10100211 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7566 LOCKFORD CT CC NTRACTOR:SANDER WANDA J AND PERMIT NO: 10100211
WI.NDELL B T
OWNER'S NAME: SANDER WANDA J AND WENDELL B T 796 LOCKFORD CT DATE ISSUED: 10/29/2010
OWNER'S PHONE: 4083562855 CL PERTINO, 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# R EPLACE 9 WINDOWS LIKE FOR LIKE NON-
SI RUCTURAL
Contractor Date
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. Sq.Ft Floor Area: Valuation:$8175
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 APN Number:36226048.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
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 Iss ued by: Date: /G
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
ins alled without first obtaining an inspection,I agree to remove all new materials for
ins'section.
1�' OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). "AVI h ive read the hazardous materials requirements under Chapter 6.95 of the
Ca ifornia Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: He filth&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. wil I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. r
Section 3700 of the Labor Code,for the performance of the work for which this OH ner or authorized agent:A
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 California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I he reby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. wo k's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
_qw/
APPLICANT CERTIFICATION Leiider's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I ui derstand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Lic;nsed Professional
9.18.
Signature ,cl,�G� Date/O/Z
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: `VALUATION: 1$8,175
q;PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY ,il, PENTAMATION
USE: SFD or Duplex 1GENRES
��.� � f; ��_
PERMIT TYPE:
WORK
SCOPE
F-1 _L_ FD Li
P)
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 09-051 L6 7,'1:'10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 9 # Window/Sliding Glass Door
Suppl. PC Fee: E) Reg. 0OT 0.0 hrs $0.00 $506.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee.0 Reg. 0 OT 0.0 I hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes E) No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 E)
Planning E; $0.00 Select a Non-Residential Q
i. Building or Structure 0
Strong Motion Fee: IBSEISMICR $0.82 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.82 $506.00 TOTAL FEE: $507.82
Revised: 10/17/2010
� �e e
Scope of Work:Window Replacement Like for Like el,,e 4,f hG 7�0 nni-*
7566 Lockfod Coin �2Y- 20 a'7 C 0 C
71WX38H Y 71WX38H
Meets Egress Reqt Meets Egress Reqt
r
e r m x
x 0
3 022
P&A x
38W X 20
No Replacemen 71W X 79H
71WX40H
Meets Egress Reqt
er 40W X 38H
.
I,
A did
Al.II `Jt ; rX
ANU(7
DATE�G'�Z
phis set of plans and specifications MUS'T
rte-kept on the Iib at all tv,les-and it is
n wful to make a!+y c hanger or alterations
c thout written permission frons
the Building Department, City of Cu rtino
The ;tamping of thv� plan and speCif�ations 71W X 48H
,riAl t NOT hr held to permit or to be an
approval of th +ooi+ )n.,f 1ny
provisions ons
"I 'garage
71W X 50H 47W X 50H ``� +7
tcr—)
CITY OF CUEERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36226C48 . 00
DATE ISSUED. . . . . . . : 10/29/ 2010
RECEIPT # . . . . . . . . . BS000C11872
REFERENCE ID # . . . : 1010011
SITE ADDRESS . . . . . : 7566 I,OCKFORD CT
SUBDIVISION . . . . . . .
CITY CUPER-INO
IMPACT AREA . . . . . .
OWNER SANDED WANDA J AND WENDELL B T
ADDRESS 7566 I,OCKFORD CT
CITY/STATE/ZIP . . . : CUPER-INO, 95014
RECEIVED FROM . . . . : WENDELL SANDER
CONTRACTOR LIC # *OWNER*
COMPANY SANDER WANDA J AND WENDELL B T
ADDRESS 7566 LOCKFORD CT
CITY/STATE/ZIP . . . : CUPER"INO, 95014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---- ------ ---------- ---------- ----------
1BCBSC VALUATION 8, 175 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 8, 175 . 00 0 . 82 0 . 00 0 . 82 0 . 00
1WINREP EACH 8 9 .00 .306 . 00 0 .00 506 . 00 0. 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT 307 . 82 0 . 00 507 . 82 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- - -------------------
CHECK 507. 82 1L01
---------------
TOTAL RECEIPT 507 . 82
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBC'ONTRACTOR LIST
JOB ADDRESS: C c L PERMIT# ,0 0 2
OWNER'S NAME: LV-e 11 c ✓ PHONE# 40e) 6c/7—(7Z
GENERAL CONTRACTOR: BUSINESS 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 INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signat are Date
Please check applicable subcontractors and complete 1 he following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass /Glazing V,r��.. �0 ,,,, (���, f 4 0
Heating
Insulation
Landscaping
Lathing
Masonry
Painting /Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTME14T•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA,35014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• bulldllaCd)cuDerdno.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS7_9 C`' Lv c It �r3� APN 3�Z1r7 _ �I v, v B _02Z Z
22
OWNEFZNA wts,% s�''�/�y OWNER/2 �,PGIrRw;S6fICf / C141
DESCRIPTION OF WORK: ^
We are providing you with an Owner-Builder Acknowledgment,3nd Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you,the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to: signify you understand or verify this information.)
