12100059 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21327.GLEN PL CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12100059
CONSTRUCTION
OWNER'S NAME: AVERY CONSTRUCTION 528'S MATIIILDA AVT?STE 2 DATE ISSUED: 10/09/2012
OWNER'S PIIONE: 6509618330 SUNNYVALE,CA 94086 PHONE NO:(408)806-9145
❑ LICENSED CON7'RACfOR'S DECLARATION' .TOR DI.SCRIPTION: RESIDENTIAL 0 COMMERCIAL❑
License Class / Lie.# REMOVE AND REPLACE 28 WINDOWS
Contractor �-
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 perjury one of the follmving 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:$20000
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 APN Number:32627036.21327 Occupancy Type:
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 1 0 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY F M 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 16 q /a
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 7
with all non-point source regulations per the Cupertino Municipal Codc, eclion
9.18.
fd /� RE ROOFS:
Signature Date NI roofs 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
inspection.
❑ OWNER-RUILIIER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO RE CLASS"A"OR RETTER
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 oBered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to IIA%ARDOIIS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Cade). I have read the hazardous materials requirements under Chapter-6.95 of the
California llealth&Safety Code.Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: - I Icalth&Safety Code,Section 25532(x)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 AN defined by the Ray Area Air Quality\la nagement District
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the llealth&Safety Code.Secti .25505 53.,anJ'_553J.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dale: 10
permit is issued. -
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 California. If,after making this cenificate 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
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and slate that the above information is
correct. I agree to comply with all city and county ordinances and state Imus relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.ffe)agree to save
indemnify and keep harmless the City of Cupertino against Iiabilities,judgmcnts, ARCIIITFCT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand m)•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
C U P ERTI N O (408) 777-3228 • FAX (408) 777-3333• buildinpng cupertino.og
r
❑ NEW CONSTRUCTION ❑ ADDIT/ION ALTERATION/Tl ❑ REVISION/DEFERRED ORIGINAL PERMIT A
PROJECTADDRESS ^n /n S e L- 1 r I APNH
OWNER NAME 1, 4 /C• I PHON o(i �(�^. �C r� E-MAIL
STREET ADDRESS�7 0 W eS r �� Q S D CS 0 k-.1 ZIP LVA /9 9a.0 gN FAX
CONTACT NMI f PHO' OC /.I_/7�/O E•���1•C CdGy L2 1 .
STREET ADDRESS CITY STATE, ZIP C( �. r w N W l 9.&
J,
OWNER ❑ OWNER-BUDDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRA OR NAME le LICEN E LI ,'SE Te!l BUS.LICA � j
COMPANYNAME (� E-MAIL FAX (,(app[(/
STREET ADDRESS^� Q
141�10
ARCH ITECT/ENGiNEEER NAME LICENSE NUMBER (Jr' / BUS.LIECV9 t
COMPANY NAME E-AWL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF R}:
l4 — if(— AJ-OW % u /e �N
S int, S
EXISTING USEPROPOSED US CONST PE tl$TO S
GW� Gv� �n7Gi ( USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REI-IODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECNPORCH AREA GARAGE AREA: DETACH
❑ATTACH
k DWELLING UMTS: ISASCCONDUNIT L]YES SECONDSTORY ❑YES
O F.L\'G ADD ED! E]NO ADDITION' EINO
PRE-APPLICATION Ll YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECE D'BY: 7 i TO VALUATION:
PLAN NG APPLq ANO PLANNING APPROVAL LETTER mC11LER IIOJIE^ �.NO tP '` YdS_ jD —
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. 1 have read this
application and the information 1 have roNT c is correct I have read the Description of.Work and verifi•it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to 'ng conswotion. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applican/Agene Date: /a'
SUPPLEMENTAL INFORMATION REQUIRED �P�•°; �iec�I�c W e'A-�S4^ A P���,.`ROUTTENG SLIP.Jb' 2
New SFD or Multifamily dwellings: Apply for demolition permit for 's�p ''+ t'"' '"' "�+ "' � C t"•�R K
d ,},ovER-TIIP COWTER It U1LD1\C PLAN RF\l6q'
existing building(s). Demolition permit is required prior to issuance of building '-`Fr` ;'M- £fi� {
EXPRESS-
permit for new building. ff
to sa.LI 1� y t � II.A\,,\rI\CP 'K RE
d PI 5
_Commercial Bldgs: Provide a completed Hazardous D{aterials Disclosure ,�❑ STANDARD .xJ=s'; ''' '❑!'k*PUBLIC4{'DRNS k • ' E:
Corm if any Hazardous Materials are being used as part of this project. -s s ,x"s
i� LARGE °` +: 't.+ FIRE DEPT ,
_Copy of Planning Approval Letter or Meeting with Planning prior to '2'�fL' �' £• n ,
submittal of Building Permit application. ❑z wusoRvy ` 4` d3.❑��SANTARY.SE � . {
'rn�a _ tJL"1-'If:Jil'C}I�v��i EENNVIRONDIENTAL HEALTH n—
BldgApp_11.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20749 CelesteAve_ej1t7 DATE: 10/09/2012 TRIEVIEWED BY: Sean
APN: BPH: ,� DD Gj -VALUATION: 1$2,100
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: pPERMITTYPE: 1GENRES
i
WORK Remove and replace 3 existing windows in bedrooms.
