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13040052 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21020 CORY CT CONTRACTOR:BROTHERS HOME PERMIT NO:13040052 IMPROVEMENT OWNER'S NAME: WILLIAM&VIRGINIA.LEE 2510 DOUGLAS BLVD DATE ISSUED:04/05/2013 OWNER'S PHONE: 6509961986 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680 ❑ LICENSED CONTRACTOR'SDECLARATION JOB.DESCRIPTION: RESIDENTIAL COMMERCIALS License Class Lic..# d REMOVE AND REPLACE 15 WINDOWS LIKE FOR LIKE, `I. BEDROOM WINDOWS TO MEET EGRESS Contractor�•I t` n! t' 14e Date 1 I hereby affirm that I am licensed under the provisions of.Chapter 9 (commencing with Section 7000)of Division 3 of tht 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:$6924 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:35904031.00 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 0 AYS 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 M LAST CALLED IN SP C ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: 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. �� 1 rl RE-ROOFS: Signature- Date � J 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. ❑ WNER-BUILDER.,DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law 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) I,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 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 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 25505 2 33,and 25534.-14 / Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY 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 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 construction,and hereby authorize representatives of this city to enter upon the above mentioned property fordtispection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless 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 and will comply with all non-point source regulations per the.Cupertino Municipal Code,Section Licensed Professional 9.18: Signature Date CONSTRUCTION PERMIT APPLICATION n- COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION [{� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(ftuoertino.oro ` U l� ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSs n APN# vq0 OWNER NAMEV v n 9 O PHONE q% J EMAIL STREET ADDRESS G� 1` (� CITY,STATE,ZIP ( FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSETYPEbro BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP 1W 2 �� PHONE ( 7 5:777 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTIL TYPE I #STORffS USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REC E TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO - By my signature below,I certify to each of the following: I am the property owner or authorize4 ag t 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 erify it is accurate. I agree to comply with all applicable local ordinances and state laws relating W ding constructi uthorize representatives of Cupertino to enter the above-i eenntif d mperty for inspection purposes. Signature of Applicant/Agent: Date:✓ /r SUPPLE O ATION REQUIRED dl�AN CHECK TYPE ROUTING SLIP New SFD or Multifamily dw ' : Apply for demolition permit for OVER-THE COUNTER BUIL PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of buildin permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD 11 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONhIENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21020 Cory ct DATE: 04/05/201 RREVIEWED BY: Mendez APN: BP#• "VALUATION: $6,924 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK remove and replace 15 windows like for like bedroom windows to meet egress SCOPE k. .,tech.Plan Check Plumb.Plan Cheek Elec.Plan Check 11i>.ch.Permit Fee..' Plumb.Permit Feer. Elec. Permit Tee: Fl ,,h. Alech.1nsp. Otlier Plumb 1nsp. Other Elec.1rup. Znsp..f ee: Plumb. firsp.Fee: Elec.Insp.lee: NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta^). These fees are based on the prefindna information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: . $0.00 15 # Window/Sliding Glass Door Suppl.PC Feer Reg. ® OT 0.0 hrs $0.00 $533.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp. Fee-.0 Reg. ® OT [_0_,0_1hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con..s uction Tczx: FT Administrative Fee: Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure Travel Documentation Fees: i Strong Motion Fee: IBSEISMICR $0.69 Select an Administrative Item. Bldg,Stds Commission Fee: IBCBSC $1.00 �Fm $ F E $5343 .69 . 0 x . irF �t Revised: 04/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST :{ JOB ADDRESS: 020 J PERMIT# OWNER'S NAME: W 1 PHONE# (tj Z; 3777 GENERAL CONTRACTOR: BUSINESS;.LICENS.RW , . Q ��f ADDRESS: CIT'Y4wODE *Our municipal code requires all businesses working in the city to have a City of Cupert�no'husiness 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 subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME ti BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing p Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile caner/ o for Signature Date owitl 0-;r, (b a 1 ttoN OLIr 1q w twbvW9 qv ,L Ike JA ter R�lo Ave 10 'ON IINV,3d sua{slnoJd 1��o oI^r.o�,m u q o�ao�{;,u�ad 1 P{ y 4 ' i;S`uol;.20;, ue{d sly}10 bu{dw-,,;e n r Lg-llr�+au,� uaoa}{enosddu}noy�m`uaoa�eaay jo'-blLjj-,3S lla SUOW2301IG'^IO Sa6UP.L{J a;ir.,rpqun sl jI ^uogoni�s too 6,,;{,+np olls Q n ;na toads ue sue{d}o;es s! ONI1H3dno-f 102,,MIG SNICI-lins (� 1N34Nldb'd3G 1N3AdO-13A3G�UlNnvmoo cv� Q6wl to 1Q i j, ` 0 5 2013 D 3 �� Zi�� X 321 y6 Mfg lYk ��! )6b ol Y