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12090232 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10010 PHAR LAP DR CONTRACTOR:RENEWAL BY PER\IIT NO: 12090232 ANDERSEN OWNER'S NAM F: KLINKOWSKI KENNETH AND MARIANN 30800 SANTANA ST DATE ISSUED:09262012 OWNER'S PHONE: 4084460604 HAYWARD,CA 94544 Pl IONENO:(510)400-7470 .[� L\ICENSPD COQ'RAC`VOR'S DECLARATION .1013 DESCRIPTION: RESIDENTIAL COMMERCIAL License Class;�a CQ LiccA OZ REPLACE 3 WINDOWS LIKE-FOR-LIKE,NON- Contractor 1 9ate STRUCTURAL I hereby affirm that I am licensed under the provisions of Chaptert) (commencing with Section 7000)of Division 3 of the Business S Professions 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. Sq.Ft Floor Area: Valuation:$6785 1 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 AI.N Number:32618035.00 Occupancy'Fype: permit is issued. 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 laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building constmction,and hereby authorize representatives of this city to enter 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 aceme against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by - C � Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. �iQ--- �7 ��I.... RF.-ROOFS: Signature d'�\ Date / "/ U �-- NI roofs shall be inspected prior to nR roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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 IIA7,ARDOUS MATFRLU S DISCLOSURE construct die project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth S Safety Code,Sections 25505,25533,and 25534. 1 will herebyaffirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the declarations: Ilealth S Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. 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[lay Area Air Quality Management District I performance of the work for which this pemnit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Ihave and will maintain Worker's Compensation Insurance,as provided for by the Ilealth S Safety Code.Sections'-5505.25533,and 25534. Sectiz"t C_V Date:on 3700 of the Labor Cade,for the performance of the work for which this �aA_1 Te Permit is issued. Owner or authorized agent: I certify that in the performance 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 Compensation laws of Cali fomia. If,alter making this certificate of exemption,I CONSIRUCFION LEN DING AGENCY become subject to the Worker's Compensation provisions of the Labor Cade,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.) Leader's Name %PI'LICAN"I'CER'I'IFIC.VI'ION Lender's Address I certify that I have read this application and sate that the above information is correct.I agree to comply with all city and county ordinonces 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, ARCIIITEC`I"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 �� J COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333• buildino(a)cuper ino.oro ❑ NEW CONSTRUCTION ❑ ADDITION K ALTERATION/Tl ❑ REVISION/DEFERRED ORIGINAL PERMIT 9 PROJECT ADDRESS 1 OU1p Ila 1>r - APS# 3 7/ - ,Q -035 OWNERNAAIE 1 I PI IONij V,� - 0(4 Ig? -035 STREET ADDRESSd'``"� ``� \A VII CITY, STATE,ZIP k \I —1 FAX J (JCONTACT NAht & \ tJ✓� PHONE D L! t7VE-M,\I STREET ADDRESSC14,STAE% o,j,J,l, FAX CI OWNER EIW' ONER-BUILDER El OWNER OWNER AGENT Iy CONTRACTOR ❑CONTRACTOR AGEM L`�(SAHCHVIITTECr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM f 1 LICENSE NUMBER�7Z7UZ LICENSE TYPE BUS.LIC# COhIPANYNANir. AL1 (<�KC G'A (t.V♦!.+ 1 /C�\G•P/TQ{t. FAX J STREET ADDRESS 6.3 `( k-tea CITY S ATE.ZIP LIArJ ^ � r, PHOo L633 n E./ ARCHITECT/ENGINER NAME A JI'* LICENSE NUhIBER "l 1 BUS.LIC# COMPANY NAAIE E-hIAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXIST V(1€ PROPOSED USE CONSTR.TYP w STO IES .``lJ 1!LU/Ovc� USE TYPE OCC. SQ.FT. VALUATION(S) GXISTG NE\VFLOOR DEMO TOTAL ARIA, ARG AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK ARG TOTAL DECKJPORCH ARG GARAGE AREA: DETACH ❑ATTACH Y DWELLING UNITS'. IS A SEC09 D 1191 1' 0YEs Sr:CONDSTr1H\' OVS Bl;nc ADDl:Dr [3Kp .ADmnoSt JaNO PR-APPLICATION El YES IFYES,PROVIURCOPYOF ISTIIEBI.UGAN [I YES RECEIVED BY: T VALUATI N: PLANNING APDL# ONO PLANNING APPROVAL LETTER EICHLER 110IMT �NO 1 95, ()0— By UUBy my signature below,1 certify to each of the folloWiug: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I 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 state Imvs relating to building cons action.. (-authorize representatives of Cupenino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: `� '"'�J�S `"�� Date: —\/2�-/ V? SUPPLEMENTAL INFOR-MATION REQUIRED 1'1.%NCIIF-CK1YPE. I ROM LNG SKIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OYER-1'1IECOUNI'F,R ❑ BUILDING PIAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permitfor new building. ❑ ExrREss ❑ P1.\NXING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Ixlaterials Disclosure Els-i-AmmRl ❑ PUBIACUORKS forth if any Hazardous Materials are being used as part of project. ❑ 1.,ARCE ❑ FmeDt:vr _Copy of Planning Approval Letter or Mecting with Planning prior to ❑ AI\HHt ❑ SANITARY SEVER DIS"1'RICr Submittal of Building Permit application. ❑ Ep'\'IRONxO:p''I',AI.II F.,ACI'll BIdgApp_2011.doc rEvised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10010 phar lap dr. DATE: 09/26/2012 REVIEWED Bl': bob s. APN: BPtt: 'VALUATION: $6,785 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERi1111T TYPE: WORK replace 3 windows non structural for sfd. SCOPE Xlech. flan Check Plumb. Plan Check Elec. Plan Check Mech. Permit Fee: f'lnnrb.!'omit/,cc: rlec.Permit ree: Oilier Mech. Insp. Orher Plumb Insp. Otber Elce.hup. Ll I Meth.bup.Fee: Plumb. bt.,p. Fee: filet.Insp.Fee: NOTE: This awinmte doer not includejees clue to other Departments(i.e. Planting, Public Works, Fire,Sanitary Stover District,School District,etc. . There feev are based on the prelindnan information availahle and are onh,nn ectiouue. Contact the Dept for addn7 info. FEE ITEMS (ree Resolution 11-053 E(! 7/1//1) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 3 # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT FO.0 hrs $0.00 $400.00 1 FEINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 SuppI. Insp. Fee:O Reg. 0 OT O,O hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consnttction Tax: Administrative Fee: 0 Work Without Permit? Yes 0 No $0.00 0 Advanced Planning Fee. -Residential$0.00 Select a Non 0 Travel Documentation roes: Building or Structure 0 A Strong Motion Fee: IBSEIS6/ICR $0.68 Select an Administrative Item 131dt; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.68 $400.001 TOTAL FEE: $401.68 Revised: 07/01/2012 Renewal byAndersen. - WINDOW REPLACEMENT an Andersen Company A „Jo [OW0 0hG,r D(fP car ` PROJECT DATE _ I t ! 1 ( i I i I ID IP-Eva IPIO 0 , yr - ildin9 Bu Pepj J_j I_ ' I I I -I-- a '-SEP 2 6 I i -i�OI_I�� ' REVIEWED�FOR co��MPLIANC - - '-Reviewed By -� '("cm I a j T%IL r : I