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10090199 CITY OF CUPERT INO BUILDING PERMIT BUILDING ADDRESS: 7635 HOLLANDERRY PL CONTRACTOR:OMNI WINDOW PERMIT NO: 10090199 SYSTEMS 'WNER'S NAME: DEBJXOTI PAUL 2156 SAN RAMON VALLEY BLVD DATE ISSUED:09/21/2010 ,,,WNER'S PHONE: 4084891971 SAN RAMON,CA 94583 PHONE NO:(925)855-3812 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class 7 Li,.# al dt s REPLACE 8 RETOFIT WINDOWS, 1 DOOR Contractor lbP't 11 4li v\ ► SV S�'r"S Date J I Q 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:$4983 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 APN Number:36226068.00 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 relati ig 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 INSPECTI ON indemnify and keep harmless the City of Cupertino against liabilities,judgments, 7_D4 costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: \ Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: signature �`'Z`Y Date y ) 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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 compensati m, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors tj HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California 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: Health&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. will 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 25505,2 533 d 25534. 7 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: , y ( Date: L permit is issued. I certify that in the performance of the work for which this permit is issued,I shal I v 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,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender'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 -on the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION lemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulatii s per the Cupertino Municipal Code,Section Licensed Professional 9.18. �7 Signature r Date v CITY OF CUPERTINO FEE ESTIMATOR-13UILDING DIVISION ADDRESS: 7635 Hollanderry Dr. DATE: 09/21/2010 REVIEWED BY: jsg APN: BP#: *VALUATION: $4,983 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY OVER THE PENTAMATION USE: SFD or Duplex COUNTER? C)Yes E)No PERMIT TYPE: WORK 8- retrofit windows 1-door replace frame SCOPE TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID OCCUPANCY TYPE: CONSTR. s.f. R-3 (Hillside, Prod. Phase) I-B,iv,v-B o $0.00 $0.00 TOTALS: C $0.00 $0.00 MECH,HOURLY © Yes Q.No PLUMB,HOUIP LY 0 Yes 0 No ELEC,HOURLY 0 Yes No Pi"„o C h<<t: ' J .' Pie±".w f'r'F NOTE. These fees are based on the preliminary information available and are onlV an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 09-051 Eff 7i1:7Oj FEE QTY/FEE MISC ITEMS Plan Check Fee: i .00 9 # Window/Sliding Glass Door Supp/. PC Fee: Reg. OOT 0.0 hrs �.00 $506.00 IWINREP Replacement PME Plan Check: �.00 Permit Fee: .00 Supp/. Insp. FeeC' Reg. OT 0.0 hrsx.00 PME Unit Fee: $().00 PME Permit Fee: $().00 f.:'tl17//-11(ziion lc 1:l Yes � No $x).00 E) Acoustical Fee: 0 Work Without Permit? 0 Yes No $).00 • Planning Fee: $).00 Select allon-Residential 0 Building or Structure 77-tr�r°!Dt�t`trtrt�°rrfulir�rt 1'`{'a'. : Strong;Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldu Stds Commission Fee: IBCBSC $1.00E SUBTOTALS: 1.50 $506.00 TOTAL FEE: $507.50 Revised: 9/14/2010 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: SylviaM 3 ITEMS OF 3 COPY # : 1 Sec: Twp: Rng: Sub: Blk Lot: APN 36226068 .00 DATE ISSUED. . . . . . . : 09/21/2010 RECEIPT #. . . . . . . . . BSO )0011518 REFERENCE ID # 10030199 SITE ADDRESS . . . . . : 7635 HOLLANDERRY PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DEEJXOTI PAUL ADDRESS . 