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11060155 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1645 ASTER LN CONTRACTOR:HOLDER INC DBA ABLE PERMIT NO: 11060155 GLASS OWNER'S NAME: GARY LEHRMAN 1129 RICHARD AVE DATE ISSUED:06/17/2011 sR'S PHONE: 4089731303 SANTA CLARA,CA 95050 PHONE NO:(408)496-9960 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C Lic.# 6 2D 9,r I r MECH RESIDENTIAL COMMERCIAL Contractor Date G'/7--// I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 2 PATIO DOORS&9 WINDOWS;NON- (commencing with Section 7000)of Division 3 of the Business&Professions STRUCTURAL 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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$7800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36624016.00 Occupancy Type: APPLICANT CERTIFICATION 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 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. 6 - 17-q Issued by: Date: Signature Date 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 declarations: HAZARDOUS MATERIALS DISCLOSURE 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 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&Safety Code,Sections 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 Owner or d gent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 1 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 work'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 it' -nify 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;".,mg 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 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: AS q PERMIT# OWNER'S NAME: PHONE# OS' GENERAL CONTRACTOR: 1,e p BUSINESS LICENSE# n ADDRESS: 1114 ,-� CITY/ZIPCODE: SAN714- C OA- J� *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 SUBCATRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: t/ 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 6 -t7- // Owner/Contractor Signature Date ]A- rl M �` Cyd n \t r• G 'C^6.�` 1 10 4' J \07 x ell, C°„ o � � � � C tn Gi g 45" 03 LIJ ra E f7 Li CL � l'1 \ � 0('0 (---) I I-S) S CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 :URERTINC> (408)777-3228• FAX(408) 777-3333• building(Qcupertino.orq U NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS I lO T ) A-S / C r` APN r OWNERNAMEGYAtelfJZA44dP71Y 47 _ ��3 E-MAIL STREET ADDRESS 1 CD tf C N e CITY, STATE,ZIP FAX CONTACT NAME 62 f G / ai /�C PHONE E-MAIL STREET ADDRESS /(21 DDRESS /r29 /J(C C CITY,STATE, ZIP /� TSZ FAX I ' ❑ OwNER ❑ OWNER-BUIIAER ❑ OwNERAGENT CONTRACTOR 1:1 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO CTOR NAME LICENSE NYMAERSE TYPE BUS.LIC# f 9 i COMPANY NAME n E-MAIL FAX STREET ADDRESS 1/7 p //_�C 1�, In n/A,iV t r CITY,STATE,ZIP <�-t*- PHONE(1 ARCHITECT/ENGINEEB NAME/evv" i►T T LICENSE NUMBER BUS.BUS.LIC#(V / COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'CRIPTION OF WORK 4 M14 EXISTING USE PROPOSED USE CONSTRTYPE #STORIES s EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHERIN x REMODEL AREA REMODEL AREA REMODEL AREA L PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH ❑ ATTACH #DWELLING UNITS: IS A SECOND DNrr ❑YES SECOND STORY ❑YES k - y `'' £ 4 BEING ADDED? NO ADDITION! NO INN— PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: ` ' PLANNING APPL# ❑ NO PLANNING APPROVAL LETTER 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 pro 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 bu' ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED ft x � New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building :$ permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ,n 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. q� �,1� y�,�RFs �,py 3Y l�� y�y��`e�a•?$!„�� .,: B1dgApp_2011.doc revised 03/16/11