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10110030CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10305 VIRGINIA SWAN PL CONTRACTOR: HOLDER INC DBA ABLE PERMIT NO: 10110030 GLASS C 'ER'S NAME: GILLETTE LYN14 H AND JOLENE G T OWNER'S PHONE: 4085242046 ❑ nLICENSED CONTRACTOR'S DECLARATION License Class '3 C' Lic. # 46 20 9d //��,, Contractor Date / / - O k(' /V I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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 9.18. 69k— S 'ure Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 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 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If, after making this certificate of exemption, I 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. 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 he above mentioned property for inspection purposes. (We) agree to save ii. ..mify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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 9.18, Signature Date. 1129 RICHARD AVE SANTA CLARA, CA 95050 DATE ISSUED: 11/04/2010 PHONE NO: (408) 496-9960 BUILDING PERMIT INFO: BLDG F ELECT r— PLUMB r— MECH r- RESIDENTIAL f— COMMERCIAL r— JOB DESCRIPTION: REPLACE WINDOWS(15) & (1) PATIO DOOR WITH DOUBLE PANEL VINYL WINDOWS & DOOR LIKE FOR LIKE Sq. Ft Floor Area: I Valuation: $10500 APN Number: 31646013.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: �'�— Date: RE -ROOFS: 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Health & Safety Code, Sections 25505, 25533, and 25534. Owner or a d agent: Date: r - 6 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31646013.00 DATE ISSUED.......: 11/04/2010 RECEIPT #......... BS000011922 REFERENCE ID # ...: 10110030 SITE ADDRESS .....: 10305 VIRGINIA SWAN PL SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER GILLETTE LYNN H AND JOLENE G T ADDRESS 10305 VIRGINIA SWAN PL CITY/STATE/ZIP ...: CUPERTINO, CA 95014-2024 RECEIVED FROM ....: JOLENE GILLETTE CONTRACTOR HOLDER, ERIC LIC # 22037 COMPANY HOLDER INC DBA ABLE GLASS ADDRESS 1129 RICHARD AVE CITY/STATE/ZIP ...: SANTA CLARA, CA 95050 TELEPHONE ........: (408) 496-9960 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 10,500.00 -------------------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 10,500.00 1.05 0.00 1.05 0.00 1WINREP EACH 8 16.00 506.00 0.00 506.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- ---------- 508.05 0.00 508.05 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CREDIT CARD 508.05 VISA --------------- TOTAL RECEIPT 508.05 CITY OF CUPERTINO WNW TF T'i F CTTIVI A TnR — RT TTT ,nINf DIVI.q'ION rnwart tho DPW for addn '[ info. FEE ITEMS (Fee Resohrtion 09-051 Ef. './1 ADDRESS: 10305 virginia swan place DATE: REVIEWED BY: ll""JI, Pict mil Fl APN: BP#: *VALUATION: 1$10,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex I(}IiZ. PENTAMATION 1GENRES USE: ;T , 001? i/,/ PERMIT TYPE: WORK $0.00 SCOPE rnwart tho DPW for addn '[ info. FEE ITEMS (Fee Resohrtion 09-051 Ef. './1 k,, h /"at C IrE r ( ' . tr ''_ P- , C /u , QTY/FEE ll""JI, Pict mil Fl 1'/w ,, /Pr la Fc(, /-'c r Per wh f ��a (I;lt r .ifc'c:=,. Irsi>.F-1 I 0 r;�f Pl z � bl'- <_ Window / Sliding Glass Door 1WINREP Replacement 1,,;,,P,,-F�c r,7ec_ M)p Vcc rnwart tho DPW for addn '[ info. FEE ITEMS (Fee Resohrtion 09-051 Ef. './1 /10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 EEI# $506.00 Window / Sliding Glass Door 1WINREP Replacement Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C011s0r11cri()17 7_(ix Acoustical Fee: 0 Yes (E) No $0.00 0 Work Without Permit? 0 Yes (F) No $0.00 Planning F ee: $0.00 Select a Non -Residential Building or Structure 0 j ( fation 7 Strong Motion Fee: IBSEISMICR $1.05 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.05 $506.00 TOTAL FEE: $508.05 Revised: 10/17/2010 ,N -A! It I C)HD'i 4ANUC- ck wi DAIE - SIGt4,-- ,on trot, of, o Afill 0 ),jCupej,no Tne )In ,IT ,,I to KAM 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: Q p ,4N PERMIT # OWNER'S NAME: (, PHONE #& o& 5Z GENERAL CONTRACTOR: Cp ,�tCBUSINESS LICENSE # ADDRESS: Ableertir, CITY/ZIPCODE: *Our municipal code requires all businesseswir fIfiiTg in the city to have a catty of uupertmo Dusiness ucense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. // I am not using any subcontractors: ` r �� /� Signature Please check applicable subcontractors and complete the following information: Date Owner / Contractor Signature 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 Owner / Contractor Signature Date 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 a0'Exposed Partioleboard or MDF B. 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 Rapidly Renewable Flooring Materials 3. Use Recycled Content Ceramic Tiles 4. Install Natural Linoleum in Place of Vinyl . 5. Use Exposed Concrete as Finished Floor 6. Install Recycled Content Carpet with Low VOCs Total Points Available: Total Points Project Received: 1 IAQ/Health pts y=yes 21AQ/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/Healtli pts y=yes 4 Resource pts y=yes 1 Resource pts y=yes 3 IAQ/Health pts y=yes B Resource pts 4 Resource pts 4 Resource pts 5 IAQ/Health pts 4 Resource pts 4 Resource pts y=yes y=yes y=yes y=yes y=yes y=yes 1401 130 57 C D 01 0 0 ,§"k- I(-04-10 G:datalprogslgreenbuildmgguidelineslremodelers/greenpointsfina1212.04proteoted.xis �- i Z17Y OF CUPEiZT1NO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # ,, Date: Building Address: /03oY 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: L 6-l' (fe Phone #: 4S'z z ym • Contractor: Phone: Av - �e94- p o Fax: 996 Contractor License #: 6 �'09/2- Cu ertino Business License #: Contact: G HOC fes.- Phone: cW- / • /bet Fax: Residential Commercial Job Description: )?6p(tce tN Ddo - L" / �' CO 10A-n'o Do 04 G-,/ 1,0viN ev V,',,(,/ k) '/u t)avr ` 110 vt 76,,� tide Building Permit Info: 'Bldg ff' 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 [�` law Valuation: Square Footage: 0/ �� v Project Size: Express Q--6tardard ❑ 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. )ints Achieved: For help, contact Build it Green at www.builditueen.or� Revised 07/14/09 i