11080164 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7640 ERIN WAY CONTRACTOR:BROTHERS HOME PERMIT NO: 11080164
IMPROVEMENT
OWNER'S NAME: WYLLIE WILLIAM J AND MARILYN C 2510 DOUGLAS BLVD DATE ISSUED:08/22/2011
ER'S PHONE: 4086621360 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class L r r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE TEN(l0)RETROFIT
(commencing with Section 7000)of Division 3 of the Business&Professions WINDOWS;NON-STRUCTURAL,FOR EXISTING SINGLE FAMILY
Code and that my license is in full force and effect. DWELLLING
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 Sq.Ft Floor Area: Valuation:$5028
permit is issued.
APPLICANT CERTIFICATION APN Number:35921016.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
granting g of this permit. Add'tionall se atf►e ppt said u d stands qu we of comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source reibns r the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
�- Issued by: :�---' Dater Z `4
Signature Date ()
L. OWNER-BUILDER DECLARATION
RE-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 a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,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
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain.
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
[certify that in the performance of the work for which this permit is issued,I shall maintain compliance wt'Pe Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safe 9de,S tions 25505,25533,and 25534.
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 Owner aut e nt•
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify 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"ork's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
irid—rinify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
u►d expenses which may accrue against said City in consequence of the
g. mg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
its ADDRESS: 7640 erin way. DATE: 08/22/2011 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: 1$5,028 —�
'°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK re lace 10 retrofit windows non structural for exisiting sfd.
SCOPE
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn7 info,
FEE ITEMS (Fee Resolution 11-053 1-f -1.11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $522.00 1 wINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee-E) Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes (F) No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 E)
Planning, Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
Strom Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $522.00 TOTAL FEE: $523.50
Revised: 07/04/2011
c)
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408),777-3228• FAX(408)77;-n33• building aQcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS ^ j J APN#,00'? I r
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OWNER NAME PHONE „ E
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STREET ADDRESS A ��,. u 1 V) CITY, STA .ZIP f�l
CONTACT NAME PHONE E_MAu
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STREET ADDRESSCITY,STATE, ZIP ` (— i FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME, , LICENS NUMBER LICENSE TYPE BUS.LIC#
L
COMPANY NAME i' E-MAIL FAX
STREET ADDRESS q CITY,SATE,ZIP PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
lcecl"i
oJrJlo� w)
EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXLSTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA P-0 /-a ,
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 UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? [-]NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: ALV UATION:
PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
By my signature below,I certify to each of the following: I am the property owne or authorized agent to act on the pr_nperty owner's be al£ I have read this
application and the information I have provided is correct. I have read the D ption of Work and verify it is accurate. I agree to comply with ail applicable local
ordinances and state laws relating to building cons on. I authorize resentatives of Cupertino to enter the above-idgntified property for inspection purposes.
Signature of Applicant/Agent: �� Date: (�
SUPPLEMENTAL INFO TION REQUIRED PLAN CHECK TYPE ROUTING SLIP
--7-New SFD or Multifamily dwellings: Apply for demolition permit for COUNTER a—W Drrlc PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PIAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1-1STANDARD ❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FM DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. MAJOR ❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
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APPROVED
This set Oflans and i;I
P p�:eifi��,�.c„ s MUST,��ke',t at the
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job �" �u°irk constri,r,4ion It is unlaVAl! .o
r 3s or alteraticFij`on snmo, or to c.w L_.e
theretrorn, without approvai from the Buill ic:ir.l. �
Thi Ctc r �ijrfj Of his pIrjn drl�i sp_C,f c t!Or vhf.' I 1
be c,ri,;�r, fit o �lE nP�',jova 1 Ut
of any provision C ✓;+y Orc:m nue o c� La'•1J.
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: 7 C" PERMIT#
OWNER'S NAME: /, v 1 f _ PHONE#
GENERAL CONTRACTOR: (j ;; Lr`t � �.,1 BUSINESS LICENSE #
ADDRESS: CITY/ZIPCODE: S GC 1
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCYIN CTION ILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONT TO VE 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 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
Ownef Contractor Siggidure Date