10080170CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1169 HUNTERSTON PL
DWNER'S NAME: PRASHANT DALAL
' 'NER'S PHONE: 4082032679
❑ LICE`NSED CONTRACTOR'S DECLARATION
j
License Class 1 Lic. #
Contractor pal,:�AlacA
ate Z
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:
1. 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.
2. 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 authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
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. i i ally, the applicant understands and will comply with
all non -point source re 1 tions er th upertino Municipal Code, Section 9.18.
Signature Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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, Business & Professions Code)
2. 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:
t. 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.
2. 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.
3. 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 property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
r and expenses which may accrue against said City in consequence of the
z ng of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
CONTRILCTOR: ARGONAUT WINDOW &
DOOR, 114C
PERMIT NO: 10080170
1901 S DASCOM AVE STE 800
DATE ISSUED: 08/24/2010
CAMPB ?LL, CA 95008
PHONE NO: (408)378-4018
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLAC E 7 WINDOWS LIKE FOR LIKE -NO STRUCTURAL.
Sq. Ft F oor Area:
Valuation: $5000
APN Nt mber: 36221018.00
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
18 D DAYS FROM LAST CALLED INSPECTION.
Issued Date, Z
RE -ROOFS:
All roof; shall be inspected prior to any roofing material being installed. If a roof is
installer without first obtaining an inspection, I agree to remove all new materials for
inspecti m.
Signatu e of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have i -cad the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety ode, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contan inants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safe ode, Sections 25505, 25533, and 25534.
Owner or 2 D
Date:
CONSTRUCTION LENDING AGENCY
I hereb � affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lende •'s Name
Lende •'s Address
ARCHITECT'S DECLARATION
I under stand my plans shall be used as public records.
Licensed Professional
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT REC]s'IPT
Sec: Twp: Rng: Sub: Blk: Lo;.
APN ........: 36221013.00
DATE ISSUED.......: 08/24/2)10
RECEIPT #.........: BSOOOO1L266
REFERENCE ID # ...: 1008017)
SITE ADDRESS .....: 1169 HUJTERSTON PL
SUBDIVISION ......
CITY CUPERT INO
IMPACT AREA ......
OWNER PRASHANT DALAL
ADDRESS 1169 HUVTERSTON PL
CITY/STATE/ZIP ...: CUPERTIVO, CA 95014
OPERATOR: suew
COPY # : 1
RECEIVED FROM ....: CHITRH HALAL
CONTRACTOR CHRIS ETTEMA LIC # 22820
COMPANY ARGONAUT WINDOW & DOOR, INC
ADDRESS ..........: 1901 S BASCOM AVE STE 800
CITY/STATE/ZIP ...: CAMPBELL, CA 95008
TELEPHONE (408)378-4018
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
----------
NEW BAL
----------
-----------------------
1BCBSC VALUATION
----------
5,000.00
----------
1.00
----------
0.00
1.00
0.00
1BSEISMICR VALUATION
5,000.00
0.50
0.00
0.50
0.00
1WINREP EACH 8
7.00
380.00
0.00
380.00
----------
0.00
----------
TOTAL PERMIT
----------
381.50
----------
0.00
381.50
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE NUMBER
----------------- ---------------
CREDIT CARD
381.50
--------------------
AMERCIAN
EXPRESS
---------------
TOTAL RECEIPT
381.50
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CITY OF
CUPERTINO
CITY OF CUPI,RTINO
GENERAL BUILDING
PERMIT APPLICATION FORM 14� go/ 1140
APN # v
/� V 6
Date:
Building Address:
r� l
c -156 t
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No
HOA:(Exterior work onlyj Yes ❑ No If yes,
pr)vide letter from HOA
Owner's Name:
Phone #:
Contractor:
Phone:
Ario n ck
Fax:
Contractor License
Cupertino Business License #:
Contact:
Gc` - c(t
Phone:
Fax:
Residential Commercial
Job Description: ''//
Y -e ;o c t Q--
P
,
i I� ws nw-S3ro vtz►.� J
Building Permit Info:
Bid E Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancyeei�
1-A, 1-B ❑ II/III/V-A ❑ I EI B, IV -HT, V -B [�
•► _
Valuation: �;, O o o
Square Footage:
Project Size: Express Standard ❑ Large ❑
Major ❑
Green Building: Please complete relevant portion of the Green Buitding/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.orf�
Revised 07/14/09
CITY OF CU PERTINO
FEE ESTIMATOR - RI 111,n11Nr_ nivicrnm
OCCUPANCY TYPE:
ADDRESS:
DATE:
REVIEWED BY:
PC FEE ID
APN:
BP#:
'VALUATION: 1$5,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRICOUNTER?
USEMARY SFD or Duplex
OVER THE
0 Yes (F)No I
PENTAMATION
PERMIT TYPE: 1 R3SFDW
WORK
$0.00
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR ARE
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,IV,V-B
0
$0.00
hrs
$0.00
l'llollz iii'p. fi ,
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. O OT:TO.01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
0
$0.00h`'��f""
Acoustical Fee: O Yes (F) No
$0.00
rs�x�wk
OURIY
LTMB H UR "Y` ` � e > o M
,i.
1r'
un vala.nalC. a,on[acsrneue r oraaan-t info.
MISC ITEMS
1,111 b, l jao (. iii'ck
Ah'.. P/an i f cck
7 #
$380.00
Window / Sliding Glass Door
:IWINREP Replacement
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
l'llollz iii'p. fi ,
$0.00
NOTE: These fees are haled an tho nrnl;sn;"o.., _JI _
FEE ITEMS (Fee Resohition 09-051 a. 7-7:10)
FEE
visa
QTY/FEE
un vala.nalC. a,on[acsrneue r oraaan-t info.
MISC ITEMS
Plan Check Fee:
$0.00
7 #
$380.00
Window / Sliding Glass Door
:IWINREP Replacement
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. O OT:TO.01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee: O Yes (F) No
$0.00
T
0
E)
Work Without Permit? Q Yes E) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
Strom, Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldy, Stds Commission Fee: IBCBSC
$1.00
SUB'l�'OTAI,S:
$1.50
$380.00T
OTrL F)�E`
$381.50
Revised: 8/17/2010
1. Use Low/No-VOC Paint
1 IAQ/f salth pts
y --yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/I- ealth pts
y --yes
3. Use Low/No VOC Adhesives
3 IAQ/F ealth pts
y --yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resoure pts
y=yes
Formaldehyde
61AQ/F ealth pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/I-ealth pts
y --yes
7. Seal aB F.Vosad Partioleboard or MDF
4 IAQ/F ealth. pts
y=yes
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resoiirce pts
y—yes
10. Install Whole House Vacuum System
3 IAQ/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Resowce pts
y=yes
2 Use Rapidly Renewable Flooring Materials
4 Resouice pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resowce pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Hi:alth pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resoure pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y—yes
Total Points Available:
Total Points Project Received:
1401 1301 57
01 0 0
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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:
PERMIT # 0 eOl�Cs
OWNER'S NAME:
PHONE 6%
GENERAL CONTRACTOR: r �(/ j,U' r
BUSINESS LICENSE #
ADDRESS: ,in AU�2
CITY/ZIPCODE: CAA46 COLSG1U
*Our municipal code requires all businesses working in the city =o nave a t,ity of t.upernno uusuiess ncense.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON RACT RS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.0 ��� ��d
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS 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
Owner / Contractor Signature
Date