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10070152 ' CITY OF CUPERTIT40 BUILDING PERMIT BUILDING ADDRESS: 22085 LINDA VISTA PL CONTRACTOR:ARGONAUT WINDOW& PERMIT NO: 10070152 DOOR,INC YER'S NAME: JAMES E&NANCY T NEAR 1901 S BASCOM AVE STE 800 DATE ISSUED:07/22/2010 OWNER'S PHONE: 4088651005 CAMPBELL,CA 95008 1 PHONE NO:(408)3784018 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT f— PLUMB License Class Lic.# MECH RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE 12 WINDOWS, I DOOR&REPLACE WITH NEW (commencing with Section 7000)of Division 3 of the Business&Professions (LIKE Code and that my license is in full force and effect. SIZES)TEMPERED AND EGRESS WHERE APPROPRIATE;NO STRUCTURAL,NO ELECTRICAL;EXTERIOR FINISHES TO 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. Sq.Ft Floor Area: Valuation:$10000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35608014.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Lure Date Issued by:_ -!7i- -i��----- Date:? Z2,h OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). 1�+ VI ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER l I hereby affirm under penalty of perjury one of the following thre Y1 . 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. !have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this 'ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& iafety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I 1 Iealth&Safety Code,Sections 25505,25533,and 25534. 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. Owner or uthorized aggnt+� ( 1 4 f/(/Q f Date: 1�. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to I­ilding construction,and hereby authorize representatives of this city to enter ter which this permit is issued(Sec.3097,Civ C.) L e above mentioned property for inspection purposes.(We)agree to save Lender's Name in�_.atify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the bender's Address 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. ( � ARCHITECT'S DECLARATION \ �yy� 7/- 2A 7 f I understand my plans shall be used as public records. Signature Date !/-2A/�)Q Licensed Professional CITY OF =ERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35638014 . 00 DATE ISSUED. . . . . . . : 07/22/2010 RECEIPT #. . . . . . . . . : BS000010935 REFERENCE ID # . . . : 10070152 SITE ADDRESS . . . . . : 22085 LINDA VISTA PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JAMES E & NANCY T NEAR ADDRESS . . . . . . . . . . : 22085 LINDA VISTA PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JAMES E NEAR CONTRACTOR . . . . . . . : CHRIS ETTEMA LIC # 22820 COMPANY . . . . . . . . . . : ARGDNAUT WINDOW & DOOR, INC ADDRESS . . . . . . . . . . : 1901 S BASCOM AVE STE 800 CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 378-4018 FEE ID UNIT QUANTITY A14OUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1WINREP EACH 8 12 . 00 506 . 00 0 . 00 506 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 508 . 00 0 . 00 508 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 508 . 00 #3517 --------------- TOTAL RECEIPT 508 . 00 CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: `VALUATION: j$10,000 PERMIT TYPE: Building Permit PLA N CHECK TYPE: Alteration /Addition / Repair PRIMARY __7OVER THE APPLICATION USE: SFD or Duplex COUNTER? 0 Yes 0 No TYPE: 1 R3SFDADD/REM MECHANICAL Q Yes Q No PLUMBING 0 Yes (F) No ELECTRICAL 0 Yes 0 No xW as 00 3 � OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. (Sq.ft.) R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 F.ff' - /%Ol) FEE QTY/FEE MISC ITEMS Plan Check Fee: $C.00 12 # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT 0.0 firs $(.00 $506.00 IWINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:0 Reg. 0 OT 0.01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (D No $0.00 0 Work Without Permit? 0 Yes E) No $0.00 E) Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Strong Motion F'ee: IBSEISMICR $1 .00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1 .00 SUBTOTALS: $21.00 $506.00 TOTAL FEE: $508.00 Revised: 6/30/2010 CITY OF C UPERTINO ADDMONMialoma= Lai FEE SCHEDULE CUPERTINO APN# ate: Is a 2" unit being added? Yes ❑ No ❑ If yes, please fill out the permit application for 2" unit. Building Address: a 9,035 LINDA- VISTP- PIACE- uPGkTi NO C+ 957DI Mailing Address (if different from building address): Owper's Name: Phone # DEAR - ,Ame -C. n A-NC T. LW_ 3�5 -1005- Contractor: 1005Contractor: Phone #: 408-376 - 401? WGioNhul WitypoW5 f DOO25 1-01% Fax#: y08- 5- Cupertino Business License: of a $'010 State Contractor License #: 998038 Contact: Phone #: 408 - 10 31 — 4 585, T\/t_lEk W 9 ITTAK `R Fax#: 'to? - G89- 0595- Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): ���` If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type [] Water Budget Building Permit Info: Bldg. 0/ Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition): 4-o Yemove- 12, W�ndowS � 1 do�R — rePlAc�. w� hew �Ijke s;zes) — ♦¢ Pcrpe9t^es5 WAAQ,i2.e, R-PPropRn le4p- — 0 S+'fac+cx"l, electk.icaQ. — eX+e2io�2 �cn�sh�g -b maw ZX;St;n Remodel Includes Re-Roof: Yes ❑ No If yes list number of squares J Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other Type of Construction (Usage Class): Occupancy Type: 10— I-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-13 aluation: � /0,tro V.pig Please check this box if the project is a Project Size: Express ffStandard ❑ Large ❑ Major ❑ second-story addition ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved- include chievedinclude in plan set & the sheet index. Revised (5/18/10 � � D � 0 , 3 or (omN VN9) Vt � WN �a n n r- -n G) a F r- a)oo Cn Cn UT : = =CC O CD CD a . . CD .c, co 00 � oo rn t— k 0 0 0 � W n r w � 0) 00 pNk - SCD y CD � � cilk C NO CD � to Q k (D Cl) CD' cn Cb 4 CD � U y a m CD a W W Wcu S CD Q0 CD � CL Q 0O Cn 0CD c 3 �, F M M •� � cn r+3 CD CD o W M CD 3 ` � C N � o j o o X,ca 1 G cc CD w I n rnL � � � 0 3 °° O v o / co OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, 3A 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333•biildingt7a cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS APN BP# la2095 LIN A ViS OWNER NAMEOWNER ADI)RESS NE — 5. mis 6.AND NAA -C. a ao Y 5 L-IND A VI,5 rA PLA-Cf CAPE r N DESCRIPTION OF WORK: Ycrr►oVE_ la w14%dows 1 Aovri — re 14ce w1A hem r'I�fe size) —ttm Reek aVIA PJrt55 A,04., a 1-(A6 We are providing you with an Owner-Builder Acknowledgm ant and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by ha%ing this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicate I. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the pe-mitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement belt w to signify you understand or verify this information.) 4 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- uilder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable Ind subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my propE ty. �1 �.,2. 1 understand building permits are not required t) be signed by property owners unless they are responsible for �(th�e�� nstruction and are not hiring a licensed Contractor to assume this responsibility. U`t,►1.3. 1 understand as an "Owner-Builder" I am the re3ponsible party of record on the permit. I understand that I may �prote—tect myself from potential financial risk by hiring a lil;ensed Contractor and having the permit filed in his or her name instead of my own. UL4. I understand Contractors are required by law tc be licensed and bonded in California and to list their license (numbers on permits and contracts. 4.P.5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an"employer" under state and federal law. Z�.6. I understand if I am considered an "employer" under state and federal law, I must register with the state and deral government, withhold payroll taxes, provide we rkers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I a so understand my failure to abide by these laws may subject me to serious financial risk. 4 hh 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures Joes not exceed four within any calendar year, or all of the work is performed under contract with a licensed general bL ilding Contractor. 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for Yaryi nancial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doe revised 04/14/10