11090155 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20268 NORTHWEST SQ CONTRACTOR:BROTHERS HOME PERMIT NO: 11090155
IMPROVEMENT
OWNER'S NAME: NATTINGER ALICE R TRUSTEE&ET AL 2510 DOUGLAS BLVD DATE ISSUED:09/21/2011
"'S PHONE: 4087365900 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB
,.
License Class 1414
671001
MECH F RESIDENTIAL` COMMERCIAL
Contractor Date C( 2 //
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE THREE(3)PATIO DOORS AND ONE(1)
(commencing with Section 7000)of Division 3 of the Business&Professions WINDOW;NON-STRUCTURAL
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 Sq.Ft Floor Area: Valuation:$4965
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:31639044.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. A ionally,th plicant understands and will comply
with all non-point so
gulations the Cupertino Municipal Code,Section
9.18. Issued Pyf" ` n Date: �- Z/—
r
Signature Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance wip the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health& /ho
ections 25505,25533,and 25534.
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 Own or autnt:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked. --
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of vork's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
inlPmnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
;._.. ing of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31639044 . 00
DATE ISSUED. . . . . . . : 09/21/2011
RECEIPT #. . . . . . . . . BS000014821
REFERENCE ID # . . . : 11090155
SITE ADDRESS . . . . . : 20268 NORTHWEST SQ
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : NATTINGER ALICE R TRUSTEE & ET
ADDRESS . . . . . . . . . . : 20268 NORTHWEST SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SEAN FERGUSON
CONTRACTOR . . . . . . . : GENE V. CAVANNA LIC # 27964
COMPANY . . . . . . . . . . : BROTHERS HOME IMPROVEMENT
ADDRESS . . . . . . . . . . : 2510 DOUGLAS BLVD
CITY/STATE/ZIP . . . : ROSEVILLE, CA 95661
TELEPHONE . . . . . . . . : (408) 295-0680
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 4, 965 . 00 1. 00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 4, 965 . 00 0 .50 0. 00 0 .50 0.00
1WINREP EACH 8 4 . 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
----------------- --------------- --------------------
CREDIT CARD 393 . 50 MC
---------------
TOTAL RECEIPT 393 .50
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228- FAX(408)777-3333 • buildingCcDcupertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL P RMIT#
PROJECT ADDRESS -31 to -54�
/ �S �. APN#
OWNER NAME ` U PHONE / E-MAIL
v f,r 73C�- mo
STREET ADDRESS CITY, STATE,ZIP r FAX
s , 6.1b1(j�c� �VP ��r'J C,
CONTACT NAME /' PHONE E-MAIL
soSTREETADDRESS m CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT v CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME }I LICENSE ER LI SE TYPE BUS.LIC#
COMPANY NAME C"' _ a E-MAIL FAX
STREET ADDRESSr G `� �aJ �o CITY,SATE,ZIP G �' ! 6 PHONE
ARCHITECT/ENGWEER NAME l LICENSE NUMBBEERJ (/`1 BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
1 v �o C� CAJ 111 1 d tIj
e 6 jj- I
EXISTING USE PROPOSED USE CONS TR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL C.
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER l C(>
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO RECEIVED BY: TOTAL V( N: dS!
—�"
By my signature below,I certify to each of the followin am the property o authorized agent to act on the prpperty owner's behalf. I have read this
application and the information I have provided is G ct. I have read e ption of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin roes tion. I auth e r sentatives of Cupertino to enter the above-ident}fed 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 o�II>E cooly TER L�f BUII DENG PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1-1STANDARD El 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 ❑
submittal of Building Permit application. SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20268 northwest sq. DATE: 09/21/2011 REVIEWED BY: bobs.
APN: BP#: '"VALUATION: 1$4,965
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex1-7 PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK replace 3 patio doors and 1 window non structural.
SCOPE
F-1 __L_
NOTE. This estimate does not include fees due to other Depts(i.e.Public Works,Sanitary Sewer District,School District,etc.).
Thesefees are based on the preliminary in ormadon available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 11-053 Eff 7,'],,'/1) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 ® # Window/Sliding Glass Door
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $392.00 1 wINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Feer Reg. 0 OT 10.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (D No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential Q
Building or Structure 0
i
Strona Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS; $1.50 $392.00 TOTAL FEE: $393.501
Revised: 09/02/2011
F-I
rN 21"
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Lai C O P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: C PERMIT#
OWNER'S NAME: ,, AkfHvit i PHONE# �
GENERAL CONTRACTOR:f BUSINESS LICENSE#
ADDRESS: NX , ,' CITY/ZIPCODE: (Z
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPAN INSPECT N(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBC RACTO AVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
q
1 am not using any subcontractors:
Signature D to
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
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
Owner/ ontrfictor Signature Date
CITY OF CUPERTINO BUILDING PERMIT
BI'ILDING ADDRESS: 19920OLIVFWOOD S'I' CONTRACTOR: EDEN LANDSCAPE-: PERMI'I'NO: 11070014
MANAGEMM'
ON NEWS NAME: ESSEX THE:POINTE:LP 12550 PASEO CERRO DATE ISSUED:09/15/2011
-R'S PIIONI•.: 6>0S1>162_2 S:%RA I OGA,CA 95070 PHONE,NO:(408)858-9085
(� LICLNSED CON'TRACTOR'S DECLARA I fON
BUILDING PERMIT INFO: BLDG ELECT � PL[`ti1B
C 2A ----_-- MECH � RESIDENTIAL ' COMMERCIAL{
M 1Mle_____(��/I
I hcrchy affirm that lain licensed under thprovisions trovisiuns of Chapter 9 JOB DESCRIPTION: INSTALL-rw0(2)NEW SHADI:SAILS A I IXI LRIOR 01
MUL'i 1-1:ANIlLY DWFI.I.INGJNCE.UDES S-1'RUC"I-URAL.
