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11040135 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10267 VISTA KNOLL BLVD CONTRACTOR:BROTHERS HOME PERMIT NO: 11040135 IMPROVEMENT OWNER'S NAME: AVERY&KAY CHING 2510 DOUGLAS BLVD DATE ISSUED:04/19/2011 O R'S PHONE: 4082309306 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C- Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 15 WINDOWS&2 PATIO DOORS LIKE FOR LIKE RETRO- FIT (commencing with Section 7000)of Division 3 of the Business&Professions Cod and that my license is in full force and effect. ereby affirm under penalty of perjury one of the following two declarations: I ave 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 Sq,Ft Floor Area: Valuation:$11192 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32613127.00 Occupancy Type: APPLICANT CERTIFICATION fy that I have read this application and state that the above information is Itni 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 sourc regulation r the Cupertino Municipal Code,Section 9.18. Issued by: Date: r Signature Date WIF L 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. 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, 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 I 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 contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,S ctions 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,I Owne autho ' a t: `� become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of Aork's I 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 i-' unify 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 gr.i.ting 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 . . . . . . . . : 32613127. 00 DATE ISSUED. . . . . . . : 04/19/2011 RECEIPT #. . . . . . . . . BS000013225 REFERENCE ID # . . . : 11040135 SITE ADDRESS . . . . . : 10267 VISTA KNOLL BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER AVERY & KAY CHING ADDRESS 10267 VISTA KNOLL BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SEAN FERGUSON CONTRACTOR GENE V. CAVANNA LIC # 27964 COMPANY BROTHERS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 2510 DOUGLAS BLVD CITY/STATE/ZIP . . . : ROSEVILLE, CA 95661 TELEPHONE (408) 295-0680 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 192 .00 1. 00 0.00 1.00 0.00 1BSEISMICR VALUATION 11, 192 .00 1.12 0. 00 1.12 0.00 1WINREP EACH 8 17.00 632 . 00 0.00 632 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 634. 12 0.00 634 .12 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 634 . 12 MC --------------- TOTAL RECEIPT 634 . 12 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10267 Vista Knoll DATE: 04/19/2011 REVIEWED BY: gs APN: BP#: "VALUATION: 1$11,192 —� y PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Du lex PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK SCOPE F-] L NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn'1 info, FEE ITEMS (Fee Resolution 09-05)LJ 1.-10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl.PC Fee: 0 Reg. 0 OT 0.0 I hrs $0.00 $632.00 1wINREp Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee4@ Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (D No $0.00 0 Work Without Permit? 0 Yes No $0.00 e) Plannitr Fee: $0.00 Select a Non-Residential G Building or Structure 0 i Strong Motion Fee: IBSEISMICR $1.12 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.12 $632.00 TOTAL FEE: $634.12 Revised: 01/15/2011 �= m Ll. V) hze T �x . 66X691 h 3 / `� µ � o 40 40 goo s 59 ,y xo Igo L i W s 100 '9 M s d \! I NITY D ELOPME5CDEPARTME ILDING (VISION- PERTINO �+ a) `+ls 31�a x b�r'Cs (X15 � x�b43"rs✓:�n PR6V45 d 4 rz ) T�� d ` sr► 3�• This sesbf pe pt a t 5xba1 45MO t ® C !Wk,,- job sitF'9'+�"' ctian. It=, A* rA'to attee any ^ F c t,r ns on c7! therefrom,without approval from the Building UtTICIal. r The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation i• of any provisions of any City Ordinance or State Law. By DATE ` PERMIT NO. Building Department City Of Cupertino 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: PERMIT# OWNER'S NAME: PHONE# — 0 77 GENERAL CONTRACTOR: USINESS LICENSE# ADDRESS: CITY/ZIPCODE: Sa S "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) ILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON ACTORS OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date 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 Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature ate CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 •FAX(408)777-3333•building cDcupertino.org CUPI-RTI>rt0 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ' APN , OWNERNAMEAV& PHONE E-MAIL STREET ADDRESS r CITY, STATE,ZIP TFA-< CONTACT NAME5Cp,, F- PHONE! E-MAIL STREET ADDRESSCITY,STATE ZIP FAX r�loV 2 ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT COM CrOR ❑CONTRACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT COME LI E ER LICENSE TYPE BUS.LIC# 81 C— COMPANY L4AME E-MAIL FAX STREET ADD RESCrrY,STATE ZIP PHONE v yta so� �, IT ARCHTTECT/ENGINEERNANE LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK -20aics64 EXISTINGUSE PROPOSEDUSE CONSTR.TYPE #STORIES .. EXISTG NEW FLOOR DEMO TOTAL a AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER ` S zs REMODEL AREA REMODEL AREA REMODEL AREA �.,, N A ✓ ?.�, .,. _ .' PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA:❑ DETACH ❑ ATTACH M DWELLING UNITS: IS A SECOM UNIT ❑YES SECOND STORY ❑YESNE BEADDED! NO ADDITION! NO ING T PRE-APPLICATION El YES IF YES,PROVIDE copy OF PLANNER'S NAME: a REEEE I4�E[T$W , i m PLANNING APPL M ❑ NO PLANNING APPROVAL LETTER ¢ ,, By my signature below,I certify to each of the fol owing: I e property owner or authorized agent to66t on the property owner's behalf fhavereadthis application and the information I have provi s correct. I read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui construct' authorize representatives of Cupertino to enter the above-i ntifre property for inspection purposes. Signature of Applicant/Agent: Date: �� SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for M� m existing building(s). Demolition permit is required prior to issuance of building permit for new building. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure foproject. rm if an Hazardous Materials are being used as art of this ro ect. � � £ Y g P P .1 Q �� N�� _Copy of Planning Approval Letter or Meeting with Planning prior toIIaaB Y submittal of Building Permit application. BldgApp 2011.doc revised 03/16/11