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11040130 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 837 KIM ST CONTRACTOR- PERMIT NO: 11040130 OWNER'S NAME: CATHERINE BOND � �, Gyri/� t-� DATE ISSUED:04/19/2011 PHONE NO: OVINER'S PHONE: 4082525930 [i LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG T_ ELECT F PLUMB License Class Z Lic.# C��U 26 – MECH RESIDENTIAL COMMERCIAL Contractor Rftp EA1 1 AJ Uk.,S`fI? ate y'��Z I I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 1 DOOR&13 WINDOW REPLACEMENTS,NON- STRUCTURAL, (commencing with Section 7000)of Division 3 of the Business&Professions CM/SD INSTALLED ACCORDING TO 210CBC Code and that my license is in full force and effect. PT hereby affirm under penalty of perjury one of the following two declarations: 1 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:$10000 permit is issued. C�c APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35920006.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this pe . Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point rc gulations per t ' pertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signatur Date(/ Issued by:/` �` ~ –Z—` Date: OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: Ail roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: 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: I 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 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 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must horize a en forthwith comply with such provisions or this permit shall be deemed revoked. Owner Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby a correct.I agree to comply with all city and county ordinances and state laws relating affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, C and expenses which may accrue against said City in consequence of the Lender's Address ng of this permit.Additionally,the applicant understands and will comply wnu 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 Apr 18 11 11:03p joke vandenbulcke 925-833-8927 p.1 -t-4 �ITGRW 91 Pi IV X ` C5, fA 0 � fl � 0 ., caZ o ' ca 0 _ > co 77-040j o :� Cc: � o D � O m ca c c E m � � o � U o ui o CalCOp � moo Zu o � � Qor , .- 14c o o o o am00 a:2 o z m� m © N U) .r- C13 -0a } QW m o a coo " . 1 w N cal , � � Building Department City Of Cupertino ELI] 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Irn PERMIT# OWNER'S NAME: '60'tos PHONE# GENERAL CONTRACTOR:A4q,4pl� i BUSINESS LICENSE# ADDRESS:2Ws-- ,,. CITY/ZIPCODE: �f'; *Our municipal code requires all busine ses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUP �Y INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU CTORS H E 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 Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 837 kim st. DATE: 04/19/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$10,000 —� 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK 1 door 13 window replacements, non structural CM/SD installed accoroding to 2010 CBC. SCOPE ew; NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh7 info. FEE ITEMS (1�' e Resolution 09-051 I;ff.' 7.1.10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl.PC Fee: 0 Reg. 0 OT 1 0.0 1 hrs $0.00 $506.00 1 wINREP___] Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Feer', Reg. 0 OT FO.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.00 LEE00 TOTAL FEE:_1 $508.00 Revised: 01/15/2011 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUFERTINO (408)777-3228 • FAX(408)777-3333•building ,cupertino.org MISC ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS /' 77Ni OWNER NAME PHONE eIP2� _ ���(''' E-MAIL STREET ADORES �^ CITY, STATE,ZIP ( ;�� ` FAX ». J C. /�' CONTACT NAME G� JG PHONE E-MAIL STREET ADDRESS y/ CITY.STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT -2 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGMEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME f, 1 LICENSE NUMBER .y LICENSE TYPE BUS.LIC# COMPANY NAME y� �i � E MAII FAX r /,_ \l �•Lf STREET ADDRESS-7, ✓ ✓' C]TY,STATE.ZIP PHONE yi•j' .� " �X� ARCH IECTIENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'SE OF ❑ SFD or Duplex y. ulti-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ZINO FLOOD ZONE ❑ Yes J2'No DES ON OF WORK 1,e_VG/ Z / I0 � 1 TOTAL VALUATION: RED; 00 H BY 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 p vided 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 b�' ,suuc"/ I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED "'t = � .` �i�r�Js�iiiQ�s '�� aT MEPMucApp 2011.doc revised 03/16/11