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13010115 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6721 JOHN DR CONTRACTOR:ANDERSON PERMIT NO:13010115 INSTALLATION OWNER'S NAME: DEGEUS RICHARD AND LORENE D 696 AUZERAIS AVE DATE ISSUED:01/222013 OWNER'S PHONE: 4082524309 SAN JOSE,CA 95126 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class 5 Lie. L # �5wnK-d REMOVE AND REPLACE 14 WINDOW IN EXISTING ContractorDate /�7 ndes�^ /_a.Z� AREA, A J n srvl/ler_ MEETS EGREES IN BEDROOMS 1 hereby affirm that I 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. I 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:$15000 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 APN Number:36927057.00 Occupancy e: permit is issued. p y TyP 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 WITIIIN 18KD1S 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 DAYSLAST 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 /l�ai� granting of this permit. Additionally,the.applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. T' Z RE-ROOFS: signature r��—jam Date 2 .. All 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-BUILDER DECLARATION I hereby affirm that LSignature of Applicant: Date: am exempt from the Contractor's License Low for one of _ the following two reasons: ALL 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 HAZARDOUS MATERIALS 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. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&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 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 Bay Area 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 5505,25533,and 25534. _ Section 3700 of the LaborCode,for the performance of the work for which this Owner or authorized age Date: �'2 t —r 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 Califomia. If,after making this certificate 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. work'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 state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building concoction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harnless the City of Cupertino against liabilities,judgments, 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 awkwill comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION e COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \O 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 �_0 C (408) 777-3228•FAX(408)777-3333•buildinecllcuoertino.ore ❑ NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROSECT ADDRESS 6 7 T I 6 IVI W J(-' APN# OWNERNAME De G et4 PHONE E- os —`!)05MAIL/- STREET ADDRESSCITY,STATE,ZIP D FAX S m s C u r h `( CONTACT NAMEII - PHONE Yog— 5,S_^t2Od E-MAI� (jhn C ✓11'11 JJ STREET ADDRESS �r S CITY,STSA-TE,YZIP S` ITJPZ� F d -LS r--eYul OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME T C L,1 SENUMBER LICENSETYPE BUS.LIC# 0 1 CA Mt nrn J�0601 COMPANYNAMEFAX r ou d- Door n E-MAn. v&- 2. 75—v` ad STREET ADDRESS q �V ZP 1.617 S CITY,STATE,ZIP HONE ADDRESS, n s1--37 co ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ' /ndlK UI✓J !� T IDUSTING USE PROPOSEDUSE CONSTRTYPE I #STORIES USE TYPE OCC. SQ.Fi. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN onm REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTALDECR/PORCHAREA GARAGEAREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES BEMG ADDED? [3NO ADDITION? [3NO PR APPLICATION ❑YES IF YES,PROVIDE COPY OF ISTHEBLDGAN [I YES CEIVED: F bSv'[v TOTA�,t�L ATION: PLANNINGAPPL# []NO PLANNINGAPPROVALLETTER EICHLERHOME? [3NO 1 `1Y_ By my signature below,I certify to each of the following: I am the property owner or authorized agentact on the pro owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of'Vork and ver it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin nstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Date: 2 ��'1 — 13 SUP NTAL INFORMATION REQUIRED �>wxs;c` +SCA C4 a RooTT�csc e i _New SFD or Multifamilydwellings: Apply for demolition permit for � g PPY P � , LD�NcR REVIe existing building(s). Demolition permit is required prior to issuance of building 3i p,. ��v�a sx permit for new building, w® 'E 'FiE§ i O'eLnrmIryc Piai`tnevtew a4` J. h `L 1� {1sS Sy}n NY _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Form if any Hazardous Materials are being used as part of this project 4i'Er;Yxn A 'st ' 'r6!'4^ p _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. . � " !: e9 t .L-"� ENVJI NMENT HEAL BldgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 6721 john dr I DATE: 01/22/2013 REVIEWED BY: Mendez APN: I BP#: `VALUATION: $15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK remove and replace 14 window in existing area SCOPE : Mech. Plan Check Plumb.Plan Check Elea Plan Check Much. Permi[Fee: Plumb. Permit Fee: Elec.Permit Fee: Orher M11ech. Insp. O/der Plumb/nap. O/her Elec.Insp. ED p. Imp. Fee: Plumb. Lre'p.Fee: Flee. Insp.Fee.- NOTE:This estimate does not include fees due to other Departments(ie.Planning,Public Works,Fire,Sanitary SewerDistrict School District ete). These ees are based on the prefimin in ormadon available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 14 # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $533.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:O Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee: O .Work Without Permit? O Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Trm,el Documentation Fees: . . Building or.Structure D, Strove Motion Fee: IBSEISMICR $1.50 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 . . { ° TOT�AL"F��jE $535.50 _ $250 $53300e� `_s Revised: 10/01/2012 vc_ lSevStie > . !rte ,•,v .� J ,,4. Sfi fn e?ctJr, ;S dPanr ,S } eg,esS c Fp 5 pry Xo o D`lo �✓in� P De d o r i�+AStei �a x a sQ'3� �kr� � LIVIhS gW6h a V � • S q ` 4 o� � � mRln enrrgncC SIlo,aS w,nd��- � 6 Go Ya •ST F LO(- l3 �}fASe OFFICE �'' / Uihn,)Ws f%�� e��STi� S Gpeht"gJ Q ; Sa1ak� �4crectrJi' �U ko Vu 5 Dtid � 5ta i�� u 1 w n✓�' D U 5`b 1�7-rc 60Yo rL (U Yo S � ,oi;lg l �lho.w vih°aw �c o (o L,o '51I0,11S �INO�I-+ SI10�%,5 �✓In+�"v e5 re-(SY6 t?5rcrs �G 2 n -F/L)C) � t (� oeP EG �G l��gvv0a0y Building Department City Of Cupertino I 10300 Torre Avenue C;unertinn. : 4 8-777.3228 t etephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 917L 777• $ - , PERMIT# OWNER'S NAME: ,ti t .•d K riDIFPu S PHONE# GENERAL CONTRACTQR:' Gl:&r. � u w v- BUSINESS LICENSE# 46—al ADDRESS: 6 cJ ,( • ✓ Y "`S lis:` CITY/ZIPCODE: s os c! 5-11, *Our municipal code requiresa7l`busnesses 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 CITY OF CUPERTINO BUSINESS LICENSE.` - I am not using any subcontracts. . 2 —2 Z 2 �� Signature Date Please check applicable:suliconbaetors and complete the following information: SUBCONTRACTOR• ` BUSINESS NAME BUSINESS LICENSE # Cabinets & Mtllwork ` Cement Finishing 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 Date Owne Contractor<Slgnature