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11040096 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11074 LA PALOMA DR CONTRACTOR:ARGONAUT PERMIT NO: 11040096 WINDOW&DOOR, INC OWNER'S NAME: AYYAPPAN ARASU 1901 S BASCOM AVE STE 800 DATE ISSUED:04/13/2011 SER'S PHONE: 4084069576 CAMPBELL,CA 95008 PHONE NO:(408)378-4018 LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Cl Lic.# U 0��3 0 r f ' / MECH RESIDENTIAL COMMERCIAL Contractor A T�ti 06W Date Z'"1,3 11 JOB DESCRIPTION: REPLACE 14 WINDOWS&1 DOOR NON-STRUCTURAL 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. Sq.Ft Floor Area: Valuation:$10600 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 APN Number:35616046.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 1 PAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point sour r ns per the Cupertino Municipal Code,Section 9.18. �/3��/ RE-ROOFS: Signature Date 77 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. LJ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupe mo Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent- Date: 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,[ CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 neon the above mentioned property for inspection purposes.(We)agree to save emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,sts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 35616046 . 00 DATE ISSUED. . . . . . . : 04/13/2011 RECEIPT #. . . . . . . . . BS000013183 REFERENCE ID # • • . : 11040096 SITE ADDRESS . . . . . : 11074 LA PALOMA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER AYYAPPAN ARASU ADDRESS 11074 LA PALOMA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : AYYAPPAN ARASU 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 10, 600 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 10, 600 . 00 1 . 06 0 . 00 1 . 06 0 . 00 1WINREP EACH 8 15 . 00 506 . 00 0 . 00 506 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 508 . 06 0 . 00 508 . 06 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 508 . 06 1076 --------------- TOTAL RECEIPT 508 . 06 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 11074 La Paloma Dr. DATE: 04/13/2011 REVIEWED BY: gs APN: BP#: '"VALUATION: $10,600 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK SCOPE NOTE: Thesefees are based on the preliminarV information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 F;ff. 7.-10) 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 $506.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp. Fee.e 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 G No $0.00 E) PCannin� Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Strong Motion Fee: IBSEISMICR $1.06 Select an Administrative Item Bld€'Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.06 $506.00 TOTAL FEE: $508.06 Revised: 01/15/2011 i is •�}+.: V + Q w �MA Q OX Z14 left Lh in AA I ;•,:t; XLn .� Tr 0 CD Y N Qti ch a �D �: �>frii 1►rj Mn C� (C ,y Co C s, m I*► �U t* a Y W,.._ 4.J_ } v K x N li t1 CL Ln m 1, c p eo x < y in . N L V, r .is _ ((�,:.-. �.•,;, Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: //O ?Y PERMIT# OWNER'S NAME: ,4" PO' JC— 376—K0/-e- GENERAL CONTRACTOR: ,( BUSINESS LICENSE# ADDRESS: /6(,/Z A-54o >l CITY/ZIPCODE: �'vl *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 SUBCO T CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. -3"l 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 •FAX(408)777-3333•building(cDcugertina.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ( ( O -Zj, O OWNER NAME STREET ADDRESS CITY. STATE,ZIP FAX CONTA NAME P _ E-MAII. GWS L 0 6 cl s !t STREET AD RESSP� � Cl fY.STATE ZIP FAX 0 �� OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO CTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# r tiJ L I M' o Z COMPANYaME - v E-MAIL FAX _ 3 STREET ADD SSLs+-� ` �}� STATE.ZIP 7f PHO ��o � D I C ARCHITECTIENGINEER NAME 1, LICENSE NUMBER BUS.LIC# O . COMP ANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE DESCRIPTION OF WORK tt EXISTINGUSE PROPOSED USE CONsm TYPE #STORIES EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH A 11AREA GARAGE AREDETACH El ATTACH _ A DWELLING UNITS. IS A SECOND UNIT ❑YES SECOND STORY ❑YES _ RM MG ADDED? ❑NO ADDITION? [:3140 PRE-APPLICATION ❑ YES IFYFAPROVMECOFYOF PLANNER'SNAME: PLANNING APPL M ❑NO PLANNING APPROVAL LEr TR 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 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 ordinances and state laws relating to building co tion. I autho ' e representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent: %cyv�' Date: LO1 SUPPLEMENTAL INFORMATION REQUIRED _New SFD or Multifamily dwellings: Apply for demolition Permit for existing building(s). Demolition permit is required prior to issuance of building IlP permit for new building. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. B1dgApp 1011.doc revised 03/16/11