10070056 I CITY OF CUPERTIT40 BUILDING PERMIT
BUILDING ADDRESS: 10039 OAKLEAF PL CONTRACTOR:ARGONAUT WINDOW& PERMIT NO: 10070056
DOOR,INC
`NER'S NAME: PATTY NG 1901 S BASCOM AVE STE 800 DATE ISSUED:07/07/2010
V WNER'S PHONE: 4085170998 CAMPBELL,CA 95008 PHONE NO:(408)378-4018
❑ LICENSED CONTRACTOR'S DECLARATIONI—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH r- RESIDENTIAL [_ COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:WINDOW REPLACEMENT
(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:
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.Tt Floor Area: Valuation:$13441
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:32618055.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Issued b Date..--7) r/®
9.18.
C1,-nature Date
r
RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code). ITry
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District 1 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,Sec'ons 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner or authorized agen r
Compensation laws of California. If,after making this certificate of exemption,I Date: (�
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that 1 have read this application and state that the above information is Lender's Name
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 Lender's Address
the above mentioned property for inspection purposes.(We)agree to save
.mify 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 I understand my plans shall be used as public records.
with all non-point sourc regulations per the Cupertino Municipal Code,Section
9.18. ��t Licensed Professional
Signature Date 1
CITY OF CUPERTINO
FEE ESTIMATORBUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$13,441
,`PERMIT TYPE: Building Permit PLE►N CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex __[OVER TIS E APPLICATION 1 R3SFDADD/REM
USE: COUNTE R 0 Yes 0 No TYPE:
MECHANICAL 0 Yes No PLUMBING 0 Yes (E) No ELECTRICAL 0 Yes (E)No
as
3 �
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s+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 in ormation available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS 0-'ee Resolution 09-05I P'f 7,1,09) FEI QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl. PC Fee: 0 Reg. 0 OT Ro I hrs $0.00 $632.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT 0.0 1 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 (F) No $0.00 0
Planning I"ee: $0.00 Select a Non-Residential
Building or Structure 0
Strong Motion t=ee: 1BSEISMICR $' .34 Select an Administrative Item
B dg Stds Commission Fee: IBCBSC $' .00
SUBTOTALS: $2.34 $632.00 TOTAL FEE: $634.34
Revised: 6/30/2010
CITY OF CUPERTINO
3 ITEMS OF 3 PERMI'P RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl{: Lot:
APN . . . . . . . . : 32518055 . 00
DATE ISSUED. . . . . . . : 07/07/2010
RECEIPT #. . . . . . . . . : BS300010804
REFERENCE ID # . . . : 10370056
SITE ADDRESS . . . . . : 10339 OAKLEAF PL
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . PATTY NG
ADDRESS . . . . . . . . . . : 10039 OAKLEAF PL
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1127
RECEIVED FROM . . . . : CHRISTOPHER SZETO
CONTRACTOR . . . . . . . : CHRIS ETTEMA LIC # 22820
COMPANY . . . . . . . . . . : AR3ONAUT WINDOW & DOOR, INC
ADDRESS . . . . . . . . . . : 1901 S BASCOM AVE STE 800
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 378-4018
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 13, 441. 00 1 . 00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 13,441. 00 1 .40 0 .00 1.40 0 . 00
1WINREP EACH 8 17. 00 632 . 00 0 . 00 632 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 634 .40 0. 00 634 .40 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 634 .40 #5765
---------------
TOTAL RECEIPT 634 .40
v --
h CITY OF C'UPERTINO
CITY OF
CUPEI�TiNO GENERAL, BUILDING
PERMIT APPLICATION FORM
APN # -- Date: A
4� o� lc
Building Address: ` �3
95014-
Mailing
iMailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No,�
HOA: (Exterior work only) Yes ❑ No If wes, provide letter from HOA
Owner's Name: Phone#:
Contractor: Phone:
Y 1 a-� Fax: ��k -3 - q (?
Contractor License#: ,$ O
Cupertino Business License#:
Contact: t,,,� Phone: _
,4 APY�, W Fax:
Residential -Commercial
Job Description:
Building Permit Info:
Bldg �' Elect ❑ :dumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, VJH� P-- 7 _
Valuation: � �,.��1 ` 1 Square Footage:
Project Size: ExpressET—STandard ❑ Large [] Major ❑
Green Building: Please complete relevant portion (of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
1 For help, contact Build it Green at www.builditgreen.or
Revised 07/14/09
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OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•_ ai�inaiu��aa� .�-a
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:
_T5
SITE ADDRESS - {f�r e A BP#
OWNER NAME , ` v v` OWNER AC DRESS saw S
DESCRIPTION OF WORK: N
We are providing you with an Owner-Builder AcknowledgrT ent and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, inil ialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you,the property owner, obtain the prior approval of the PE rmitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
V�). I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder"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,and 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 propffty.
p
rV'\2. I understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contract)r to assume this responsibility.
understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may
otect myself from potential financial risk by hiring a li tensed Contractor and having the permit filed in his or her
name instead of my own.
InN. I understand Contractors are required by law tc, be licensed and bonded in California and to list their license
numbers on permits and contracts.
a 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.
-VA. I understand if I am considered an "employer" tinder state and federal law, I must register with the state and
federal government,withhold payroll taxes, provide wcrkers'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.
`. I understand under California Contractors' Stat 3 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 does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
JVJ&8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any sub Sequent owner(s)that result from any latent construction
defects in the workmanship or materials.
0i4117erBui1derFo7-7n2010.doc revised 04/14110
I understand I may obtain more information regarding my obligations as an "employer"from the Internal
R venue Service,the United States Small Business,%dministration,the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I a so understand I may contact the California Contractors'State
License Board (CSLB)at 1-800-321-CSLB (2752)or www.cslb.ca.gov for more information about licensed
contractors.
SPO. I am aware of and consent to an Owner-BuilJer building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner-Builders as well as employers.
I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed co itractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a licer se, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed
Contractors may be in civil court. It is also important f)r you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while woi king on your property'you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the statu 3 of their workers'compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agencI for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued,this form must be completed and s6lgned by the property owner and
returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the ci y may be required to be presented when the permit is issued
to verify the property owner's signature.
Property Owner's Signature: Date:
----------------------------------------------------------------------- --------------------------------------------------------------------
(NOTE. The following Authorization Form is required to b s completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner,the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s)to;apply for, sign,and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):_
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property ovmer for the address listed above and I personally filled out the
above information and certify its accuracy. Note:A copy oi*the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
Oi4,nerBuilderFornt 2010.doc revised 09/19/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: �b34 PERMIT# OCA
OWNER'S NAME: PHONE# C -
GENERAL CONTRACTOR: BUSINESS LICENSE# Sq'
ADDRESS: �, CITY/ZIPCODE: y
*Our municipal coTe requires all businesses working in"the city to have a City of Cupertin business iicense.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTP ACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Si,;nature Date
Please check applicable subcontractors and compl ate the following information:
V 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
t'n—)e /Contrac4 Sig nat re Date