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10030021 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22445 LINDA ANN CT CONTRACTOR:ARGONAUT WINDOW& PERMIT NO: 10030021 DOOR,INC ""'NER'S NAME: RARICK JAMES 1901 S BASCOM AVE STE 800 DATE ISSUED:03/02/2010 1,..NER'S PHONE: 4082452753 CAMPBELL,CA 95008 PHONE NO:(408)378-4018 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB License Class Lic.# MECH r RESIDENTIAL I— COMMERCIAL Contractor Date JOB DESCRIPTION:REPLACE 4 WINDOWS&1 SLIDING GLASS DOOR 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:$5000 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:32613076.00 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 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 by: Date:7 e_r(o 9.18. S�"Tiature Date 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 r�'reby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,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) 1,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). 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. 1 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 I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safe ode,Sections 25505,25533,and 2 534. . 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 Owne r aut riz Id nt: !l Compensation laws of California. If,after making this certificate of exemption,I Date:.M, J 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 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, ARCHITECT'S DECLARATION WAS,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-po' our e regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date V CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32613076 . 00 DATE ISSUED. . . . . . . : 03/02/2010 RECEIPT #. . . . . . . . . BS000009862 REFERENCE ID # . . . : 10030021 SITE ADDRESS 22445 LINDA ANN CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RARICK JAMES ADDRESS 22445 LINDA ANN CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1026 RECEIVED FROM . . . . : JAMES B RARICK 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 5, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 5, 000 . 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 ----------------- --------------- -------------------- CREDIT CARD 381 . 50 VISA --------------- TOTAL RECEIPT 381 . 50 c Ir �MeS �C��cry r It 1 x �0yox � � � 09-70 _ �b `� r ALA r OQ M r Mel alelS �o a)uewp,p APO�(ue;o suaIS�nO,d ALA?;o uotleloin ayl 40 lenadde ue aq of jo pwaad of Play aq ION-11VHS suolte�+Oads pu{ uvid yn;,jo 6uodwets e41 ouil�a�n�;u (�_) l.�aul�e aQ6wp;m8eyt wo3;UOISSowja(, 00L411M awes e alew of 1 n p suaite�al�e ,,saf, ��,i V'^ 1 f si 1� p,�t ;a�.,il il� qol ayt u0 idaj aq K� Q� sup F, �� i- , tiueld;0 las Slyl CHNOIS t O ) -Z,- -c 31b(l Z r CITY OF CUPERTINO CUPEf�TINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date:, Building Address: Mailing Address (i diffeUtfr m bu'ldin ress): I 0 Cu-)A- �' S,v i S Are Hazardous Materials being used as part of this project? Yes LJ No J0 HOA: Exterior work only) Yes ❑ No If Yes, provide letter from HOA Owner's Name: Phone#: Contractor: `` Phone: - () 6 '2_ a'- LU Fax: Contractor License#: Cupertino Business License#: Contact: (� L / Phone: j�"� --71 C -(�,�E.. Fax: Residential PQ Commercial ❑ Job Description: �C �z V,. �r��v S `C Cj�C1S �!coo Building Permit Info: Bldg 9 Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B � R r-- Valuation: Square Footage: J,C>CSU Project Size: Ex ressZ[�andard ❑ 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 help, contact Build it Green at www.builditgreen.org Revised 07/14/09 CITY OF CUPERTINO STV:4� aOF GENERAL BUILDING APPLICATION CUPEkTINO 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) IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK 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) hourly-stand alone r 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel &Documentation B 1 BUSLIC Business License B 5 of 5 Community Development 4`''°: 10300 Torre Avenue 'i Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ;UPEkTIN0 Building Department JOB ADDRESS: ZZ-gC( L_w.-JA--,x XN r\ C+-- PERMIT # OWNER'S NAME: ez-,V,=Q(�— i GPHONE # U u Z q S` Z7 � GENERAL CONTRACTOR: o 1,.c,-., w , ,� FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock ' e lil�il�a�&- er/Contractor Signature Date