7635 HOLLANDERRY PL CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM • " BAN: ROBERT WS CONTRACTOR . . . . . . BENTLEY LIC # 27371 COMPANY OMNI WINDOW SYSTEMS ADDRESS 2156 SAN RAMON VALLEY BLVD CITY/STATE/ZIP SAN RAMON, CA 94583 TELEPHONE FEE ID UNIT QUANTITY .%MOUNT PD-TO-DT THIS REC NEW BAL ---- ---------- ------- ---------- ------------- ---------- ------ 0 .00 1. 00 0 •00 1BCBSC VALUATION 4, 983 .00 1.00 1BUSLIC FLAT RATE 1 .00 114 . 00 0 .00 114 . 00 0. 00 1WINREP EACH 8 9 .00 506 . 00 0 . 00 506 . 00 ------0_00 TOTAL PERMIT 621 . 00 0 .00 621 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---- --------------- CHECK 621. 00 --------------- TOTAL RECEIPT 621. 00 W - x i � k � 3 n J 9J .r. ori H �J Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SU13CONTRACTOR LIST JOB ADDRESS: -� C 1 I r�, ��� C . PERMIT# � OWNER'S NAME: Dcj i PAu PHONE# GENERAL CONTRACTOR: k C�k /l�✓it BUSINESS LICENSE# ADDRESS: 30 j0 - a=I fi• ' CITY/ZIPCODE: *Our municipal code req fres all busi esses working in rhe city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY SUBCONTR]CTORS ION(S) WILL BE HAVE OBTAINED AHCITY OF CUPERTINO UNTIL THE GENERAL CONTRACTOR AND ALL BUSINESS LICENSE. J I am not using any subcontractors: Date Sig nature Please check applicable subcontractors nd complete the following information: SUBCONTRACTOR BUSINEISS 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 11y'fi Date Owner/Contractor Signature M.Indoor Air Quality and Finishes " 1.Use LOWINo-VOC Paint 1 IAQMealth is es 2.Use Low VOC,Neater-Based Wood Finishes p Y--yes; 21AQ/Health pts y=yes p 3.Use LowNo VOC Adhesives 3 IAWHealth tS es 4.Use Salvaged Materials for Interior Finishes s y� 0 3 Resource pts Y--yes p 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 3IAQ/Health is r- es 6.Use Exterior Grade Plywood for Interior Uses p y AD 1 IAQ/Health pts y=yes 7.Seal.all Exposed P3riioleboard Dr MDF _1 IAQ/Health pts = esB.Use FSC Certified Materials for Interior Finish �Resource pts y--yes p 9.Use Finger-Jointed or Recycled-Content Trim t Resource pts y=yes p 10.Install Whole House Vacuum System 3 IAQ/Healthis P Y=yes 0 N.Flooring / D D 1.Select FSC Certified Wood Flooring B Resource pts y=yes p 2. Use Rapidly Renewat�le Flooring Materials 4 Resource pts y=yes p 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes p 4.Install Natural Linoleum in Place of Vinyl . 5 IAQ/Health pts y=yes 5.Use Exposed Concrete as Finished Floor p 4 Resource pts y=yes p 6.Install Recycled Content Carpet with Low VOCs 4 3esource pts y=yes p ■ 1 (t B Total Points Available: 140 130f— Total 30 Total Points Project Received: 0 0 0 G:data/progs/greenbL ildingguidelines/ramod�-lers/greenpointsfina1212.D4pmleDled.xis .� CITY OF C„UPER 1 INO CUPEKTINO GENERALJ BUILDING PERMIT APPLICATION FORM APNL5 Z 2-4P b� Date: ( . Building Address: r� Mailing Address (if different from building address): Are Hazardous Materials being used as part of the s project? Yes L No HOA: (Exterior work only) Yes ❑ No If Yes, provide letter from HOA Owner's Name: , Phone#: Contractor: j3 Phone: Pe s S,� -lao Fax: �- - - � 1,6 Contractor Licens #: S Cupertino Business License#: Contact: , Phone: S/O f S 3- /6ei U I /v,/ i V Fax: /,6 Residential Commercial Job Description: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ E/III/V-A ❑ IUIII B, IV-HT, V-B 3 <. Valuation: 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. 'oints Achieved: For help,-contact Build it Green at www.builditpreen.or Revised 07/14/09 2