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09120023 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 10832 LEAVESLEY PL CONTRACTOR:ARGONAUT WINDOW& PERMIT NO:09120023 BOOR,INC (C"'NER'S NAME: WINSTON BRUCE AND ANNETTE 1901 S BASCOM AVE STE 800 DATE ISSUED: 12/03/2009 (,..NER'S PHONE: 4089962654 CAMPBELL,CA 95008 PHONE NO:(408)3784018 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB License Class Lic.# MECH I— RESIDENTIAL r COMMERCIAL Contractor Date JOB DESCRIPTION:WINDOW REPLACEMENT LIKE FOR LIKE BEDROOMS TO I hereby affirm that I am licensed under the provisions of Chapter 9 MEET (commencing with Section 7000)of Division 3 of the Business&Professions EGRESS REQUIREMENT 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 Valuation:$6000 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: permit is issued. APPLICANT CERTIFICATION APN Number:35615035.00 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by. Dat c:-^ature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of 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 the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, inspection. 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 permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I er o t toriz agent: �1 become subject to the Worker's Compensation provisions of the Labor Code,I mue t Date: 17 z forthwith comply with such provisions or this permit shall be deemed revoked. ---�— CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION ove information is I hereby affirm that there is a constriction lending agency for the performance of work's 1 certify that I have read this application and state that the ab correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) Lender's Name to building construction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save Lender's Address rnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting 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. ,/,' Signature Date Licensed Professional 0 06.3 CITY OF C.UPERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: C� S� ) �_- Cho Building Address: E D t3Z L.C- AV1e-r-.LM`t VLACX- Co U-41100 C q- Sol A Mailing Address (if different from building address): Are Hazardous Materials being used as part of thi i project? Yes No [� HOA: (Exterior work only) Yes ❑ No a If yes, provide letter from HOA Owner's Name: Phone#: � IZUCc W � t 9`g �a� ars �y Contractor: AP-6-t V VA.�-,� 1 �, Phone: ->Ao 1 Fax: A Q46 ctc\ Contractor License#: eb Cupertino Business License#: Contact: � AUL ' A,0\\ A Phone:L b6 (e ft iP 12 2.?J Fax: 6)101-1 Residential Commercial Job Description: �+l 4�d�(,� t I C U, - -t L\.1C.IE7 �CYL U` `CJE Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B L� Q Valuation. 4? Square Footage: Project Size: Express �tandard ❑ Lar e ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 Stu-, CITY OF �CUPERTINO nOf GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCZEDULE Quantity/Sf Fee ID Fee Des,-.ription Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application / 1 WINREP Replacement windows/sliding glass B / door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck fee) IEPERMITFEE Electrica. Permit Fee E 1 MPERMITFEE Mechani,;al Permit Fee M 1 PPERMITFEE Plumbing;Permit Fee P 1 ELCPLNCK Stand Al ane Electric Pln Ck(hourly) E 1 MECPLNCK Stand Al z)ne Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alane Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-sl and alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel &: Documentation B 1BUSLIC Busines, License B 5 of 5 11 1 If Ct N `° 01" N jr Dpi j..ezau a Sly W ( o M Ile. �V 3 �� Uvia m -av C) •-�- ug AJ �iUtU� u -7:0 S� Z N w tow ealA.ccvMcN-r C- l 1C L -I;&2 C 146 �i]�Ntnn��c�751.lA.et'� �'(�S S ��V 11Zk�Wt�G.�s-�S flyr 2d07 11 If 41W �� n 'N r � r Uei 3 � r xx 0 o!' La m _ x O U 2' - Cm a ' Q m e _ l QQ cCk t o a' c m�Q Z 21- A � E - moo �V • � —72:X -� — N UL) w e)a t6kit6NT L l 1C l: jr&& C X14* 12it,N rnn w c"'Ct s l.U.eP� ��S � �11lk'�t G•�-�S r��?60'� Community Development 10300 Torre Avenue N? E Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEkTINO Building Department JOB ADDRESS: t m -3,Z LLAVer& I T L-kL4-- PERMIT # OWNER'S NAME: t rLvLc- w i &-, 5-mPHONE # Q m l GENERAL CONTRACTOR: Ar-&o FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Clete 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date