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10020120 CITY OF CUPERTI vO BUILDING PERMIT BUILDING ADDRESS: 19720 AUBURN DR CONTRACTOR:CUSTOM EXTERIORS INC. PERMIT NO: 10020120 OWNER'S NAME: MR.GHIO 440 BOULDER CT STE 400 DATE ISSUED:02/22/2010 4ER'S PHONE: 4082567811 PLEASANTON,CA 94566 PHONE NO:(925)249-2280 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT I— PLUMB License Class �' Lic.# r T� 36I— r /' _ MECH RESIDENTIAL COMMERCIAL Contractor S_h'`� '�J 0 Date 7, Z.- '- I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:8 WINDOWS,2 SLIDING PATIO DOORSS,ALL RETROFIT (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL 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 Sq.Ft Floor Area: Valuation:$4875 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:31635019.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section �2 2-4d 9.18. . / Issued by" Date: �7 Signature Date C 7 C) y v OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one o' installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: 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). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by 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 contaminants as defined by the Bay Area Air Quality Management District I 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,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owner aut wrized agent: become subject to the Worker's Compensation provisions of the Labor Code,I mus tDate: forthwith comply with such provisions or this permit shall be deemed revoked. _;77 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating, Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address unify and keep harmless the City of Cupertino against liabilities,judgments, ,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 with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. 'Z L /v Licensed Professional Signature Date l CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B]k: Lot: APN . . . . . . . . : 31.635019 . 00 DATE ISSUED. . . . . . . : 02/22/2010 RECEIPT #. . . . . . . . . : B:;000009798 REFERENCE ID # . . . 10020120 SITE ADDRESS 19720 AUBURN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MR. GH I O ADDRESS 19720 AUBURN DR CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2414 RECEIVED FROM . . . . : CUSTOM EXTERIORS, I CONTRACTOR K:3VIN GUNDRY LIC # 23679 COMPANY CUSTOM EXTERIORS INC. ADDRESS 410 BOULDER CT STE 400 CITY/STATE/ZIP . . . : P'�EASANTON, CA 94566 TELEPHONE ( )25) 249-2280 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- -------- 1BCBSC VALUATION 4, 875 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4, 875 . 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 #4199 --------------- TOTAL RECEIPT 381.50 02/22/2010 13: 12 FAX 19252492289 CUSTOM EXTERIORS INC. 0002/003 Floor Plan Drawing (for Permits only) �Ptla��lN iNt ( IV oil' IN A..('.OHl�Atw- 1 ANL: �Nt;NANCES CUPk p"IINO "Oil DATE Z�2 SIGNED �" a Ions MUST lam au1 51 it is 7hbe keptet tOn the I"t'ata Vstifiland unlawful to make`ic'Y�ha�lyes '�alterations 'ntte� pern fission from on Same withoutrtino. De city A C i cations X� the Building of th's pla�"�and �P� a The Stamp g " �� 7 U 0 (L NOT be held to P�t� vis� Q x co q X QSHALL Violathon J Y haw. CJ approval of the Q 0f any City Onjm,ir<"e ur iQ L eul/l^ ;ice, Y W F� � 47Y LL x- ly ZZ .„ .. X10 ,f c X fl bc� ?0)e 3� x� c�XA V1 '7o )C L4-7 "?U V L(7 Ekkixq X0 X � . -I - i - T CE 17-3 z i F("`Q -70 X l4$ Last Name Address 1 °I 7 z0 City C-up&=+,�. CA q5o i N ��e +�'� � �c �� (�f�� e fL'SS d`+ �--° +�l)t,✓j Z�afJ�1 02/22/2010 13' 12 FAX 19252492299 CUSTOM =XTERIORS INC. @001/003 . Cir I-}wlt CITY OF 300 -Ferri_ Ave . C.,P�+;,,o CLi08- 777-3200 Fee S � : I wlN/ZEP CITY OF CUPERTINO Fe-e- G.-o,r = Q GENERAL :BUILDING CUPERTINO PENT APPLICATION FORM APN# I Date: I -7 ' 8uildinb Address: t 7�L Mailing 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 ye;, rovide letter from HOA Owner's Name: Phone#: Contractor: Phone: `t _� 2_ ") Fax: Contractor License#: _,-� i✓ Cupertino Business License#: Contact: ... , Phone: ;)P (/ �L'A'% I -T-Fax: Residential W Commercial Job Description: r S ►�`s i-r "� , � 1 'i S��s �J > > o Building Permit Info: Bldg B-' Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A. 1-B ❑ I1/11I/V-A II/II1 B IV-HT V-B P —Valuation: _ Square Footage: `-t��-s- Project Project Size: Express Standard ❑ Large❑ Major Ll 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 shect index, Points Achieved: For help, contact Build it Greene at www,buildit reewor Revised 07/14/09 w { CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEI�T1N0 FEE S(.HEDULE 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) 1WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) IEPERMITFEE Electrica. Permit Fee E 1 MPERMITFEE Mechani,:al Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standarc Plan Check(when no E/M/P) B when not over counter) hourl -s:and alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT r TYPES } 1BSEISMICR Seismic Residential B- 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel WDocumentation B 1BUSLIC Busines3 License B 5 of 5 Community Development 10300 Torre Avenue ;:: Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: /"1 r — v PHONE # L(07 e_S 6 GENERAL CONTRACTOR: �c �-. i-xt�-,�� FAX # '77-s— I Zs-I am not using any subcontractors: -`l Z Z Z / 1 (, S-.gnature 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 Tile 7 - 2Z - tQ Owner/Contractor Signature Date