10120001CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10395 MELISSA CT
CONTRACTOR: ARGONAUT WINDOW &
PERMIT NO: 10120001
DOOR, INC
OWNER'S NAME: DAVID SMENTEK
1901 S BASCOM AVE STE 800
DATE ISSUED: 12/01/2010
ER'S ONE: 408725919
CAMPBELL, CA 95008
PHONE NO: (408)3784018
LICENSED CONTRACTOR'S DECLARATION
C` F
ELECT PLUMB
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License Class Lic. # 0 S b
BUILDING PERMIT INFO: BLDG
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MECH RESIDENTIAL COMMERCIAL
Contractor / (4y7- Id «OV Date
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REPLACE 12 WINDOWS,3 PATIO DOORS & 1 ENTRY
(commencing with Section 7000) of Division 3 of the Business & Professions
DOOR.
SAME SIZES, SAME OPENING. STCCO PATCH EXTERIOR TO
Code and that my license is in full force and effect.
MATCH EXISTING
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
Section 3700 of the Labor Code, for the performance of the work for which this
pennit is issued.
Sq. Ft Floor Area:
Valuation: $15000
APPLICANT CERTIFICATION
APN Number: 34245017.00
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18. fA
Signature_��5e 2 �v
Issued by: Date: /0Z_ /—
Lr OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec. 7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
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
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance 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 I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
O r o u or e a ent:
Date:1. ! 2 l v
APPLICANT CERTIFICATION
/TK�7
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
' �mnify and keep harmless the City of Cupertino against liabilities, judgments,
, and expenses which may accrue against said City in consequence of the
Lender's Address
grdnting 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.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 34245017.00
DATE ISSUED.......: 12/01/2010
RECEIPT #.........: BS000012121
REFERENCE ID # ...: 10120001
SITE ADDRESS .....: 10395 MELISSA CT
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER ............: DAVID SMENTEK
ADDRESS ..........: 10395 MELISSA CT
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: ARGONAUT WINDOW & D
CONTRACTOR .......: CHRIS ETTEMA LIC # 22820
COMPANY ..........: ARGONAUT WINDOW & DOOR, INC
ADDRESS ..........: 1901 S BASCOM AVE STE 800
CITY/STATE/ZIP ...: CAMPBELL, CA 95008
TELEPHONE ........: (408)378-4018
FEE ID UNIT
QUANTITY
AMOUNT PD
-TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
15,000.00
--------------------
1.00
0.00
----------
1.00
----------
0.00
1BSEISMICR VALUATION
15,000.00
1.50
0.00
1.50
0.00
1WINREP EACH 8
16.00
506.00
0.00
506.00
0.00
TOTAL PERMIT
---------- ----------
508.50
0.00
----------
508.50
----------
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------------- ---------------
CHECK
508.50
---------------------
#13938
---------------
TOTAL RECEIPT
508.50
CITY OF CUPERTINO
TF F F cTTM a TnR _ RI TTI .nING nIVI.SION
Li,ADDRESS:
10395 melissa ct.
DATE: 12/01/2010
REVIEWED BY: bobs.
APN:
BP#:
*VALUATION: $15,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
PENTAMATION 1GENRES
USE:
-�1� �
PERMIT TYPE:
WORK
window and door replacements non structural 16 total
$0.00
SCOPE
..I:— ...L ..{:n Daol.l- ow,i — __A, nN ocfimn%O i'nNIO/'/ flfo Dont %RT add" 11 Info_
FEE ITEMS (Fee Resolution 09-051 Elf. %%L"10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
16 #
$506.00
Window / Sliding Glass Door
1 wINREP Replacement
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consloit'llon 11",-,
F71
Acoustical Fee:
0 Yes (F) No
$0.00
0
E)
Work Without Permit? 0 Yes E) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
O
0
,
Strong Motion Fee:
IBSEISMICR
$1.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.50
$506.00
TOTAL FEE:
$508.50
Revised: 11/08/2010
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
PERMIT # `
OWNER'S NAME: tiles
PHONE # 9&V C.3 S if
GENERAL CONTRACTOR:
BUSINESS LICENSE it 2 2 IQ—of O
ADDRESS: /fot S. A ca a Sir fV0 CM?J6
CITY/ZIPCODE: S -
*Our municipal code requires all businesses working in the city to have a City of Cupertino business ncense.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. 11Ajj,&,4A/
/0
I am not using any subcontractors:
Sig re Date
Please check applicable subcontractors and complete the following information:
�Z1t/10
Date
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
�Z1t/10
Date
S cg-r-ez ct A --e- ipf c ItV H94E:(-- jt�- RAJ
t) Ile
Pit= 2--o 0 7
i IJ
k IT Y
S
This se, ar MUS'
r* ind I
inlawt_d to
on Saine wjthol,7
the Fitilding Dflt. f uplll�-tln(;
The stamping o p-cifications
"AAL NOT t., bt,, a,,
-approval of the
L4 Q
EM
K,G:?e4� 12- i s 3 ?A -Vo
-W-41L
� 2011
6?17
EM
K,G:?e4� 12- i s 3 ?A -Vo
-W-41L
� 2011
1. Use Low/No-VOC Paint
2. Use Low VOC, Water -Based Wood Finishes
3. Use Low/No VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
7. Seal allEqiosed Partiolei Mrd or MDF
S. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
2. Use RapidlyRenewahle Flooring Materials
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl .
5. Use Exposed Concrete as Finished Floor
S. Install Recycled Content Carpet with Low VOCs
Total Points Available:
Total Points Project Received:
1 IAQ/Health pts
y=yes
21A0/Health pts
y=yes
31AQ/Health pts
y=yes
3 Resource pts
y=yes
61AQ/Health pts
y=yes
1 IAQ/Health pts
y=yes
4IAQ/Health pts
y=yes
4 Resource pts
y=yes
1 Resource pts
y=yes
3 IAQ/Health pts
y=yes
B Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
5 IAQ/Health pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
140 1301 57
1 01 01 0
L �114
G:data/progslgreenbuildingguidelineslremodelerslgreenpoints5na1212.D4protected.zls
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CITY OF CUPERTINO
CITY OF
CUPS TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # ,.._
Date:
Building Address:
0 3 Y-. — c. , s 5A- C v ve—
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA:(Exterior work only) Yes ❑ No & If yes, provide letter from HOA
Owner's Name:
Phone #: _?Z !�-
`7
L A S M rcL7-E— K',
Contractor:
lxtc-
Phone:
Oro /v,(Vr
Fax: --
Contractor License
Cupertino Business License #: 2
Contact:
L V�f lrl ! T��
Phone: d
Fax:
.esidential Commercial ❑
Job Description: F?L -cam l Z VJ ! gk dleS
Al (A(4 s�Le�o �,� �-c�� a ib�-r�K
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Co struction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ IUIII/V-A ❑ 1T/III B, IV -HT, V -B E..
Valuation: a7 Square Footage:
Project Size: Express Standard ❑ Large ❑ 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:
)r he1D, contact Build it Green at www.
Revised 07/14/09