13030071CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22436 RANCHO DEEP CLIFF DR
OWNER'S NAME: RITA FINN
OWNER'S PHONE: 4082573396
❑ LICENSED CONTRAC(T'OWSS DECLARATION
License Class y _ Lic. # 0 V CQ'''
Contractor An d e .S�tA&2,. Date
I 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.
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.
APPLICANT CERTIFICATION
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 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date ?-/y —i7
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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 certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands andwill comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
CONTRACTOR: ANDERSON PERMIT NO: 13030071
INSTALLATION
696 AUZERAIS AVE DATE ISSUED: 03/14/2013
SAN JOSE, CA 95126 PHONE NO:
JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL11
REMOVE & REPLACE 5 (E) WINDOWS & 2 (E) DOORS
(ALL
WINDOWS TO MEET EGRESS & BE TEMPERED WHERE
REQUIRED)
Sq. Ft Floor Area: I Valuation: $4000
APN Number: 35602053.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM ALLED INSPECTION.
Date: N r3
— RE- ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit.hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: Date /i ^r7
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION QO
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 - building(ftuaertino.org \
❑NEW CONSTRUCTION ❑ ADDITION P ALTERATION /TT F-1 RFVTCTCIN /TIFFFRRFTI fWMINAT DRRT.TTT14
PROJECT ADDRESS
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❑ OWNER ❑ OWNER- BuiLDER ❑ OWNER AGENT OPCONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER [ ��
LICENSE TYPE
BUS. LIC #
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COMPANY NAME
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STREET ADDRESS / �v LCr�l 3
CITY, STATE, ZIP � G`�1 � C
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ARCHITECT/ENGINEER NAMOE
LICENSE NUMBER
BUS. LTC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
RZ
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO -
TOTAL
AREA
AREA -
AREA
NETAREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL.AREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECKNORCH AREA
GARAGE AREA: DETACH
I
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? []NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # []NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑
EICHLER HOME? ❑ NO
TOTAL VALUATION:
pv
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. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above- identified property for inspection purposes.
Signature of Applicant/Agent: Date: —
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OVER-THE-COUNTER
UILDING PLAN REVIEW
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
_
submittal of Building Permit application.
❑ MAJOR
SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_MLdoc revised 06121111
CITY OF CUPERTINO
FFE ESTIMATOR - BUILDING DIVISION
Mech. Plan Check I I
F-f"111, Permit Fee:
Oth(!rAlech. Insp,
Allech. Imp. Fee:
Plumb. Plan Check I I
[Plumb. Permit Fee:
Other Plumb Insp.
Plumb. hasp. Fee:
n M
mom ma
Elec,.Plan (,heck
Ff"lec. Permit Fee:
Other Elec. Insp.
Flee. Insp, Fee:
NOTE. This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). Theseftes are based on the prelimina information available and are only an estimate Contact the Deptfor addn 7 info.
ADDRESS: 22436 RANCHO DEEP CLIFF 1DIL.
DATE: 03/14/2013
REVIEWED BY: MELISSA
MISC ITEMS
APN: 356 02 053
T P#:
*VALUATION:
1$4,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION 1GENRES
I PERMIT TYPE: 'A
WORK
REMOVE & REPLACE 5 (E) WINDOWS & 2 (E) DOORS ALL WINDOWS TO MEET EGRESSA BE
SCOPE I
TEMPERED WHERE REQUIRED)
Mech. Plan Check I I
F-f"111, Permit Fee:
Oth(!rAlech. Insp,
Allech. Imp. Fee:
Plumb. Plan Check I I
[Plumb. Permit Fee:
Other Plumb Insp.
Plumb. hasp. Fee:
n M
mom ma
Elec,.Plan (,heck
Ff"lec. Permit Fee:
Other Elec. Insp.
Flee. Insp, Fee:
NOTE. This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). Theseftes are based on the prelimina information available and are only an estimate Contact the Deptfor addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= # Window Sliding Glass Door
$400.001 IWINREP Replacement
Suppl. PC Fee: (E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.(E) Reg. 0 OT
F-0—.0-1
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C lonstruction Ti. zx: -F-F
Adininistrative Fee:
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non-Residential
Building or Structure
I
Travel D oeteinentation Fees:
Strong Motion Fee: IBSEISAffCR
$0.50
Select an Administrative Item.,
Bldg Stds Commission Fee: IBCBSC
$1.001
$1.501 $400.00
Afre
$401.50
MID M.
Revised: 01/01/2013
*Our municipal code requires all businesses working in the city to have a: Cit,,Y'wCupeir- k business license.
JOB ADDRESS: 2 y J %Z , 4, ID C /, 1f 0It.
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAKE OB9AIIED A= CITY`. OF CUPERTINO
BUSINESS LICENSE.
F ti
I am not using any subcontractors:
OWNER'S NAME: R t .,
PHONE #, %O a'a2/G — 6 TT
GENERAL CONTRACTOR: ti des, des / �.
BUSINESS` "LICENSES #s. - 5 C06'0(- 'ZZ 7 80
BUSINESS LICENSE #
ADDRESS: 9 C ,9�Le� .1
-CITY /ZICODE:1� >:are �S /Z 6
*Our municipal code requires all businesses working in the city to have a: Cit,,Y'wCupeir- k business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILD, -, SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAKE OB9AIIED A= CITY`. OF CUPERTINO
BUSINESS LICENSE.
F ti
I am not using any subcontractors:
Signature' Date
a,
Please the "following
check applicable subcontractors and complete mton��
SUBCONTRACTOR
BUSINESS NAME" = k
BUSINESS LICENSE #
k
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
`r ~
Glass / Glazing
-
�-
Heating
k
Insulation
".
Landscaping
"
Lathing
Masonry
Ya t
Painting / Wallpaper
Paving
i
Plastering;
Plumbing
x<
Roofing
Septic Tank
x
Sheet Metal
Sheet Rock
y ;
Tile
J1,
Owner / Contractor Signature ; , Date
�.
DEPARTMENT d36 90cg
COMMUNITY 51068
ICUPE
AP VED
F&
This set of p. t
job si e dur g construction. It is unlawful to make any
chang s or a same, or to deviat Gt+� All
therefrom, ithou g oval from the Building O&fr
The stampin of this Pend specifications SHALL NOT
be held to ern* or to an approval of the violation p � r S ,0 do h
o r City Ordinance or State Law. l•
BY
DATE
PERMIT NO. t3 V
Vat l�
20 'to C Ici
Yo (t O kl 1 r ^M
2U�O O
C U ERfiINO
11�!rsu.3uildi g Decar(me t
PEAR 14 213
REVIEWED FOR CODE qMPLlA CE
Reviewed By:
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