11020092 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7649 ERIN WAY CONTRACTOR:BROTHERS HOME PERMIT NO: 11020092
IMPROVEMENT
OWNER'S NAME: BABB HAROLD D AND CHERYL L 2510 DOUGLAS BLVD DATE ISSUED:02/24/2011
l,J ?R'S PHONE: 4082576628 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680
LJ LICENSED CONTRACTOR'S DECLARATIONF
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.it
MECH RESIDENTIAL COMMERCIAL
Contractor Date v� Z �
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL 6 WINDOWS&2 PATIO DOORS,LIKE FOR LIKE
(commencing with Section 7000)of Division 3 of the Business&Professions RETRO-FIT INSTALLATION
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:$6274
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:35920022.00 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 sourc gulations the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Signature _ Date 2 2
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
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
I certify that in the performance of the work for which this permit is issued,I shall Health&_S ty 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 Own r authori aent-
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 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
i- unify and keep harmless the City of Cupertino against liabilities,judgments,
c 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.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 7649 Erin Way DATE: 02/24/2011 REVIEWED BY: gs
APN: BP#: *VALUATION: 1$6,274
;kPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY PENTAMATION 1 GENRES
USE: SFD or Duplex PERMIT TYPE:
WORK
SCOPE
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NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS ( ee Resolution 09-051 E. 711.110) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 ® # Window/Sliding Glass Door
Suppl. PC Fee: (F) Reg. OOT 0.0 hrs $0.00 $380.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee{' Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Tox 1 i
Acoustical Fee: 0 Yes G No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 G
Planning I"ee: $0.00 Select a Non-Residential
f
Building or Structure
7'atrrE°c Dt�r trtrlr�rt��:tir�r� 't�°s:
I
Strong,Motion Fee: IBSEISMICR $0.63 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.631 $380.00 TOTAL FEE: 1 $381.63
Revised: 01/15/2011
CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35920022 . 00
DATE ISSUED. . . . . . . : 02/24/2011
RECEIPT # . . . . . . . . . : BS000012763
REFERENCE ID # • . . : 11020092
SITE ADDRESS . . . . . : 7649 ERIN WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BABB HAROLD D AND CHERYL L
ADDRESS . . . . . . . . . . : 7649 ERIN WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4342
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 6, 274 . 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 6, 274 .00 0 . 63 0 .00 0 . 63 0 . 00
1WINREP EACH 8 8 .00 380 . 00 0 .00 380 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 381. 63 0 . 00 381 .63 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 763 . 17 MC
---------------
TOTAL RECEIPT 763 . 17
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RTI N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# ZCw
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: SINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY PECTI ) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO CTORS AVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: —
Sig ture Dat
Please check applicable subcontractors and complete the following information:
V 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 Date
1l `CITY OF
� �i2—
CITY OF CUPERTINO
IM GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
APN# r,� ,.� Date:
u A�z,
/
Building Address: 7� G �� w`
Mailing Address (if differe t from building add ss):
Are Hazardous Materials being used as part of is project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No a If yes, rovide letter from HOA
If Residential,is house an Eichler? Yes ❑ No If yes, needs planning approval.
Owner's Name: he Phone #:
527 iyl,2
Contracto : Phone:
�(C vi Fax:
Contractor License#: 790
Cupertino Business License #: �-
Contact* Phone:
eo r-fv-.< d Fax/e-mail:
Residential EY Conimercial ❑ I ,
Job Description:
4/0 S fU c r' 10A
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K{ -P-or Li 14 t e-t�-pc) - �1 -- 1voh;Ilof 1411
Building Permit Info:
Bldg p' 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-�'d
Valuation: n Square Footage:
/ y-
LPro'ect Size: Counter ❑ Ex ress ❑ Standard Large ❑ Ma'or ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
for the application or if applicable, include in plan set & the sheet index.
Points Achieved: (0
For help, contact Build it Green at www.builditEreen.org
Revised 12/06/10