09080384 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10411 CASTINE AVE CONTRACTOR:CUSTOM EXTERIORS INC. PERMIT NO:09080384
OWNER'S NAME: CH1EW MOOT NEO 440 BOULDER CT STE 400 DATE ISSUED:08/26/2009
t 7R'S PHONE: 4089749732 PLEASANTON,CA 94566 PHONE NO:(925)249-2280
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class Lic.#
MECH F_ RESIDENTIAL r COMMERCIAL
Contractor Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 2 PATIO DOORS&2 WINDOWS
(commencing with Section 7000)of Division 3 of the Business&Professions FACING THE
Code and that my license is in full force and effect. BACKYARD/GARDEN. LIKE FOR LIEK(EXISTING HEADERS
TO STAY)
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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.
1 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 Sq.Ft Floor Area: Valuation:$9600
permit is issued.
APPLICANT CERTIFICATION APN Number:32641038.00 Occupancy Type:
1 certify that I have read this application and state that the above information is
correct.1 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. /
SignatureDate Issued b Date:
i OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
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,
Business&Professions Code) Signature of Applicant: Date:
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:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by -ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material.
permit is issued. additionally,should I use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued,I shall =ontaminants as defined by the Bay Area Air Quality Management District 1 will
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
become subject to the Worker's Compensation provisions of the Labor Code,I must 3wner or auth riz ages
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating or which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter i.ender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
aify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. Y 1 understand my plans shall be used as public records.
Signature w(I / Date_ ' 01
Licensed Professional
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN � (P0 � � Date: j
Building Address: 0 (��( CA S 71�u t~ A a E
r 6G1PM7.N o GA 5S-0/,(,c
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of thi3 project? Yes 0 No
HOA: Exterior work only) Yes ❑ No 2r If yes, provide letter from HOA
Owner's Name: Phone#:
GtiiE,,� moo/ Ngo ( Y�;,8) q7If x'732-
Contractor: Phone: y s 7—
C44 5-rOA4
_CitS?on., Fx761Qiok-S Fax:
Contractor License#: 7 9 53,6
Cupertino Business License#:
Contact: a Phone:
y Fax:
Residential Commercial
Job Description: /?EP4A&6 2
r—atiN -70 F /.?ACK y,be 16"+R-0F1
(,. LIKE h 04 p XX 7 fr,-q y
Building Permit Info:
Bldg ❑ Elect ❑ :dumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-Ft ❑
Valuation: Square Footage:
0 g60a Lz
Project Size: Express ❑ Standard ❑ Large [] Major ❑
Green Building: Please complete relevant portion c,f 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.builditgre m.or
Revised 07/14/09
CITY OF CUPERTINO
sto-ze
OF GENERAL BUILD[NG APPLICATION
CUPEkTINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacem,;nt windows/sliding glass B
door (ea f windows)
1WINMEWSTR New Winslow-structural shear B
wall/masonry (includes plan ck fee)
IEPERMITFEE Electrical Permit Fee E
• I MPERMITFEE Mechanic it Permit Fee M
IPPERMITFEE Plumbing Permit Fee P
I ELCPLNCK Stand Alc ne Electric Pln Ck (hourly) E
I MECPLNCK Stand Alc ne Mechanical Pln Ck(hrly) M
IPLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourl -st,md alone
IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
l TYPES
IBSEISMICR Seismic I:esidential B
IBSEISMICO Seismic Commercial B
1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 of 5
Floor Plan Drawing (for Permits only)
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Floor Plan Drawing; (for Permits only)
APPROVED
IN ACCORDANCE WITH THE CITY OF
CUPERTINO CODES AND ORDINANCES
DATE � _ -��-
- GA P-A6rE
SIGN _
This set of plans and spe if kft Aff
be kept on the job at alt and it is
unlawful to make any char
on same without written permission from
the Building Department,City of Cupert g)
The stamping of this plan and spectficato ���-r cAi G-N)
SHALL NOT be held to permit or to be ad'.'-OY`^
approval of the violation of any provisions
of any City Ordinance or State Law.
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