(commencing t,ith Section 7000)of Division 3 of the Business& Professions
( ode and that my license is in full force and effecl.
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 ha\e and%\ill maintain Worker's Compensation Insurance,as provided for by
Section 37110 ol'the Labor Code_for the performance of the work for which this Sq.Ft Floor Area: Valuation:57000
pcnnu n i,,ued
APPLICANT CERTIFICATION APN Number:31643004.19920 Occupancy hype:
I :mit\ that I have read this application and state that the above information is
comet I agrcc to comply with all city and county ordinances and state laws relating
to hlllldlnfl construction-anis hereby authorize representatives of this city to enter
upon the ahosC mentioned property for inspection purposes (we)agree to save PERMIT EXPIRES IF WORD IS NOT STARTED
ineicntnify and keep harmless the Cite of CupCrtino against liabilities. ludgmenls.
0): It anal expenses which may accrue against said City in consr(Inence of'file WITHIN 180 DAYS OF PERMIT ISSUANCE OR
cr;+nting:,f thy,penttil Additionally.the applicam understand,and mll compl` 180 DAYS FROM LAST CALLED INSPECTION.
1111 all non-point mmi-cc rCQl1ati0ns per the Cupertino'y11.11110pal Codc.Section
_ _
Z_Dalc
Date.
Issued by': - . _. � _-
SrvnauuC__ _
L ON\'N'ER-BUILDER DECLARATION
RF,-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If it roof is
the follm%ing two reasons: installed without first obtaining an inspection. I agree to remove all new materials for
I a,omni of the property.or my emplovecs with wages as their sole compensation, inspection.
\�)ll do the work.and the structure is not intended or offered for sale(See.7044,
13u,111Css& Professions(.'ode) Signature of Applicant Date
I.as owict of the propert),am exclusively contracting with licensed contractors to — --
,:on,truct the pr jest(See 7044,Business& Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BEY14:11
I hereby affirm under penalty of perjury one of the following three
declarations:
have.+n(t%vill ntuinlain a Certificate of Consent to self-insurC for AWorker s ILAlAItDOUS M:ATE:RIALS DISCLOSURE
C ompen,atinn-as provided for M Section 3700 of the Labor C odc. liar the I have read the hazardous materials requirements under Chapter 6.95 of the
pci limnan.c of the(pork for which this permit is issued. California Ilealth&Safety Code,Sections 25505,25533,and 25534. I will maintain
I 1101 and kill maintain\Non Worker's Compensation Insurance.as provided for b1 compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth&
Secunn 3700 of the Labor Code.for the pertixmancC of the work for which this Safety Code,Section 25532fa)should 1 store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
pernut i,usucrl contaminants as defined by the Bay Area Air Quality Management District I will
I ccmt� that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Hot cmpin ani person m any manner so as to become subject to the Worker's Ilealth&Sa• (-ode,Sections 25505,25533,and 25534.
Crn+pcnsatlon laws of California. If,atter making this certificate ol'e.xentption. I
become suhjcct to the Workers Compensation provisions of the Labor Code, I most Ow r or rt ri e It Q �r
I"rth\\5th comply with such provisions or this permit shall be deemed revoked —_llate:_—/
CONSTRUCTION LENDING AGENCY
APPIACAN-T CERTIFICATION
I ccrtil\ that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of'work',
correct I agree to comply with all city and county ordinances and state laws relatin.- for which this permit is issued(Sec.3097.Civ C)
to huilding construction.and hereby authori/.c representatives of this city to enter Lender's Name
upon thi ahovc mentioned property lbr inspection purposes.(We)agree to save
indcnuulc and keep harmless the City of Cupertino against liabilities, judgments. Lender's Address. —
and expenses which may accrue against said City in consequencC of the
I ng of thi,permit.Additionallq,the appliCant understands and will contpiv AR('I IITFC I'S 1)E:CL:\R.ATI0N
all nun-point source rcaulations per the Cupertino Municipal Code,Section
�t I,� I understand my-plans shall be used as politic records.
SienauuiC Date Licensed Professional -------_—__--