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10090046CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21764 REGNART CT CONTRACTOR: HOLDER INC DBA ABLE PERMIT NO: 10090046 GLASS 1ER'S NAME: ARTHUR S MUTO 1129 RICHARD AVE DATE ISSUED: 09/08/2010 OWNER'S PHONE: 4082577865 SANTA CLARA, CA 95050 PHONE NO: (408) 496-9960 LICENSED CONTRACTOR'S DECLARATION r r r— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C" Lic. # 6 90 9l r r 941-110 MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE WINDOWS & PATIO DOOR LIKE FOR LIKE PER (commencing with Section 7000) of Division 3 of the Business & Professions 2007 CBC; 3 WINDOWS & 1 SLIDING PATIO DOOR 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: $5400 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. APN Number: 35624047.00 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 source regulations per the Cupertino Municipal Code, Section 9.18. Issued b � ature Date ' � �� RE -ROOFS: ❑ OWNER -BUILDER DECLARATION 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) I, 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 HAZARDOUS MATERIALS DISCLOSURE 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 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. 1 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 contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. 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 & Safety 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 Owner or rized agent: become subject to the Worker's Compensation provisions of the Labor Code, I must Date:.9�� 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 t� huilding construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save Lender's Address ,__.,mnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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 3 ITEMS OF 3 CITY OF =ERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35624047.00 DATE ISSUED.......: 09/08/2010 RECEIPT #.••..•...: BS000011401 REFERENCE ID # ...: 10090046 SITE ADDRESS .....: 21764 REGNART CT SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ARTHUR S MUTO ADDRESS 21764 REGNART CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: ARTHUR MUTO CONTRACTOR .......: HOLDER, ERIC LIC # 22037 COMPANY HOLDER INC DBA ABLE GLASS ADDRESS ..........: 1129 RICHARD AVE CITY/STATE/ZIP ...: SANTA CLARA, CA 95050 TELEPHONE (4C8) 496-9960 FEE ID UNIT QUANTITY PMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 5,400.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 5,400.00 0.60 0.00 0.60 0.00 1WINREP EACH 8 1.00 380.00 0.00 380.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 381.60 ---------- 0.00 381.60 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CREDIT CARD 381.60 VISA --------------- TOTAL RECEIPT 381.60 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION lim ADDRESS: DATE: REVIEWED BY: Plan Check Fee: APN: I I BP#: *VALUATION: 1$5,400 --1 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex T 1'I'l l: FI A rtiE„' PENTAMATION 1 GENRES PERMIT TYPE: USE: -00H Permit Fee: WORK Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs SCOPE _ —_ _. .._ _ __ _.i___.__ __. s__t—...s:..........:/..61n ns.d nra nn/v nn acfimnty_ Contact the Dept for addn'l info. NO E These Lees are based on [ne reurrunutv N[ v..•suuw NOTE: FEE ITEMS (Fee Resolt:tion 09-051 E f . 7/1;101 af,t:h. P 11"m t'h, ( k �••» »• - -- QTY/FEE Iles_ 1 hzt: C r ,�,k Plan Check Fee: I'IL' iPtt Pe`lrrEtl FJE'; CC Pcrlrit; `:'c __ET__1_ Other ;lkcA Irvq olhccr PhImb Irts,�� Utlr�r l ies. Insp L— ^11"ch, Mv) 1"v. P,hwd)l bzi/z Fc',: I;l<�c_ Msp, F��e _ —_ _. .._ _ __ _.i___.__ __. s__t—...s:..........:/..61n ns.d nra nn/v nn acfimnty_ Contact the Dept for addn'l info. NO E These Lees are based on [ne reurrunutv N[ v..•suuw NOTE: FEE ITEMS (Fee Resolt:tion 09-051 E f . 7/1;101 - u ras..s•iw FF E �••» »• - -- QTY/FEE MISC ITEMS Plan Check Fee: 50.00 4 # $380.00 Window / Sliding Glass Door I WINREP Replacement Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: 50.00 Permit Fee: 60.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C. Olt,i7i°lPC`ZiOt7 1 -OX Acoustical Fee: 0 Yes (F) No $0.00 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure %1-ave'l Ooctonc motion 1" ccs Strong Motion Fee: IBSEISMICR $0.54 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.54 $380.00 TOTAL FEE: $381.54 Revised: 9/01/201 u - CITY OF CUPERTINO C1TY Of CUPEKT1NO GENERAL BUILDING PERMIT APPLICATION FORM APN # � �24 --047 - Date: 9 A/1v • _ Buillin a Addre-T (2 CA sz) Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes 7 No e- HOA:(Exterior work only) Yes ❑ No If fes, provide letter from HOA Owner's Name: Phone* Contractor: _ AV(P DO+ C er— Phone: Tom (94(, Mo Fax: ontractor License #: 6 % 'O'�%ff Cupertino Business License #: Contact: Phone: FOY) 7,6/_ Fax: Residential Commercial Job Description: / / �t / ��-CC% (N /N LK) C G6 At -77 O �((CP feYL a o 7 013 3 w -xj DUW � l �a -0 A�11 y Building Permit Info: 'Bldg L� Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ U/MN-A ❑ II/III B, IV -HT, V -B Valuation:r� /p O Square Footage: Project Size: Express �tandard ❑ Large E Major ❑ Green Building: Please complete relevant portion o�F the Green B' ' ding/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.buildil�n.or Revised 07/14/09 J