09100007 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20967 FAIRWOODS CT CONTRACTOR:ARGONAUT WINDOW& PERMIT NO:09100007
DOOR,INC
0.—H'ER'S NAME: VINCE&SANDY GRELLI 1901 S BASCOM AVE STE 800 DATE ISSUED: 10/01/2009
0 vs NER'S PHONE: 4088385705 CAMPBELL,CA 95008 PHONE NO:(408)378-4018
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT F PLUMB f—
License Class C. Lic.# S<�8,0-5-
,, � MECH r RESIDENTIAL r— COMMERCIAL �
Contractortt�''t.0.vnbT 1✓J w,&. f A Gdle/ ITate !D o/ O
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE EXISTING DOORS&WINDOWS WITH
(commencing with Section 7000)of Division 3 of the Business&Professions NEW LIKE FOR
Code and that my license is in full force and effect. LIKE, 19 WINDOWS STUCCO EXTERIOR TO MATCH
EXISTING,TEMP&EGRESS WHERE REQUIRED
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:$15000
permit is issued.
APPLICANT CERTIFICATION APN Number:35913114.00 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,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this pen-nit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Si- +ure Date f Z_11
l o Issued byr-' Date:
❑ 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:
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:
1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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. 1 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.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
1 certify 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
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 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 or authorid agent-
forthwith
forthwith comply with such provisions or this permit shall be deemed revoked. Date: to/at
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 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 work'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
U .ie above mentioned property for inspection purposes.(We)agree to save
il. .eify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
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 Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional \
r��
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35913114 . 00
DATE ISSUED. . . . . . . : 10/01/2009
RECEIPT #. . . . . . . . . : BS000008811
REFERENCE ID # • . • : 09100007
SITE ADDRESS . . . . . : 20967 FAIRWOODS CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : VINCE & SANDY GRELLI
ADDRESS . . . . . . . . . . : 20967 FAIRWOODS CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ARGONAUT WINDOW & D
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 15, 000. 00 1 .00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 15, 000. 00 1 .50 0 .00 1 . 50 0 .00
1WINREP EACH 8 2 . 00 760 .00 0 .00 760 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 762 .50 0 .00 762 . 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 762 . 50 #12135
---------------
TOTAL RECEIPT 762 .50
CITY F UPERTIN
C O C O
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
? 77s��
C
Building Address: ��f
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA
Owner's Name: Y Phone vN-10
�d
Contractor: Phone: (4�-
Fax:
Contractor License#: 7?t
Cupertino Business License#:
Contact: .� Phone:
Fax:
Residential Commercial Fj
Job Description: SCI, . LU Ayc_ZA)
rCr
t CCS
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑ (� �7(A L
Valuation: tri- Square Footage:
Project Size: Express12- Standard Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 07/14/09
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEI�TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter) hourly-stand alone
r 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
I TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
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Community Development
10300 Torre Avenue
z
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
XPERTINO
Building Department
JOB ADDRESS: PERMIT #
2014 '7 FA,(K WovtLS Oq I
OWNER'S NAME: vCr-az-e-( PHONE # g 3 76
GENERAL CONTRACTOR Ag&o Af 4ti i G/[e&o ,1 av je/ FAX#
I am not using any subcontractor : LI°l
Sign a Daie
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
z(--, A L AXtcak 7
L�l r/ ntractor Signature Date