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10080073
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 923 BROOKGROVE LN OWNER'S NAME: YENPO LIN NER'S PHONE: 4088651876 ❑ LICENSED CONTRACTOR'S DECLARATION 1-5 License Class{ Li 7� Contractor Date - t� I hereby affirm that en d under the provisions of Chap er 9 (commencing with S ion ) 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 autho ' e representatives of this city to enter upon the above mentioned property for i -_tion purposes. (We) agree to save indemnify and keep harmless the City Cupertino against liabilities, judgments, costs, and expenses which may acc against said City in consequence of the granting of this permit. Addition the applicant understands and will comply with all non -point source regula +ns; per the Cupertino Municipal Code, Section 9.18. Signature Date!is��/, 0 L- OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 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 California. 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 upon the above mentioned perty for inspection purposes. (We) agree to save •nnify and keep ha e the City of Cupertino against liabilities, judgments, and expenses wh' h ay accrue against said City in consequence of the g.unting of this permiv4ditionally, the applicant understands and will comply with all non -point soregulations per the Cupertino Municipal Code, Section 9.18. Iro1 '0/ 1 b CONTRACTOR: CUSTOM EXTERIORS INC. PERMIT NO: 10080073 440 BOULDER CT STE 400 DATE ISSUED: 08/10/2010 PLEA SANTON, CA 94566 PHONE NO: (925)249-2280 BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r MECH r— RESIDENTIAL I— COMMERCIAL r— JOB DESCRIPTION: 4 REPLACEMENT WINDOWS (RETROFIT BOTTOM ONLS )& 2 SLIDI VG PATIO DOORS(BLOCK FRAME) Sq. F: Floor Area: APN Number: 37539026.00 Valuation: $6670 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS M LAST CALLED INSPECTION. Issu :d by: —10-16 Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is insta led without first obtaining an inspection, I agree to remove all new materials for inspt _tion. Sign. tture of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I ha to read the hazardous materials requirements under Chapter 6.95 of the Cali Fornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain com Aiance 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 eq?Cupertino ment or devices which emit hazardous air contaminants as defined byBay Area Air Quality Management District I will mail stain compliance with Municipal Code, Chapter 9.12 and the Hea.th & Safety Code, ons 25505, 25533, and 25534. Owner authorize CUL, , f4- - Date. L I hei eby 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 un ierstand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUF ERTINO PERMIT REICEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37539026.00 DATE ISSUED.......: 08/10/2010 RECEIPT #......... BS000011148 REFERENCE ID # ...: 10080073 SITE ADDRESS .....: 923 BROOKGROVE LN SUBDIVISION ...... CITY CUPER-INO IMPACT AREA ...... OWNER YENPO LIN ADDRESS 923 BROOKGROVE LN CITY/STATE/ZIP ...: CUPER"INO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: IE INC CONTRACTOR KEVIN GUNDRY LIC # 23679 COMPANY CUST014 EXTERIORS INC. ADDRESS 440 BOULDER CT STE 400 CITY/STATE/ZIP ...: PLEASANTON, CA 94566 TELEPHONE ........: (925):249-2280 FEE ID UNIT QUANTITY AMO"JNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION -------------------- 6,670.00 ---------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 6,670.00 0.70 0.00 0.70 0.00 1WINREP EACH 8 6.00 380.00 0.00 380.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- ---------- 381.70 0.00 381.70 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CHECK 381.70 #4381 --------------- TOTAL RECEIPT 381.70 AUG -06-2010 FR I 12:58 PM CUSTOM EXTER I ORS J NC FAX NO. 9252492290 Floor Plan :drawing (ror Permits only) 1',• �� Ih/i ��Qdws �-I� �a.F►-c•�;� iiof-f'o�"• Oc,fY 'A0 tj—W.'iip qct `r -e ".