10020103 CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: 10060 SCENIC BLVD CONTRACTOR:BROTHERS HOME PERMIT NO: 10020103
'MPROVEMENT
"'VNER'S NAME: DEAN&CATHY SCHIAVONE ::510 DOUGLAS BLVD DATE ISSUED:02/17/2010
.,NER'S PHONE: 4088024095 IOSEVILLE,CA 95661 PHONE NO:(408)295-0680
�9 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r
License Class L`( Lic.# 6g900q MECH[_ RESIDENTIAL r COMMERCIAL
Contractor Date_A44�ZL_L
TOB DESCRIPTION: 10 WINDOWS&2 PATIO DOORS LIKE FOR LIKE RETRO
I hereby affirm that I am licensed under the provisions of Chapter 9
FIT
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL;NON-STRUCTURAL
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:$12546
permit is issued.
APPLICANT CERTIFICATION APN Number:35709042.00 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. Date:
Issued by
Si-nature Date4 LI
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of 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
I,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,
Signature of Applicant: Date:
Business&Professions Code)
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 gen
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or thoragen
Date: Z22
forthwith comply with such provisions or this permit shall be deemed revoked.
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 relating 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
the above mentioned property for inspection purposes.(We)agree to save
nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
cwts,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally3 the applicant understands and will complyARCHITECT'S DECLARATION
with all non-point source regulat' per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature _. �1 Date Licensed Professional
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIP RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl<: Lot:
APN . . . . . . . . : 35709042 . 00
DATE ISSUED. . . . . . . : 02/17/2010
RECEIPT # . . . . . . . . . : BS000009773
REFERENCE ID # • • • : 10020103
SITE ADDRESS . . . . . : 10060 SCENIC BLVD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DEAN & CATHY SCHIAVONE
ADDRESS . . . . . . . . . . : 10060 SCENIC DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SEAN FERGUSON
CONTRACTOR . . . . . . . : GENE V. CAVANNA LIC # 27964
COMPANY BROTHERS HOME IMPROVEMENT
ADDRESS . . . . . . . . . . : 2510 DOUGLAS BLVD
CITY/STATE/ZIP . . . : ROSEVILLE, CA 95661
TELEPHONE . . . . . . . . : (408) 295-0680
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 12, 546 .00 1 . 00 0 .00 1 . 00 0 . 00
1BSEISMICR VALUATION 12, 546 . 00 1 .30 0 . 00 1 . 30 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1WINREP EACH 8 2 . 00 760 . 00 0 . 00 760 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 804 .30 0 . 00 804 .30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 804 .30 MC
---------------
TOTAL RECEIPT 804 .30
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date: o
n
...moi
Building Address:
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 yes, provide letter from HOA
Owner's Name: I lit 0 Phone#:
hin w)
Contractor: Phone:
Fax: - O'
- 6-17-- - 3727
a
Contractor License#: yq
Cupertino Business License#:
Contact: Phone:
U Fax: '4 Cl'J 90
Residential EV Commercial
Job Description: ' l
�i KT 12�1 L-M� 12-4y j
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 1_ 0 LJ
Valuation: _Flo 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 help, contact Build it Green at www.builditgreen.or
Revised 07/14/09
CITY OF CUPERTINO
"at�-
COPE(OF GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Des eription Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additions 1 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 Mechani:al Permit Fee M
1PPERMITFEE Plumbin;;Permit Fee P
1 ELCPLNCK Stand Al one 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 Standard Plan Check (when no E/M/P) B
when not over counter) hourly-sl and alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel &;Documentation B
1BUSLIC Business License B
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Community Development
- 10300 Torre Avenue
;` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
r In(-)2-010 3
OWNER'S NAME: , nv, PHONE #
GENERAL CONTRACTOR: r� cr FAX #
_ A
I am not using any subcontractors: - '
Si.,-u a 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
r/ ontractor Signature Date