12110054 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10552 CEDAR TREE CT CONTRACTOR:ANDERSON P ERMITNO: 12110054
INSTALLATION
OWNER'S NAME.: JOAN WELLER 696 AUZERAIS AVE- DATE ISSUED: 11/092012
OWNER'S PDONF,: 4082539705 SAN JOSE,CA 95126 PRONE NO:
❑ LICENSED CONTRACT'OR'S DECLARATION JOB DFSCRII"PION: RESIDENTIAL El COMMERCIAL[]
License Class a Lia H is 60 co REPLACE 7 WINDOWS AND 3 DOORS THROUGH OUT
.�• SFDWL
Contractor' 4hde,5.n Date //-06i-It
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business S Professions
Code and that my license is in full force and effect.
1 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 perinit is issued. Sq.Ft Floor Area: Valuation:$7500
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:31634025.00 OccupancyType:
permit is issued.
APPLICANT C1sR'r1F1CA•1'10N
I certify that I have read this application and state that the above information is PERMIT EX. ORES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1 (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 DAY /TROM7LAST CALLED INSPE
indemnify and keep harmless the City of Cupertino against Iiabilities,judenicns,
costs,and expenses which may accrue against said City in consequence of the �� '(' i7
granting of this permit. Additionally,the applicant understands mid will comply Issued by: Dale: L-.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
y RE-ROOFS:
Signature/—/%—_
Date//-Of -/ Z All roofs shall he 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.
❑ OWNER-BITILDER DECLARA'T'ION
Signature of Applicant: Date:
hereby affirm that I am exempt from the Cmnrrector's Licrnsc haw for one of
the following two reasons: ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages astheir sole compensation,
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 DA'LARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Cnde,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: - Ilealth S Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Cenificate 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 Bay Arca Air Quality Management District I
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 Health&Safety Code,Sections 25505.25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �^ L
Owner or authorized ngynt;/" Date:
permit is issued -�- �
1 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 certificate of exemption,I CONSTRIJC`flON LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is at 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
APPLICANTCERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and slate Imus 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, ARCI I I"1-ECI"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
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR /SUBCONTRACTOR LIST
JOB ADDRESS: U 5 S Z e .4� y-ec- CrPERMIT#
OWNER'S NAME: PHONE # (IoO- 2-7 S'
GENERAL CONTRACTOR: gdeec Lewd _ cl a- BUSINESS LICENSE#
ADDRESS: 14d `16' Av2er a 4"-- CI"rY/zIPCODE: Js. `1I LC
*Our municipal code requires all businesses working in the city'to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CTTI' OF CUPERTINO
BUSINESS LICENSE.
1 am not using any sobcontracto
Signature Date
Please check applicable subcontractors and complete the following information:
t/ SUBCONT ACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Mt work
Cement Finishin
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum / Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature D tc
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10552 cedar tree ct. DATE: 11111091201 2 REVIEWED BY: bobs.
APN: BPH: VALUATION: $17,500
•PERMITTI'PE: Building Permit PLAN CIIECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTADIATION
USE: pPERMITTYPE: 1GENRES
WORK sfd window replacement 7 windows and 3 doors.
SCOPE
Much. Plan Check Plumb.Plan Check Flec. Plan Check
Meeh.Permit Fee: Plumb.Pcrmir Fee: Edge•.Permit Fee:
Other Afech. Insp. Other Plumb Insp. Other Elec.Imp.
Hech.lrup.Fee: Plumb. hrep.Fee: Flee.Lisp. For:
NOTE: This eainate does not include jeev due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc.). These ees are bused on die prelintinan•information available and are onh,an estimate. Contact the De t or adiht'I in a.