„ � CE i "77,5 Last Name_ -.. Address—_1131-6--sulfa rp %de i~ -Gin City --corder ' -� -!b•- -r-e,.,• ee {.e W AUG -06-2010 FRI 12:58 PM CUSTOM EXTERIORS,INC CITY OF CUPERTINO FAX NO. 9252492290 P. 03 ,-;t`y 1,4 11 C� �7� I � 3 �b 'moo ,- r�•e. A •► � . R -X7"7- 3 ZOO) CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Building .Address: L rove Mailing Address (if different from building address): Are Hazardous Materials being used as part of this proiect? 'Yes L1 Na 'I 0A: (Exterior work only Yes aNo fL If yes, orovidee�letter from HOA Owner's Name: y p 8 -- J� $- 18 7 C Ye -In no L- ,V% Zg^ F',,. .r p : l w1NPF-P Fe -e- G..o V r : 13 Date: 9-4-14) Contractor' ' 1 + VS�h•+ +-,LII' Phone: '7 ZS- 1- -1 - z Rax. q Z5-- 2-'i'i -2�qy Contractor License #: -78S-361 Cu ertino Business License #: % Contact: Thone: `� 2S - � y � � � 2 9 O �a I' c r'a- a �, �� a ��,'.�ax: ` t• - z K 9 ^ 2 S' Residential CotYunercial Job Description: 4 � t�ce.:-r �,�, # W•, dew s �' k9e-��--o -A' •l, 4 1 v -e) - Build ng Building Permit Tufo: Y+� Type a Colistruction (Usage Class): 1-A, 1-E IM/V-A L3 I/VI B, IV -HT, V -B Valuation: 7 Project Sire. Express ❑ Standard ib © Meeb .� Occupancy Type: Square Footage: or Green Building: Please complete relevant portion of the Green I3uildingf.LEED Checklist & attach it to the application or if applicable, in elude in plan set & the sheet index. Points Achieved: Far hel , contact Build it Green at www.buildit reen.ur Revised 07/14/09 CITY OF CU]PERTINO FFF. Ti.QT1MATnR —RT RIMING DIVISION LarAPN DRESS: --- ----- -_ - - --- QTY/FEE T: ATE: 08/10/2010 REVIEWED BY: gs Plan Check Fee: : BP#: "VALUATION: I$N,670 *PERMIT TYPE: Building Permit Suppl. PC Fee: G Reg. 0 OT PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex $0.00 TC)7.2L. _008 APPLICATION 1GENRES TYPE: �W Permit Fee: $0.00 94 a cc 0.0 hrs 3U A7l1Tc. TL...... ,... ,...,, L..o. 4 „� 01%., istfnrm,7dnn avaikrhte and are anly an estimate. Contact the Dept for addn 7 info. [TW 8 ♦ is CaL= "I. usocas v ....... ...........», _.. ... FEE ITEMS (Fee Resolution 09-051 E.,ff' 7,,1`09) .. �__._._ �. �__- FEE --- ----- -_ - - --- QTY/FEE MISC ITEMS Plan Check Fee: $0.00 6 # $380.00 Window / Sliding Glass Door 1 WINREP Replacement Suppl. PC Fee: G Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('017 N 11,U(I 11(11l -1-60" , Acoustical Fee: Yes Q No $0.00 'l ick'r�i. l�i�Lti7l r5't ?i P1,1110, MO! 01ho NN1,, ;_ to :/z 1 (,.. P£'t-3T f )"v Ipy. I T71 A7l1Tc. TL...... ,... ,...,, L..o. 4 „� 01%., istfnrm,7dnn avaikrhte and are anly an estimate. Contact the Dept for addn 7 info. [TW 8 ♦ is CaL= "I. usocas v ....... ...........», _.. ... FEE ITEMS (Fee Resolution 09-051 E.,ff' 7,,1`09) .. �__._._ �. �__- FEE --- ----- -_ - - --- QTY/FEE MISC ITEMS Plan Check Fee: $0.00 6 # $380.00 Window / Sliding Glass Door 1 WINREP Replacement Suppl. PC Fee: G Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('017 N 11,U(I 11(11l -1-60" , Acoustical Fee: Yes Q No $0.00 0 Work Without Permit? Q Yes (D No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 � 7r•irti'c; l:?ut rrrrte=111c1ti«rz Fcus, Strong Motion Fee: IBSEISMICR $6.67 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS:' $9.67 $380.00 TOTAL FEE: $389.67 Revised: 8/06/2010 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: 2Z ` r. PERMIT OWNER'S NAME: PHONE # GENERAL CONTRACTOR: tip. 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 INSI' ""J� ION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRAC .P#S HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signatt re Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS N AME 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