10040032 CITY OF CUPERTINO BUILDING PERMIT
ESS: 11002 NORTHSEAL SQ CONTRACTOR:ARGONAUT WINDOW& PERMIT NO: 10040032
DOOR,INC
.VIE: BOHRINGER WILLIAM F AND PAULIN
1901 S BASCOM AVE STE 800 DATE ISSUED:04/05/2010
HONE: 4082445922
CAMPBELL,CA 95008 PHONE NO:(408)378-4018
®" LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class /21 Lic.# J9 ( D, y MECH r RESIDENTIAL r— COMMERCIAL�
Contractor '`Q Qy (VA6K a ff V,,r t
JOB DESCRIPTION:LIKE FOR LIKE NON-STRUCTURAL 1 WINDOW&3DOORS
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:
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.Ft Floor Area: Valuation:$6740
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 APN Number:31640038.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter WITHIN 18 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DA OM 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 /V—S — Date:
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by:
9.18. !!11
ture Date��y
i
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: Date:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
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&
Safety Code,Section 25532(a)should I store or handle hazardous material.
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or aut rized agent: Date:
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. 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 I 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 hililding construction,and hereby authorize representatives of this city to enter Lender's Address
ie above mentioned property for inspection purposes.(We)agree to save
It.
.nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
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 source regulations per the Cupertino Municipal Code,Section
Licensed Professional
9.18.
Signature Date r `' l�
C
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
3 ITEMS OF 3 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31640038 . 00
DATE ISSUED. . . . . . . : 04/05/2010
RECEIPT #. . . . . . . . . BS000010106
REFERENCE ID # 10040032
SITE ADDRESS . . . . . : 11002 NORTHSEAL SQ
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER BOHRINGER WILLIAM F AND PAULIN
ADDRESS 11002 NORTHSEAL SQ
CITY/STATE/ZIP CUPERTINO CA, CA 95014-0532
RECEIVED FROM W.F. BOHRINGER
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 6, 740 .00 1. 00 0 .00
1. 00 0 . 00
1BSEISMICR VALUATION 6, 740 .00 0 .70 0 .00 0 .70 0 . 00
1WINREP EACH 8 1 . 00 380 . 00 0 .00 380 . 00 - --- -
TOTAL PERMIT
381.70 0 .00 381.70 0 . 00
METHOD OF PAYMENT AMOUNT --REFERENCE-NUMBER -
__ ---------------
CHECK 381 .70 #4651
TOTAL RECEIPT 381.70
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date:
� � / � � � l�U
L9 -
Building Address: ( D O
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No
HOA: Exterior work onl Yes No ❑ If es, rovide letter from HOA 2
Owner's Name: Phone#: 5
Contractor:
U tv D J Fax:
Contractor License#: O S�
Cu ertino Business License#:
Contact: A ,J ,_0 it � Phone:
Fax: D
Residential Commercial
Job Description: kms- ti C// _ A)o
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Occupancy Type:
Type of Construction(Usage Class):
1-A, 1-B ❑ I1/III/V-A ❑ IUIII
Valuation: Square Footage:
Project Size: Express ❑ 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:
For hel , contact Build it Green at www.builditgreen.org
Revised 07/14/09
CITY OF CUPERTINO
Urn OF GENERAL BUILDING APPLICATION
CUPEI�TINO FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
IEPERMITFE"I Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter) =Bldg
dlone
--E d
1BCBSC Cal Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
ITRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 of 5
NORTHPOINT HOMEOWNERS ASSOCIATION
PROPERTY MODIFICATION NOTICE
Please indicate below which modification(s) are planned for your property. Provide
brochure(s) if possible and a copy of any proposal(s), including the contractor's
license number. Any modification not expressly listed herein, or not conforming to
the restrictions and requirements listed herein for that modification will require an
Architectural Review Application to be submitted to the Grounds and Architectural
Committee and the Board of Directors for approval. Satellite Dish installation has a
separate form to be completed and submitted for approval.
Modification Restrictions and Requirements
Air conditioning unit Unit will be designed for quiet
residential use. Unit will be
f- _ t ?fa_ located within the enclosed yard
of the property. There will be no
part of the unit visible to common
pY areas. Installed by a licensed
contractor.
Replacement window/ Must be same size aperture and
Sliding door location of existing window or sliding
door. Any necessary touch-up
painting is the responsibility of the
Homeowner. Installed by a license
contractor.
Garage door Must be windowless and in conformity
with general architectural style of the
complex. Repainting to conform to
exterior color scheme is responsibility
of the Homeowner. Installed by a
licensed contractor.
Any damages caused to property as a result of modifications will be the homeowner's
responsibility. All prohibitions, restrictions, conditions, and rights of the Association
enumerated under Article V of the amended and restated Covenants, Conditions and
Restrictions of the Northpoint Homeowners Association are applicable to modifications
Contained herein. City permits may be required.
Please Print
Homeowners Name(s):
Property Address: 000 2 AJQ11 F Li*j t S Phone:
u �
Date of Notification: f O Date of Completion:
Homeowner has 6 months to complete the designated modifications and is responsible for
notifying management upon project completion.
Ottrce Use Only
Notification received by: Date:
Completion verified & approved by: Date:
Form adopted 8/10/1999 Revised 5/00
0
k
C�
o 01
k
00 r,
O
N
`0
N �
cn
cn
O
o � oPTI
00
N
I �
,
1
------------------------1
C3, o�
T 00
i
N
{ i J
i
i
t
t