SCOPE
Mech. Plan Check Plumb. Plan Check Flee.Plan Check
Mech. Permit Fee• Phanh.Permit Fee: riec. Pernnit Fee:
Ocher d/eeh. Insp. I Other Plumb Insp. Other Elce.It
Wch.htsp.Fee: Plumb. htsp.Fee: Elec. Insp.Fee:
NOTE: This estint le does not inclurdejees due to other Departments(i.e. Planning, Public 11 arks, Fire,Sanitary Seaver District,Schaal
District,etc. . Thesefees are based oat the prelitninan information available and are oath,ant estimate. Connect the Det faraddh'l in a.
FEE ITEMS fFee Resolution 11-053 E'll' Z/ 1/1 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. Q OTO 7 hrs $0.00 $400.00 17t'1NRF.P Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee: Q
Work Without Permit? Q Yes (j) No $0.00 (F)
Advanced Planning Fee: $0.00 Select a Non-Residential (F)
Trane/Docmnentation Fees: Building or Structure 0
Strome Motion Fee: 1BSEISHICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $400.00 TOTAL FEE: $401.50
Revised: 10/01/2012
De Anza Forge.
Association
10/3/2012
File Reference # A38689-SR1
Isabelle & John Gunn
2704 West Graves Road
Spokane, WA 99208
RE: Architectural Approval - 20749 Celeste Circle
Dear Mr. & Mrs. Gunn,
At the October 2, 2012 Board of Directors meeting for the De Anza Forge Association, the Board reviewed your
request for the installation of three (3) vinyl windows at your unit, 20749 Celeste Circle.
Please be advised that the Association approved your request as submitted with the following conditions:
1) The windows are to be installed by the licensed contractor submitted with your request form.
2)The vinyl trim for the windows must be tan in color to the exterior.
3)The glass panes must be the plain glass style or grid glass style as shown on your
application and consistent with the windows in your building. In other words, if the
existing window has grids, the replacement window must have grids. You must
replace"like for like".
4) No tinting of the windows is allowed. Low"E"glass is allowed.
5)The owner is responsible to repair any damage to the structure caused because of
the window installation.
6)The owner is,responsible to obtain any required permits.
Please contact our office if you have any questions or need additional information.
Thank you for your cooperation with the rules and regulations for the Association.
Sincerely,
n
ckie OW arty O
Association Manager
cc: Board of Directors
Unit He
P.O. Box 320819 Los Gatos, CA 95032-0113
406.866.4537 - Fax: 408.866.4619
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OCT 0 9 2012
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO
APPROVED
I. This set of plans and specifications MUST be kept at the
/1 iO job site during construction. It is unlawful to make any
33 Changes®� changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
NNN The stamping of this plan and specifications SHALL NOT ,
be held to permit or to be an approval of the violation
Of any provisions of any City ordinance or State Law.
BY
DATE — /G 9 • /
PERMITNO.
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C N ro ?- to SCA-(C)
OCT 0 9 2012
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