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
uilder" building permit that erroneously implies that the pro perty owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and:subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while work ng on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as,in Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
`7a, 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
4�3. 1 understand as an "Owner-Builder' I am the resporsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
IV44. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
4W 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollar ($500), including labor and materials, I may be
considered an"employer' under state and federal law.
V�6. I understand if I am considered an "employer" unde•state and federal law, I must register with the state and
federal government,withhold payroll taxes, provide worker:;' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also u iderstand my failure to abide by these laws may subject
me to serious financial risk.
W&7. 1 understand under California Contractors'State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
�8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04/14110
`21&9. 1 understand I may obtain more information regard ng my obligations as an "employer"from the Internal
Revenue Service, the United States Small Business Admi iistration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed
contractors.
114-1110. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that
am the party legally and financially responsible for propos:d construction activity at the site address listed above.
fe�11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner-Builders as well as employers.
"W12. 1 agree to notify the issuer of this form immediate y of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a re:ult of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for yc u to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors, you will)be responsible for verifying whether or not
those Contractors are properly licensed and the status of-heir workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction/ending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city in gy be required to be presented when the permit is issued
to verify the property owner's signANe.
Property Owner's Signature: Date: ZDIU
---------------------------------------------------------------------------------------------------------------------------------------------
(NOTE: The following Authorization Form is required to be cc by the property owner only when designating an
agent of the property owner to apply for a construction permit For the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be prese,7ted when the permit is issued to verify the property owner's
signature. /f
Property Owner's Signature: �/��r ' Date: ���L ��� 0A)
OwnerBuilderForm 2010.doc revised 04/14/10
M.Indoor Air Quality and Finishes
1.Use LowMo-VOC Paint 1 IA(1/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAO/Health pts y=yes 0
3.Use Low/No V.00 Adhesives 3[M/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Re3ource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61A(VHealth pts y=yes 0
0
6.Use Exterior Grade Plywood for Interior Uses 1 IA(UHealth pts y=yes
7.Seal all Exposed ftrtioleboard or MDF 4 IA(IMealth. pts y--yes 0
B.Use FSC Certified Materials for Interior Finish 4 Re,,ource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Re Source pts y=yes 0
10.Install Whole House Vacuum System 3 IAo IHealth pts y=yes 0
1 1 1
N.Flooring M M
1.Select FSC Certified Wood Flooring B Res)urce pts y=yes 0
2.Use Rapidly Renewable.Flooring Materials 4 Res)urce pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Res)urce pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAG/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Res)urce pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Res)urce pts y=yes 0
1 1 1
Total Points Available: 1401 1301 57
Total Points Project Received: 01 01 0
G:data/progslgreenbuildir gguidelinestremodelers/greenpointsfina1212.04protected.xls
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CITY OF CUPERTINO
CvPEKTINO GENERAL BUILDING
PERMIT APPLICATION FORM
/0/6 � o
APN #3 l0 Cd/ ry Date: } / / 1
2 - � �i "' c �F/"� C� (J C,'Tp G C'r 2- Lr/
Building Address:
7 S4/� Lv L- A C �
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No El-
HOA: (Exterior work only) Yes ❑ No If es, provide letter from HOA
Owner's Name: Phone #:
We,4; -// awe l t, AXIA Tem 5'A•fA.- 1' ¢e) y "- 35'e" Z
Contractor: Phone:40q ., G s4 - gf/o
U oto l r le W�',►401 C o Fax: Z
Contractor License#: 7z 7,411f
Cupertino Business License#:
Contact: Phone: c-fdu� -07-- / 7 13
wrl n 141 Fax:
Residential Commercial
Job Description: (,W;h jaw (2ep�� cern rm ;`�rc ��''
Building Permit Info:
' Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/VI B, IV-HT, V-B [�
Valuation- Square Footage:
Project Size: Express E&I Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, incl ide in plan set & the sheet index.
Points Achieved: -
For help, contact Build it Green at www.buRditzreen.org
Revised 07/14/09