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11090112 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20559 CEDARBROOK TER CONTRACTOR:ARGONAUT PERMIT NO: 110901 12 WINDOW& DOOR, INC OWNER'S NAME: LINAN ESTHER 1901 S BASCOM AVE STE 800 DATE ISSUED:09/19/2011 VNER'S PHONE: 4083984076 CAMPBELL, CA 95008 PHONE NO:(408)378-4018 ❑ LICENSED CONTRACTOR'S DECLARATION {� r, BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 1`__ F_ z MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE 2 SLIDING PATIO DOORS (commencing with Section 7000)of Division 3 of the Business&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 permit is issued. Sq.Ft Floor Area: Valuation:$5000 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:32345016.00 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 180 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 D=71ell 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 9•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. RE-ROOFS: Signature Date 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. �I OWNER-BUILDER 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 BE CLASS"A"OR BETTER 1,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 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 1 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 2553 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 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 1 certify that I have read this application and state that the above information is correct. 1 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 ARCHITECT'S DECLARATION and keep harmless the City of Cupertino against liabilities,judgments. ,osts,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. q Signature ' L l CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 32345016 . 00 DATE ISSUED. . . . . . . : 09/19/2011 RECEIPT # . . . . . . . . . : BS000014789 REFERENCE ID # . . . : 11090112 SITE ADDRESS . . . . . : 20559 CEDARBROOK TER SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LINAN ESTHER ADDRESS . . . . . . . . . . : 20559 CEDARBROOK TER CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0457 RECEIVED FROM . . . . : ESTHER LINAN CONTRACTOR . . . . . . . : CHRIS ETTEMA LIC # 22820 COMPANY ARGONAUT WINDOW & DOOR, INC ADDRESS 1901 S BASCOM AVE STE 800 CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (408) 378-4018 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1WINREP EACH 8 1 . 00 392 . 00 0 . 00 392 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 393 . 50 0 . 00 393 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 393 . 50 7592 --------------- TOTAL RECEIPT 393 . 50 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20559 cedarbrook terrice FDATE: 09/19/2011 REVIEWED BY: bob s. F9, APN: BP#: "VALUATION: 1$5,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK replace 2 sliding patio door. No inspections till homeowners association letter. SCOPE NOTE: This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.). Theseees are based on the preliminary in ormation available and are only an estimate. Contact the Dept-for addn7 info, FEE ITEMS (!ee Resolution I1-053 Flf 7`1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.002= # Window/Sliding Glass Door Suppl. PC Fee: (D Reg. () OT 0.0 hrs $0.00 $392.00 iwiNREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feed Reg. 0OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes Q No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure C) i Strong,Motion Fee: IBSEISMICR $0.50 Select an Administrative Ite � Bldg Stds Commission Fee: IBCBSC $1.00 \ SUBTOTALS: 1 $1.50 $392.00 TOTAL FEE: $393.50 Revis : 09/02/2011 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 12— CUPERTINO (408)777-3228• FAX(408)777-3333•building ancupertino.org 32.3 • g5,C)ICP ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS '�� AP 11 S ^cY �i pis^ T�i sr + 'r f OWNER NAME PHONE C� I E-MAIL 9'_ STREET ADDRESS C -Y STATE,Z[P FAX 0 o n! a �' o FAX CONTACT NAME PHONE E-MAIL 4- "Le-STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME /�� LICE N E NUMBER LICENSE TYPE BUS.LIC# C6 COMPANY NAME //�� � E-MAIL �Cc�.<-� Pu i FAX f–I fGo n i D L,( —O STREET ADDRESS /h/.l 1 < �e�J ! CITS�TATE,ZIP Q ©j PHONS- 3 - LICYL ARCHITECTIENGINEER NAME v ✓ /// 111 LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK rldotJ ��,�d rytuste; YIL dNv S rum u✓ �t�n EXISI ING USE PROPOSED USE CONSTR TYPE #STORIES -5—r— USE TYPE OCC. SQ.FT. VALUATION($) AREA NEW FLOOR DEMO TOTAL AREA — AREA AREA NET AREA Tj[ BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA 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 RECEIVED RY' TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? NO 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 bueg construction. I authorize re esentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: g�l SUPPLEMENTAL INFORMATION REQUIRED PT AN CHECK TIpE 1iQOTiNG51' New SFD or Multifamily dwellings: Apply for demolition permit forzv iii- I cauNTr xt j5i P[1XNREVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ Exp Ess. © pLANNnv pukri vzEw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 171 ❑ PTJHI(C w0PKS form if any Hazardous Materials are being used as part of this project. ❑ LAROE ❑- FIREDEPT Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. MT ❑ saf>ARS€SWER;DISlil2IC M ❑_MWIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• buildincIC1cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE QDR SS AP l BP# OWNF.Ii NAM OWNER ADDRESS 123 DESCRIPTION OF WORK: j",)Ie d e-�& We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) , A 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. -2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. A3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may proct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. _L4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. Arede6. I understand if I am considered an "employer" under state and federal law, I must register with the state and al lgovernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. A7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family res ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is ertormed under contract with a licensed general building Contractor. 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for an financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. Ox,nerBuilderForm 2010.doe revised 04/14/10 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal Rev nue Service, the United States Small Business Administration, the California Department of Benefit Payments, and he California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed Inactors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am he party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by I applicable laws and requirements that govern Owner-Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the infor ation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si natu Property Owner's Signature: a Date: ------------------------------------------- ------------------- -- -- ------------ ------- -------------------------------------------------- (NOTE: The following Authorization-Form is required-to-be-completed-by the-property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: GrvnerBuilderFornz 2010.doc revised 04/14/10 Sep 12 2011 5: 23PM HP LRSERJET FAX p. 2 s(lot o ti N otxq N2� D 4 K -b%N;k �M Kaci �s��K l �ro �Ct 335 7 �S�n�r �.i�loUU . 2o5S� CJe�ar��cx�K`^Cer�cc,�, Cv 'VN01 c,. 15011 V,lf(qo�) MZA076 9 lei,61 DEPARTMENTNT C� �MBUILDI GDIV�ONECUPERTINO ppRU ED tat the This set of plans d specifications MUST be kept Jab site during c nstruction. It is unlawful to make any ` changes or iterations on same,or to de'��official. therefrom,with It approval from the Building Ian and specifications SHALL NOT The stamping of his p of the viol�;tion be held to per it or to be an.approval � © rovisi s of any City Ordinance or State Law. (� r1 {p of any p � 5l icatQ j� L , u �j, BY------ DATE PERMIT NO. t r70* X 5'7 " - -T- x O M�s}�r RAA