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11080158CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10416 PLUM TREE LN I CONTRACTOR: FIVE STAR WINDOWS I PERMIT NO: 11080158 OWNER'S NAME: BRIAN ADEN 11450 DELL AVE STE C I DATE ISSUED: 08/22/2011 1 PHONE: 4083148304 LICENSED CONTRACTOR'S DECLARATION License Class _ Lic. #_ Z Faa I Contractor `,' c� c V_cAbate ZZ j 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 Cupertinoj�icipal Code, Section 9.18. ) / / Signature -- Date D 2Z OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 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, c- ' . and expenses which may accrue against said City in consequence of the ng of this permit. Additionally, the applicant understands and will comply ...... all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date CAMPBELL, CA 95008 PHONE NO: (408)370-3331 BUILDING PERMIT INFO: BLDG ELECT r— PLUMB r— MECH r RESIDENTIAL COMMERCIAL f— JOB DESCRIPTION: REPLACING ONE(1) WINDOW Sq. Ft Floor Area: I Valuation: $3104 APN Number: 31633115.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued Date: 4f �2_2— tr 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 ections 25505, 25533, and 25534. Pwner athor' ped ag Z Z 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 Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professio 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31633115.00 DATE ISSUED.......: 08/22/2011 RECEIPT #.........: BS000014509 REFERENCE ID # ••.: 11080158 SITE ADDRESS .....: 10416 PLUM TREE LN SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. BRIAN ADEN ADDRESS ..........: 10416 PLUM TREE LN CITY/STATE/ZIP ...: CUPERTINO, CA OPERATOR: patg COPY # : 1 RECEIVED FROM ....: JEFFREY A PICKARD CONTRACTOR .......: JEFFREY PICKARD LIC # 23690 COMPANY ..........: FIVE STAR WINDOWS ADDRESS ..........: 1450 DELL AVE STE C CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408)370-3331 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- 1BCBSC VALUATION ---------- 3,104.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 ---------- 0.00 1BSEISMICR VALUATION 3,104.00 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 ----------------- --------------- CREDIT CARD 393.50 -------------------- VISA --------------- TOTAL RECEIPT 393.50 CITY OF CUPERTINO WM FEE ESTIMATOR - BUILDING DIVISION NnTF.r Thoco foo.c aro ha.cod nn tho nroliminary infarmatinn availnhlo and Oro nn/v ,I" octisnnto Cnnfn�f fho /lonf fnr Odds. 11 ;"jr- FEE ITEMS (1^�e Resolution 11-053 1ff. 7j-11 ADDRESS: 10146 plum tree In. DATE: 08/22/2011 REVIEWED BY: bobs. APN: BP#: `VALUATION: 1$3,104 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 GENRES PERMIT TYPE: WORK re lacing 1 window. SCOPE PME Plan Check: NnTF.r Thoco foo.c aro ha.cod nn tho nroliminary infarmatinn availnhlo and Oro nn/v ,I" octisnnto Cnnfn�f fho /lonf fnr Odds. 11 ;"jr- FEE ITEMS (1^�e Resolution 11-053 1ff. 7j-11 FEEQTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $392.00 Window / Sliding Glass Door 1 wINREP Replacement Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. 0 OT 0.0 hs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes E) No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 Planninf Fee: $0.00 Select a Non -Residential Building or Structure Q Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld€' Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.50 $392.00 TOTAL FEE: $393.50 Revised: 07/04/2011 CUPERTINO r � CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408):777-3228 • FAX (408) 777-3333 • buildingCcDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION E `tt.TERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ((a APN 4 ` �i O AME PHONE E-MAII- ch�� L 3 - ' 30' STREET ADDRESS+, ii CITY] STATE, ZIP FAX CONTACT NA*'� PHONE E-MAIL } _ CTil(, STATE ZIP STREET ADDRESSFAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTO NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # r l ::tom COMPANY ]NA10 E-MAIL FAX - r STREET ADDRESS CITY,S TE, ZIP PHONE ARCHIrECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRJPTION OF WORK -"L— C LAD l �7) EXISTING USE PRMSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXLSTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA ` yyyyy-7777�7 L//� 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 OYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY -TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO I C) ' By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prpperty 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 repre ordinances and state laws relating to,buildfng cons ction. I authorizenveS Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent4-- Date: Z Z___ SUPPLE 0)IRMA O UIlZED 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 COUNTER BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAIN 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 4�, DATE: Shining Above The Competition Family Owned and Operated Since 1983 1450 Dell Avenue, Suite C, Campbell, CA 95008 Tel 408-370-3331 Fax 408-370-3110 License# 628381 www.fivestarwindows.com J = �M OB NAME:-'' COMBUILDING DI SIIONEC PERTINO NT DEPARTMENT 'rhls set of plans and Specifications MUST be kept at;the-`_ job : tri during construction. It is uniavvfui to 175s11,e chaKIEIs or alterations on Gam. or to deviat(3 therefrom, without approval from the Buildir,g r ficatio;ls; ALL �10T —� The rtamc�inp of this plan and sir i he I),aid to 10 i -mit onto, be ars acp;o:,�al of the tai2,[��n �d'�nance or �,t;�te of �,,,y provl�ions of an City J. BY PERU � v .- s ,:`:, , � Never Promising More Than We Can Deliver. Striving To Deliver More Than We Promise. Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: \()k4 PERMIT # -rc OWNER'S NAME: t jL�''�.-1 PHONE # GENERAL CONTRACTOR: — 1� ��t� .� BUSINESS LICENSE # ADDRESS: l \k r CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business 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: Sig ature Date Please check applicable subcontracto and complete a following information: Owner / Contractor Signature Date 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 / Contractor Signature Date