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10090104 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11144 LA PALOMA DR CONTRACTOR:HOLDER INC DBA ABLE PERMIT NO: 10090104 GLASS IWNER'S NAME: VINCENT LIANG 1129 RICHARD AVE DATE ISSUED:09/15/2010 OWNER'S PHONE: 4088901036 SANTA CLARA,CA 95050 PHONE NO:(408)496-9960 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class C' Lic.# �0 //p WINDOW REPLACEMENT(10)LIKE FOR LIKE Contractor Date -('S''�J I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Profession! Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarati ms: 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:$5600 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:35616042.00 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 rel:.ting WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to entt r upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYFROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgment,, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will compl, Issued by: Date: with all non-point sowce regulations per the Cupertino Municipal Code,Sectiot 9.18. -�T-,/0 RE-ROOFS: ?nature Date 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 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 I,as owner of the property,or my employees with wages as their sole compensz tion, 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 contractor: to 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,Sectio 05,25533,and 25534. Owner or authorized agent: Section 3700 of the Labor Code,for the performance of the work for which this .11 . b permit is issued. Date: 1 certify that in the performance of the work for which this permit is issued,I sh ill 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 inust 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 rel:.ting to building construction,and hereby authorize representatives of this city to entt r n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION :mnify and keep harmless the City of Cupertino against liabilities,judgment 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 regulations per the Cupertino Municipal Code,Sectior Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATORBUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $5,600 *PERMIT TYPE: Building Permit PL.\N CHECK TYPE: Alteration /Addition/ Repair __rPRIMARY PENTAMATION SFD or Duplex 1GENRES USE: p �'f t)t3f � �� PERMIT TYPE: WORK SCOPE r f Lj L_ ai:'i-ft. l'�tYi f'Yii.ck. `E?r;n [!cat-.n'r;w "'I",- � 'li. b1'P NOTE. These fees are based on the preliminary in ormatio,:available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS LFee Resohrtion 09-051 Eff. 7-'1!I0) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 10 # Window/Sliding Glass Door Suppl.PC Fee: (F) Reg. OT 0.0 hrs $0.00 $506.00 I WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee O Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'rtzstr!1Cfiurz 7-C 1,\ Acoustical Fee: 0 Yes No $0.00 Work Without Permit? 0 Yes No $0.00 Plannim£;Fee: $0.00 Select a Non-Residential Building or Structure 0 Tr<n�rl �)t�<�rrtt7crti�rtrr,rt f'e'E'.4 � Stronk;Motion Fee: IBSEISMICR $0.56 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.56 $506.00 TOTAL FEE: $507.56 Revised: 9/14/2010 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 3E616042 . 00 DATE ISSUED. . . . . . . : 0S /15/2010 RECEIPT #. . . . . . . . . BE;000011461 REFERENCE ID # . . . : 10090104 SITE ADDRESS . . . . . : 1:_144 LA PALOMA DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VLNCENT LIANG ADDRESS . 1L144 LA PALOMA DR CITY/STATE/ZIP CUPERTINO, CA 95014-4773 RECEIVED FROM VINCENT LIANG CONTRACTOR HDLDER, ERIC LIC # 22037 COMPANY . . . . . . . . . . : HDLDER 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 5, 600 .00 1. 00 0 .00 1 .00 0. 00 1WINREP EACH 8 10 .00 506 . 00 0 .00 506 .00 -- 0. 00 ---------- ---------- ---------- - TOTAL PERMIT 507 . 00 0 .00 507 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------ CHECK 507 . 00 559 TOTAL RECEIPT 507 . 00 � ayt k ' P F i '�y'1 i P•R'�'G � M�4�t r•t 'r1 �t+��.`4M ' M ° � � ° �` � ...,iii•-. O • Q r , X P (gyp �' �7 a � • x iz IN ,.,� �, is ..� , � ��{ �� . • •.. AM A �� ,','mob.°. ktt��.�:�`- t a w rd� ay P ,f^f„i � °�".!, .:S •,- �� _ s �� 1, � �Q • --� • y�'-"kta y'-wx �.At k*�i. ,c ' r a rc.,w.n CITY OF (.UPER 1 INO CUPCof ERTINO GENERAL BUILDING PER1V41T APPLICATION FORM APN # _ l Date: Building Address: 'I/ / n Il1_l, ✓� Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes E] No HOA: (Exterior work only) Yes ❑ No 7 If77:5 HOA Owner's Nan : Contractor: ' ff M (o Nrc .T'nl c P eAr t4 6It- �S r Fax: Contractor actor License#: ?O qte eno Business License#:rt Contact: Phone: yI0BJ 761- 160.0 'Pi'G Fax: Residential Commercial ❑ Job Description: A--p � o (�/('N DWT (/j, ✓�- c�kcc- �� l� Building Permit Info: ' Bl d ❑ Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy e: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B Valuation: Square Footage: Project Size: Express [Standard ❑ Largf; ❑ Major ❑ �� Green Building: Please complete relevant portiou of the Green Building/LEED Checklist & attach it to the application or if applicaYle, include in plan set & the sheet index.' ?oints Achieved: For help, contact Build it Green at www.builditereen.or Revised 07/14/09 3