ TETVANT
CONTRACTOR NAME LICENSENUMEEt LICENSE TYPE BUS.LIC a `�
A ILho NaJ lrT Two SB- C- (1 oC�
COMPANY NAME E-MAIL FAX
ALCre. uPaT tw..moo ud I (4.0frJ3 . j - I( 3
STREET ADDRESS CT',STATE,ZIP PHONE
1 `1-\ fi A5C0w AvE 53'G- boo IC A,%P L3CLl C !-1 c) SooX (yoy-) 3-7 to- 4co '6
ARCHrrELZhNGA'EER NAME LICENSE NUMBER I BUS.LC R
COMPANY NAMEE-MAIL FAX
STREET ADDRESS CITY,STATE,ZB PHONE
USE OF ❑SFD w DUPLEX ❑ MULTI-FAMILY PROJECT a W'LDLAND ❑ YES I PROJECT IN ❑YES I IS THE BLDG AN ❑ YES
BUTIDA'G: (j MM RCW. URBAN INTERFACE AREA 0N FLOOD ZONE 0N EICHLERHOMET 0N
DESCRIPTION OF WORK '
(ZE�c.9CL-
LIKE 7=oti LI (�c
TOTALVALUATION: -) 0 Sy, I I RECEIVED BY:
By my signature below,I 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 conecL I have read the Description of Work and verity it is accurate. I agree as comply with all applicable local
ordinances and state laws relating m building wnsavctian. I auth 'ze representatives of Cupertino to enter the above-identified pmper,/for inspection pu($oses.
Signature of Appl(cznt/AgenD Date: �- 2-`f-I L
"PPLEMENTAL OR,V(ATION REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
❑ EXPRESS
1
m
' - ❑ STANDARD
U
❑ LARGE
❑ MAJOR
MEP,L1hrc9pp201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 18825 Pendergast DATE: 09/24/2012 REVIEWED BY: jsg
APN: BP#: 'VALUATION: $7,000
*PERMIT TYPE: Building Permit PLAN CII ECR Tl'PE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: pPERMIT TYPE: 1GENRES
A
WORK Replace 7 windows like for like.
SCOPE
Meth. Plan Check Phmsh. Plan Check Flee. Plan Check
blech. Permit Fes Plumb.Permi!Fee: Elec.Permit Fee:
Other Much.lisp, Other Plumb Insp. Li I Other Elce.Insp.
,Neth.Insp.Fee: Plumb. last.Fee: Elce.lay.Fee:
NOTE: This eatintate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District.etc.). These ees are based on the prelindnan information available and are on&an estimate Contact Use De t or adeln 7 into.
FEE ITEMS (Fee Resohaion 11-053 Eff 7/1/111 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/.Sliding Glass Door
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $400.00 IIVINREP Replacement
PME Plan Check: $0.00
Permit Pee: $0.00
Suppl. Insp. FeeQ Reg. OOT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consnwetion Tax:
Administrative Fee: Q
Work Without Permit? Yes 0 No $0.00
Advanced Planning Pee: $0.00 Select a Non-Residential E)
Building or Structure O
Travel Documentation Fees: A
Strong Motion Pee: IBSEISA-IICR $0.70 Select an Administrative Item
Bldg Stds Commission Pee: IBCBSC $1.00
SUBTOTALS: $1.70 $400.00 TOTAL FEE: $401.70
Revised: 07/01/2012
2- PEN OE/RGr9S 1 (AvC- C J P C-CTwU
57.5"x41.5" Lower for egress
Sheetrock patch Bed 2 Trapezoid- Right
Stool and apron Block Frame
Trapezoid-Left: block frame
U•vinz
57.5"x41.5" Lower for Bed 1
Egress.Sheetrock patch with stool and apron 24.5"xg1.75 PW
Trapezoid-Right: block frame Remove stops&caulk
Between perimeter
Dining
MBR Trapezoid-Left
Retro Fit-Mar Block Frame
56.5"x32.5" XO
69.5"x41.5" XO lower for egress
Stool and apron 6" patch of SR
2x4 Sides and 2x6 Top and bottom
RECEIVED
ir I"
111 0
PEKE C®p SEP 24 2012
BY:----
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