FEE ITEMS (Fee Resolution 11-053 E(L 7///12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 10 # Window/Sliding Glass Door
Supp]. PC Fee: 0 Reg. O OT 0.0 hrs $0.00 $533.00 /naNREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consnruclion Tac:
Adminisirative Fee:
Work Without Permit? O Yes Q No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fees: Building or Structure
i
Strong Motion Fee: IBSEISHICR $1.75 Select an Administrative Item
Blclp Stds.Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $2.75 $533.00 TOTAL FEE: F$535.75
Revised: 1 0/0112 01 2
CONSTRUCTION PERMIT APPLICATION
Ruff
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228• FAX (408) 777-3333 • building0cuoertino.oro
❑ NEWCONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT
PROJECT ADDRESS /0,5 (� ` - 1 ,- 7-r r �_ APNtl �I Co _ 0/_
OWNER NAME C/ J dr O k"''Y / PHONE lV E-MAIL l L`J
�✓ le r yofa • 253-g7oS
STREET ADDRESS CITY, STATE,ZIP FAX
V✓L
CONTACT NAME T PHONE (/N, '1 7 E-MAI
�lO h �C M ,7l� I JV A `/S'J
STREET ADDRESSCITY, TATE, ZIP FAX
96 fl�ze�q,1 f��c � ., ./sc � 5/� �
❑Ow'NER ❑ OWNER-BUI.DER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
nder LICENSE NUMBER C / �G I LICE SETYPE BUS.LIC tl
V bV
COMPANY NAME E-MAIL FAX
STREETADDRFSS TE,ZIP
6yK trZer I z CITY,6Ar,JeIyc �ISIL � PHOS Ztis- 3tO�
ARCHITECT/EN .'EER NAME LICENSENUMBER S BUS.LIC9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK /
e I''10✓t t C I « SII r7„• iJ•
RC I ce 'l
EXISTING USE PROPOSED USE CONSTR.TYPE 0STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW.FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM IUTCHEN OTHER
RENIOOEL AREA REMODEL AREA MNIODEL AREA
PORCHAREA I DECKARE\ TOTAL OECK?ORCH AREA GARAGE AREA: DETACH
[]ATTACH
I DWELLING UNTrS: ISASECOSDUNIT OYES SECOSDSTORY OYES BEING ADDED? ONO ADDITION' ONO
PRE-APPLICATION 01F5 IF YES.PROVIDE COPY OF IS TILE BLDC AN ❑YES RECEIVED BY:T�`- Jy �a P� � TOTAL VALUATION;
PLANT'PG APPLtl ONO PLANNWG APPRO\'AL LEITER EICIILER IIOpiE' ONO :P'("Y' g P'FS'ynH.. ^-, `t �QQ OL
„441?1'v' ��r Y
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 correct. I have read the Description of Work and Verify it is accurate. 1 agree to comply with all applicable local
ordinances and State Imus relating to but _ nswetion. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/AgenDate: 017—
J
I 2_
SUPPLEMENTAL iNFORNIATION REQUIRED r"-,N` ?° C -^ Et""i I' . t
'.I'f:AN.0 eK;n•re z noun NG SLIP-1 .
New SFD or Multifamily dwellings: Apply for demolition permit for a�S'�=TT k � ss"Sn`��" ie't#
5%- 11
COU\iF,R F It U1LUi\GPI.AN REV ER -
existing bui lding(s). Demolition permit is required prior to issuance of building ;� •;� ys •a a ay ,,. 3A t •
pen-nit for new building. ®kE I Rens ❑ P c rtaNRSYIEYN.IMM0
\
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure J❑ sryADAltn { +''.�'" ❑” ru¢I IC w ORKS
form if any Hazardous Materials are being used as part of this project. }` T-Il'
>iwRCB ❑!'- FIREDEP i ,y t
_Copy of Planning Approval Letter or Meeting With Planning prior to �• '' 'a n3-
❑ YIAJOR .,,�}av �* ❑ S yNIIAR155LN Flt 015TRICT
submittal of Building Permit application.
wA t • -�" `L� }'s,3uJi •�ssD-r, srr.
❑&ENV RONINIiENTA HE T I
BIdgApp-2011.doc revised 06/21/11