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12090231I CITY OF CUPERTINO BUILDING PERMIT _7_1 BUILDING ADDRESS: 10737 PAR THREE DR CO\I'RACI'OR:RENEWAL BY PERMIT N0: 12090231 �. ANDERSEN OWNER'S NAME: MAMPATTA ERINGATHODI 30800 SANTANA ST DATE ISSUED:09262012 OWNER'S PHONE.: 4087576713 HAYWARD,CA 94544 PRONE NO:(510)400-7470 LICENSED CO\1'RACI'OR'S DECLARATION 308 DESCRIPTION: RI;SIDENTL\I.U COMMERCIAL[] License Class A CLI Lie.a REPLACE 2 WINDOWS, LIKE FOR LIKE,Q NON- Contractor ,( Contractor 1 9ne�1��3! /0�'1 Date ZSTRUCTURAL 1 Z 1 hereby affirm that 1 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. hereby affirm under penalty of perjuy 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 Sq. Ft Floor Area: Valuation:54230 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. APN Number:35607041.00 Occupancy Type: API'LICAN'1'CI?R'1'IFIGVI'ION 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 laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter I 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 applicant understands and will comply Issued by:o Date: / with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 2/ RE-ROOF'S: Signature '� Date o � All roofs shall be inspected prior to my roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for OWNER-BUILDER DECLARATIONinspection. hereby affirm that I am exempt from the Contractor's License Law fortune of Signature of Applicant: Date: the following two reasons: ,\t.1,ROOF COVERINGS TO RF.CLASS'S\"OR BETTERI,as owner of the property,or my employees with wages as their sole compensation, will do the work,mid the structure is not intended or offered for sale(Sce.7044, Business&.Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to DAZARDOUS MATERIAIS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Dlunicipal Code,Chapter 9.12 and the declarations: Ilealth&Safer, Code,Section 25532(n)should 1 store or handle hazardous I have mid will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 Ray Area Air Qualim Management District I performance of the work for which this pemnil is issued. will maintain compliance with the Cupertino M unicipaf Code.Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code.S ' as 15505,21533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which thisn permit is issued. Owner or nuthorizedagent: Date; (f� I certify(hat in the performance of die 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 Compensation laws of California. If,after making this certificate ofesemp(ion,I CONSIRIICFION 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. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name ,\I'I'I,ICAN'I'CER'1'IFICA'1'10N Lender's Address I certify that I have read this application mid state that the above information is correct.I 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 indemmnify and keep harmless the City of Cupertino against liabilities,judgments, ARCUITECP'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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX (408) 777-3333 • building(a)cupertino.org /vt ❑ NEW CONSTRUCTION El ADDITION ALTERATION/TI ❑ REVISION/DEFERRFD ORIGINAL PERMIT PROJECTADDRFSS C-k ( \ APN0 55/ -07-0111 OWNEVA, � ,✓ PHONE I E-MAIL l CS.r d. l,p _ STREET ADDRES D O CITY. STATE,ZIP - A D L FAX "CPr , CONTACT NAME1 ^ PHONE E-MAIL SS `� APJS - D L63 nc 2nt'-•�a( a c�reR,c STREET ADDRESS 3 Cr FAX ❑ OWNER ❑ OWNER-BUILDER ❑` OOWN�ER AGE'S ❑CONTRACTOR coNTTRRACACTORAONNIT (❑7ARCHIT[CT 11ENGINEER13DEVELOPER ❑ TENANT CONTRACTOR NAM A- \ ^^ LICENSE NUMAER(��� 3 0 LIC:NSE TY;E BUS.LIC N COMPANYNAME (_ MAIL FAX V ci �T ��2✓N +n cv, �...