10070205 ' CITY OF CUPERTI NO BUILDING PERMIT
BUILDING ADDRESS: 10953 SWEET OAK ST CONTRACTOR:AMERICAN VISION PERMIT NO: 10070205
WINDOWS INC
OWNER'S NAME: GIOVANNA PETRICCIANI 365 REED ST DATE ISSUED:07/30/2010
NER'S PHONE: 6502699907 SANTA CLARA,CA 95050 PHONE NO:(408)617-0901
LICENSED CONTRACTOR'S DECLARATIONF
Q p�y BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class is Lic.#7783."(o r F
MECH RESIDENTIAL COMMERCIAL
Contractorh r",W Date7LWio
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:WINDOW&PATIO DOOR REPLACEMENT.6 WINDOWS&
(commencing with Section 7000)of Division 3 of the Business&Professions 1
PATIO DOOR,ALL RETROFIT
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 Sq.Ft Floor Area: Valuation:54865
permit is issued.
APPLICANT CERTIFICATION APN Number:32651014.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by:. Date:�—
SienatureDate *71_2,b11[)_
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one 01 All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,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,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California 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 Code,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
Additionally,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 mus 00"Wr or thprized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. y Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm 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 relatinl for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
-^n the above mentioned property for inspection purposes.(We)agree to save
mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
CU.LS,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 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 3: 651014 . 00
DATE ISSUED. . . . . . . : 0' /30/2010
RECEIPT #. . . . . . . . . BE-000011035
REFERENCE ID # . . . : 1( 070205
SITE ADDRESS . . . . . : 1( 953 SWEET OAK ST
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER G]OVANNA PETRICCIANI
ADDRESS . . . . . . . . . . : 10953 SWEET OAK ST
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0123
RECEIVED FROM . . . . : AMERICAN VISION WIN
CONTRACTOR . . . . . . . : W-:LLIAM ROMANO HERREN LIC # 26864
COMPANY . . . . . . . . . . : AMERICAN VISION WINDOWS INC
ADDRESS . . . . . . . . . . : 365 REED ST
CITY/STATE/ZIP . . . : SINTA CLARA, CA 95050
TELEPHONE . . . . . . . . : 0:08) 617-0901
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 4, 865. 00 1 . 00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 4, 865. 00 0 . 50 0. 00 0. 50 0 .00
1WINREP EACH 8 1. 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
----------------- --------------- --------------------
CHECK 381 .50 #1403
---------------
TOTAL RECEIPT 381.50
CITY OF CUPERTINO
FEE ESTIMATOR.- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$4,865
PERMIT TYPE: Building Permit PLikN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex OVER TEE APPLICATION
USE: ---TC �OUNTER. 0 Yes � No TYPE: 1GENRES
MECHANICAL Q Yes Q No PLUMBING Q Yes 0 No ELECTRICAL 0 Yes 0 No
xW
as
0 0
3 �
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s .ft.
TOTALS: 0 $0.00 $0.00
j-,
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept/or addn 7 info.
FEE ITEMS (l-ee Resolulion 29-051 Ef: 7%1%091 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1).00 7 # Window/Sliding Glass Door
Suppl. PC Fee: E) Reg. C) OT 0.0 hrs $0.00 $380.00 1 WINREP Replacement J
PME Plan Check: $0.00
Permit Fee: $).00
Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $).00
PME Unit Fee: $).00
PME Permit Fee: $).00
Acoustical Fee: 0 Yes Q No $).00 0
Work Without Permit? Q Yes (D No $).00 E)
Plannink,Fee: $).00 Select a Non-Residential
Building or Structure
i
Stron-Motion Fee: IBSEISMICR $).50 Select an Administrative Item
Bld(Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $380.00 TOTAL FEE: $381.50
Revised: 7/27/2010
1 -7 -2-
CITY
CITY OF CUPERTINO
CUPEiZT1NO GENERAL, BUILDING
PERMIT APPLICATION FORM
APN # Date:
l� C) l
Building Address:
1QJS_36W,9 ~ 6ST ryARIto
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this; project? Yes 0 No AJ
HOA: (Exterior work only) Yes ❑ No ® If yes,provide letter from HOA
Owner's Name: Phone#:
(A.1611MA/A frrRxe_CxA#1:_ 650 Q0 q907
Contractor: Phone:
Amnxeml 1 ,PPX Fax:
Contractor License#: -7'78Q
Cupertino Business License#:
Contact: PON Phone: 88 y3�S
Fax:
Residential Commercial
Job Description: k&MQo4) �� Pi41 .O Qo01C; R�P�,►�.�M �/r.
ALL R57&2 Cz i.
Building Permit Info:
' Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B � •► _
Val ation: Square Footage:
. 00
Project Size: Express Standard ❑ Large ] Major ❑
Green Building: Please complete relevant portion of the Green Bu' ding/LEED Checklist& attach it
to the application or if applicabl.-, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgr 2en.or
Revised 07/14/09
M.IndoDiir Air Quality and Finishes
1.Use r1No-VOC PWrd 1 IAQ/Health pts y--yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts yryes 0
3.Use Lowft VOC Adhesives 3 IAQ/Health pts y=yes D
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes D
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes 0
7 Ssalall BWsW.P-articleWardorWF 41AQMealth pts y=yes D
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes D
9.Use Finger-Mrited or Recycled-Content Trim 1 Resource pts y--yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y--yes D
3.Use Recycled Content Ceramic Tiles 4 Resource pts yeses 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y--yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes D
Total Points Available: 1401 1301 57
Total Points Project Received: 0 0 0
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Building Department
City Of Cupertino
Is 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:160Q5q SId % PERMIT# 0 2 C)--(—
OWNER'S NAME: (A i(/ ' PHONE# Q 9907
GENERAL CONTRACTOR: ' BUSINESS LICENSE# 1*78 3%Yo
ADDRESS: CITY/ZIPCODE: JAA/M C
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY NSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTR kCTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. 7/&1
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complc to the following information:
SUBCONTRACTOR BUSINE`+S 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