10080182 CITY OF CUPERTINO BUILDING PERMIT
UILDING ADDRESS: 21371 MILFORD DR CONTRACTOR: F.RMIT NO: 10080182
WNER'S NAME: JOE UENG ,-3 ro Sem DATE ISSUED:08/26/2010
IER'S PHONE: 4082521775 9 PHONE NO:
] LICENSED CONTRACTOR'S DEECLARATION BUILDII`G PERMIT INFO: BLDG r ELECT r PLUMB r
cense ClassPtat
� Lic.# 7 Ial r r
- MECH RESIDENTIAL COMMERCIAL r
ontractor Date
hereby affim licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 8 WINDOWS SAME SIZE&LOCATION AND
:ommencing with Section 7000)of Division 3 of the Business&Professions TWO(2)
PATIO DOORS
ode and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
have and will maintain a certificate of consent to self-insure for Worker's
ompensation,as provided for by Section 3700 of the Labor Code,for the
erfonnance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Flogor Area: Valuation:$18566
ennit is issued.
APPLICANT CERTIFICATION APN Number:32641102.00 Occupancy Type:
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
building construction,and hereby authorize representatives of this city to enter
pon the above mentioned property for inspection purposes. (We)agree to save PEF.MIT EXPIRES IF WORK IS NOT STARTED
idemnify and keep harmless the City of Cupertino against liabilities,judgments,
osts,and expenses which may accrue against said City in consequence of the WT CHIN 180 DAYS OF PERMIT ISSUANCE OR
ranting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
✓ith all non-point source regulations per the Cupertino Municipal Code,Section
18 Issued W. Date:
signature Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs s hall be inspected prior to any roofing material being installed.If a roof is
he following two reasons: installed v ithout first obtaining an inspection,I agree to remove all new materials for
,as owner of the property,or my employees with wages as their sole compensation, inspection
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Signature 3f Applicant: Date:
3usiness&Professions Code)
:,as owner of the property,am exclusively contracting with licensed contractors to
:onstruct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
[hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
l 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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. Californi r Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Cede,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 Addition illy,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health& Safety Code,Sections 25505,25533,and 25534.
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 Owner map � ' e
Date:/ % c;;`
forthwith comply with such provisions or this permit shall be deemed revoked.
/ CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby:.ffirn that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for whicl this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
nnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I underst and my plans shall be used as public records.
Signature Date License( Professional
CITY OF CUPER-INO
RECE::PT NUMBER: BS000011289
RECEIVED BY: PAT PAYOR: JEFF MARTIN PERMITS
TODAY'S DATE: 08/26/10 REGISTER DATE: 08/26/10
TIME: 10:59
7
1BCBSC 10080182 $1 .00
1BSEISMICR 10080182 $1.90
1WINREP 10080182 $506 . 00
1BCBSC 10080184 $1 .00
1BSEISMICR 10080184 $1 .10
1WINREP 10080184 $380 . 00
BUSINESS LICENSE TAX RENEWAL BY ANDERSEN $114 . 00
----------------
TOTAL DUE: $1, 005.00
CHECK $1, 005 .00 REF NUM: #1020
TENDERED CHANGE
$1, 005 .00 $.•00
aRK CITY OF CUPERTINO
CITY Of
CUPEKTINO GENERAL BUILDING
PERMIT APPLICA77ION FORM
APN # ;� 4 i Z-- Date:
Building Address:
Z.� \IV\Aq o C4 r `«l
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No
HOA: (Exterior work only) Yes ❑ No If yes, pro ride letter from HOA
Owner's Name: Phone#: q08 Z sz. k'V}S
Contractor: Phone:
Fax: i3to 400 -4 -�(
Contractor License '1466q5 c.t}
Cupertino Business License#:
Contact: Phone: Sio 4ce, `+4-4 o
sa- Fax:
Residential Commercial
Job Description:
I 8 �,.��.-mow s �.�-�, amu. � lo«�►:,�
Building Permit Info:
Bldg Elect ❑ Plumb C] Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑
Valuation: Square Footage:
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of 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.builditp-reen.or2
Revised 07/14/09
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: 'VALUATION: 1$18,566
*PERMIT TYPE: Building Permit PLAN CHECE TYPE: Alteration/Addition/ Repair
PRIMARY OVER THE PENTAMATION
USE: SFD or Duplex COUNTER? Yes No PERMIT TYPE:
WORK
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 Mir $0.00
i:..
1VIECI3 HOIJ ,` s4� oIy fR1;Y} tC)'YesrO NF ,_ q
nxaa 9 n „yrs in t v•.._ rt.v9, 4,t t as,?...ira, ,r 'W.,t�:tf *«i” .w„: m t..+.a,c.•x.. .'a r s
f'kot(7r,;A Elul /Torr Chtc
Li,:h 1'reu;lr Vc. !'1 r;nrii. k w. 1.11".
)lhi ED
7Uu�r l'lrtn;l>L;zl� Oth"t f;Ic(
frcc
NOTE: Thesefees are based on the preliminary in ormation available c nd are only an estimate. Contact the Dept-for addn'l info.
FEE ITEMS free Resolnlion 09-051 Gj'. 7`1.110) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 0 # Window/Sliding Glass Door
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 6506.00 1 WINREP Replacement
PNIE Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee10 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes 0 No $0.00 0
Work Without Permit? 0 Yes 0 No $0.00 0
Plannin�� Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
StronyMotion Fee: 1BSEISMICR $1.86 Select an Administrative Item
13I I�Stds Commission Fee IBCBSC $1.00
i n2.86 $506.00 $508.86
, r su�roTaLs:' $ ,F.
Revised: 8/17/2010
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
L121 Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: , PERMIT# d
OWNER'S NAME: or_ PHONE# & y7v
GENERAL CONTRACTOR: ycrrc v. BUSINESS LICENSE#
ADDRESS: d6 CITY/ZIPCODE: `
*Our municipal code requires all businesses working in the city to have a City of CuperUo business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTOF:S E OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
Z6
I am not using any subcontractors:
Signature ate
Please check applicable subcontractors and complete the 'ollowing information:
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 ontractor Signature Date