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10020095 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19732 DRAKE CT CONTRACTOR:ROCK SOLID BUILDERS PERMIT NO: 10020095 OWNER'S NAME: JANSSON ROSE PO BOX 20265 DATE ISSUED:02/16/2010 iER'S PHONE: 4089739926 SAN JOSE,CA 95160 PHONE NO:(408)997-7625 ❑ LICENSED CONTRACTOR'S DECLARA ON B ALDING PERMIT INFO: BLDG F_ ELECT f— PLUMB License Class Lic.# `{ MECH r RESIDENTIAL COMMERCIAL Contractor ( JOB DESCRIPTION:WINDOW(RETRO-FIT)REPLACEMENT,2 WINDOWS I hereby affirm that I am licensed under the provisions of Chapter 9 N:)N-STRUCTURAL (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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area: Valuation:$1160 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ?.PN Number:31632017.00 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 O 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 ap nderstands and will comply with all non-point source regulations p e C no Municipal Code,Section Date: 9.18. ssued by: Signature v Datel RE-ROOFS: V OWNER-BUILDER DECLARATION 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 of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: 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 and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 o the 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 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 or aut rued ID Date: 140 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 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 mnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue aga!n5vew Ctty in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,th pplicanturrderstands and will comply with all non-point ce regulations er tha Ctipertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. [1-01Licensed Professional Signature Dated I W CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 31632017 . 00 DATE ISSUED. . . . . . . : 02/16/2010 RECEIPT # . . . . . . . . . BS000009762 REFERENCE ID # 100,' 0095 SITE ADDRESS 197:'2 DRAKE CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER JANSSON ROSE ADDRESS 19732 DRAKE CT CITY/STATE/ZIP CUPERTINO CA, CA 95014-2432 RECEIVED FROM J YDYS G. HAMMEN LIC # 29304 CONTRACTOR . . . . . . COMPANY ROCK SOLID BUILDERS ADDRESS . . . . . . . . . . : PO BOX 20265 CITY/STATE/ZIP SAN JOSE, CA 95160 TELEPHONE (408) 997-7625 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- ---------- ------------- ---------- ---------- ---------- ----- 1BCBSC VALUATION 1, 160 . 00 1 . 00 0 .00 1. 00 0 . 0 1BSEISMICR VALUATION 1, 160 . 00 0 . 50 0 . 00 0 .50 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 .00 0 .00 42 . 00 0 . 00 1 .00 380 . 00 ---- 380 . 00 ------0_00 1WINREP EACH 8 -- -------- ---------- ---------- TOTAL PERMIT : 423 .50 0 .00 423 . 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- ---- CREDIT CARD 423 .50 VISA --------------- TOTAL RECEIPT 423 .50 c) 50-10 CITY OF CUPERTINO CUPEk ANO GENERAL BUILDING PERMIT APPLICATION FORM APN# Date: Building Address: L�- ` T Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes U No HOA: Exterior work on Yes ❑ No ❑ If yes, provide letter from HOA Owner's N Phone#: Contractor: u 1 Phone: L - Fax: �� Contractor License#: GT� Cupertino Business License#: 2,61-60 Phone: (70 ---�(a2. Contact: a 1 Fax: C�l Residential Commercial Fj Job Description: �YLAnUD C Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ IUIIUV-A ❑ II/III B, IV-HT,V-B Valuation: Square Footage: Project Size: Ex ress ❑ StandardU 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.buildM-een.or Revised 07/14/09 S�Rnw CITY OF CUPERTINO OF GENERAL BUILDING APPLICATION CUPEkT1NO FEE SCHEDULE Quantity/Sf Fee ID Fee Descr�.ption Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Aprlications (up to 400 sfl B additional stucco application 1WINREP Replaceme:it windows/sliding glass B 2 door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes lan ck fee) IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee ==Fm 1PPERMITFEE Plumbing:'ermit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Ala.-ie Mechanical Pln Ck(hrly) M 1 PLMBLNCK Stand Alo rie Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard''lan Check(when no E/M/P) B when not over counter) hourl -stEnd alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Presidential B I SEISMICO Seismic Commercial B l 1T Travel & Documentation B / 1BUSLIC Business License g 5 of 5 r �enn:n� c� to\ � G G � � r n c t O 2 � 1w Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkiNO Buildirt Department JOB ADDRESS: �,��-7 b � 171 X7111) PERMIT # _ �z /00?_06 OWNER'S NAME: �S0bse,. PHONE # 97 G GENERAL CONTRACTOR: li / FAX # 7� I am not using any subcontractors: ig.zattxre Date Please check applicable subcontractors and comp]ete 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 Owner/Contractor Signature Date