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11040142
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10072 MOSSY OAK CT CONTRACTOR:SGK HOME SOLUTIONS, PERMIT NO: 11040142 INC. OWNER'S NAME: ALICE WICHMAN 3801 CHARTER PARK CT STE B DATE ISSUED:04/20/2011 'ER'S PHONE: 6504657229 SAN JOSE,CA 95136 PHONE NO:(408)264-6964 ❑ IILICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class U Lic.# "(?j� � Q/' MECH RESIDENTIAL COMMERCIAL Contractor JL1D 0 Ift5 Date I hereby affirm that I am licensed under the provisions of apter 9 JOB DESCRIPTION: INSTALL 5 NEW WINDOWS&1 DOOR NON-STRUCTURAL (commencing with Section 7000)of Division 3 of the Business&Professions TOWNHOUSE Code and that my license is in full force and effect. Ar�eaffirm under penalty of perjury one of the following two declarations: d 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 Sq.Ft Floor Area: Valuation:$4650 Section 3700 of the Labor Code,for the performance of the work for which this pe t is issued. APN Number:34232111.00 Occupancy Type: APPLICANT CERTIFICATION RIrti 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. L n n Issued by: Date: Signature r— Date !� OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) 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 HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 1 certify that in the performance of the work for which this permit is issued,I shall Health&SafetySections 25505,25533,and 25534. 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,1 Owe or au rori agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: LD l I forthwith comply with such provisions or this permit shall be deemed revoked. OT ONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of cork's 1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address ;-A-mnify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g....iting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34232111. 00 DATE ISSUED. . . . . . . : 04/20/2011 RECEIPT #. . . . . . . . . : BS000013236 REFERENCE ID # . . . : 11040142 SITE ADDRESS . . . . . : 10072 MOSSY OAK CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER ALICE WICHMAN ADDRESS . . . . . . . . . . : 10072 MOSSY OAK CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SGK HOME SOLUTIONS, CONTRACTOR . . . . . . . : VLADIMIR MERABIAN LIC # 30341 COMPANY . . . . . . . . . . : SGK HOME SOLUTIONS, INC. ADDRESS . . . . . . . . . . : 3801 CHARTER PARK CT STE B CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 264-6964 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 650 . 00 1.00 0. 00 1 .00 0.00 1BSEISMICR VALUATION 4, 650 .00 0.50 0. 00 0 .50 0. 00 1WINREP EACH 8 1 .00 380. 00 0. 00 380.00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 381.50 0. 00 381.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 381.50 #4717 --------------- TOTAL RECEIPT 381.50 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10072 mossy oak ct. DATE: 04/20/2011 REVIEWED BY: bobs. APN: BP#: '"VALUATION: 1$4,650 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex7 PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK install 5 new windows and 1 door non structural townhouse. SCOPE _T_T NOTE. Theseees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 tff. '1.-10) 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 $380.00 I WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee4@ Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: Yes No $0.00 0 Work Without Permit? 0 Yes No $0.00 E) P(atlning Fee: $0.00 Select a Non-Residential E) Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $380.00 TOTAL FEE: $381.50 Revised: 01/15/2011 Ot ni C"h -51*4 t4ca- ce 'Ae/v f j GLIA ( -6 Xa 9Y Y- -2- 2 o A4-*A �Z Q rt COMMUNITY DEVEL MEW DEPARTMENT 6UILDING DIVI$1 N-CUPERTINO �3t8et of pians and specificationsf/IIJST be kept at the ~— job site during construction. It is unlawful to make any changes or alterations on same,from the r to eviateing icial. therefrom,without app. The stamping of this plan and specifications SHALL NO be held to permit or to be an approval of the violation of any provisions of any Glity Ordinance or State Law. BY DATE PERMIT NO. LL Building Department City Of Cupertino LM 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: Vba7 Z. ftk,.; 0,1¢ G f PERMIT# OWNER'S NAME: kzc.,- t�,�,,u�h PHONE# ZG - �9 GENERAL CONTRACTOR: S(,)IL 4 S.,Iu�-ioa,•, � ,L BUSINESS LICENSE# ADDRESS:�,�� Q„� LC ,� HiQ gzjllCITY/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 IN TION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU CONTR CTOR HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature D to Please check applicable subcontractors and complettheo owing i formation: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing 7FIooring / 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 Y2- CONSTRUCTION zCONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333•buildin-g(@cupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSAPN \(YQ # // OWNER NAME Nt` \ •A PHONE �r 0 C5 E-MAIL STREET ADDRESS t I NUw C STATE ZIP/ FAX CONTACT NAME (/ -1} / P ONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BurLDER ❑ OWNERAGENT ❑ CONTRACrOR ❑CONTRACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME CL L/ GIiA Q JL �A L LICENSE NUMBER /:n p,Z� LICENSE TYPE BUS.LIC# COMPANY NAib\ ( ►"7 E-MAIL �( GV FAX STREET ADDRESSjq,Cl �� CITY,STATE,ZIP CJ Q O PHONE L�4_p 074s� ARCHITECT/ENGINEEERCCN77 AME l�� LIC ENSE NUMBER BUS.LIC{ 0A � L1 COMPANY NAME E-MAII FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTINGUSE PROPOSED USE CONSTR TYPE #STORIES r � EXISTG NEW FLOOR DEMO TOTAL ' AREA AREA AREA NET AREA >si BATHROOM KITCHEN OTHER � � REMODEL AREA REMODEL AREA REMODEL AREA . -' F * T PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGEAREA:❑ DETACH ❑ ATTACHE N DWELLING UNQS: 19 A SECOND UNIT YES SECOND STORY ❑YES 3'" ' a BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: R� tv ... �° W,�PLANNING APPL M ❑NO PLANNING APPROVAL LEITER � '£` � R ,'+ma By my signature below,I certify to each of the following: I am a property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I h vided is come t. I ve r ad the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin building construc a I o ize representatives of Cupertino to enter the above-identified roe for inspection purposes. Signature ofApplicanbAge Date: LI fI Z SUPPLEMENTAL 3t-O=T",0 N New SFD or Multifamily dwellings: Apply for rem!nolitipermit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. '�� s a Commercial Bldgs: Provide a completed Hazardous Materials Disclosure snrF7is �� fo_rm if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to �Iir�i.Jait �� submittal of Building Permit application. B1dgApp 2011.doc revised 03/16/11