-l�'c a'cc\[ave STREEI'ADDRESS w ( _nj _ 1 CITY,S �TE-Z I �- / q(/YL/L/ ARCHI"ITC17ENGINHERNAMME \I\ LICENSENUMBER •rCl CA X17 BUS.LICK O COMPANY NAME E-MAIL FAX STREET ADDRESS CI'T'Y,STATL'.zH, PHONE f DESCRIPTIONOFWORI: 1.\�1yvCl[�.. I \ L( Ann'' �YN L EXISTING USE PROPOSED USE CONSTµ.TYPEWP— d5tOR1E5 L,)Cbd USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NE\Y FLOOR) I�-DLAIO TOTAL AREA ARTA AItFA NFT ARTA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECIUPORCH AREA GARAGENdEAt DETACH []ATTACH Y DWELLING UNITS: ISASICON'DDFIr ❑1'ES SECONDS'I'ORY [I YES a EINGADDEm r7 N0 ADDI'1'lON7 �N'O PRE-APPLICATION ❑YES IF YES.PROVIDE COPY OF ISTIIERLDCAN' ❑YTS RECEIVEOBY: ` TOT LVALUATION: PLANNINGAPPL* C]NO PLANNING APPROVAL LETTER EICHLERDOME? r.]NO /\o5 S' v By my signature below,I cenify to tach of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application mid the infonmaion 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and slate laws retrain (gt.(o b .1dii-ng,Fconstruction. I authorize representatives of Cupertino to enter the abo'c-identified property for inspection purposes. Signature ol'Applicant/AgenC V'�C `ti6T�` Date: �,/ �� SUPPLEMENTAL INFORMATION REQUIRED PIAN CHECK TN PE ROUT ING SLIT' New S17D or Multifamily dwellings: Apply for demolition permit for 701E14,TIIE-000N'IER D- nHILDING PIAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ I'IAp;N'IN'CPIAN•REVIF.W _Commercial EIdgS: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ vuBI.IC WORKS form if any I lazardous Materials are being used as pan of this project. ❑ L,\RCE ❑. FINE I)EI'1' _Copy of Planning Approval Letter or Mceting with Planning prior to ❑ Nf.\.Il1H ❑ S,\N'I1'ANY SEWER IIIS'I'NIC'1' submittal of Building Permit application. ' ❑ r;N'vIRON•DIEN-rnL UF:,M.Tu Bfdgilpp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10737 phar three dr. DATE: 09/26/2012 REVIEWED BY: bobs. ` APN: BP#: 'VALUATION: $4,230 *PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK re lace 2 windows non structural for sfd. SCOPE Aleeh. Plan Check Plumb. Pleur Cheek Flee. Plan Check blech. Permit Fee: Plumb. Permit Fee: Elec, Permit Fee: Other,llech.Insp. 01h,".Plumb Insp. Li I Other Elec.Lisp. ddcch.Insp.Fec: Plumb. hup. Fee: Elec.Lisp. Fee: NOTE: This estimate does not include jets clue to other Departments(i.e. Planning, Public B'orks, Fire,Sunitaty Sewer District,School District,etc. . These eev are based art the preliminan information available and are only an estinmte. Contact the Dept for addn'I info. FEE ITEMS (Eee Resoltuion 11-053 ED' Lill l) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 2 # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. Q O"1' 0.0 hrs $0.00 $400.00 1lvhvREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee0 Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consnvction Tae: Administrative Fee: O Work Without Permit? O Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select Non-Residential Trane!Docutnentution Fces: Building or Structure 0 A Strong Motion Fee: IBSE/SMICR $0.50 Select an Administrative Item Bldg Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.501 $400.001 TOTAL FEE: $401.50 Revised: 07/01/2012 Renewal b Andersen. % { WINDOW REPLACEMENT mAndersen Company &YO PROJECT Lo DATE Q... I - , .; o e lass e I ' a O Qi _i .'..- • .,. — ' I , I 1 I " L0. '// } t " d or- i. sd�y �f et,nl� I I r t.. 1 Building DepElFtM& t' I .SEP '2 6,2011 I i 1 ; ,- j REVIEWED FOR CODE COMPLI Kf;=6 - - Reviewed BY: QIc))s :