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10050113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1132 HUNTERSTON PL CONTRACTOR:BENTSON CONSTRUCTION PERMIT NO: 10050113 OWNER'S NAME: ZALUSKY ROBERT L AND MICHELINA 1075 FLORENCE WAY DATE ISSUED:05/12/2010 OWNER'S PHONE: 4082553642 CAMPBELL,CA 95008 PHONE NO:(408)677-1028 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r License Class Lic.# MECH r7 RESIDENTIAL r COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE&WIDE EXTERIOR FRONT DOOR FROM 36"TO (commencing with Section 7000)of Division 3 of the Business&Professions 42 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:$4025 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36222027.00 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 authorizerepresentatives 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 9.18. Issued b —""-" Date:�� Signature Date fiIV 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 of 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 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 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 permit is issued. 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 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 authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date:= IZJ2 . forthwith comply with such provisions or this permit shall be deemed revoked. RUCTION 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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. '� �_ Sig nature` ^' ; Date j2. ZCV1D Licensed Professional CITY OF CUPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# v Dater/q i o Building Address: 50 14 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: Phone#: �ZogCcl-r- L(dg =-2,55 - 3 6-1 Contractor: Phone: L(og $66 6-7-/ Ic�2g �G 6,MSo,.t fie tFl 4 Fax: Contractor License#: Cupertino Business License#: 3175'Z: Contact: Phone:CC 1,_' L(02 77;010-IS Ti�w Fax: Ll 09 2,66 M G` Residential [ Commercial ❑ Job Description: P (OQ4�ACG AAD Wk fl6 Building Permit Info- Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B [ � —3 Valuation: Square Footage: Project Size: Express Lill, Standard ❑ Large❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable,include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.orst Revised 07/14/09 Residence of Robert & Michelina Zalusky 1 132 Hunterston Place Cupertino, CA 95014 N Phone: 408-255-3642 J� �► MAY 2 D � 1Q AREA OF WORK 1 . Widen west-facing front entry door opening: From: Existing- 38" wide To: New 44 wide Widening is being done to accommodate new 42" wide door. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . S�4 r,�,..sz : i2ajoe Z`��.-.I� � {n.;�jne(�w•., �,�s - - Jo6,2,rt �Pvlcekzel:v.w Zed u.sky � � er+�, CR �sn►y Sierra Pacific WindoWS Sierra Pacific 1 -800-824-7744 M' www.sierrapacificwindows.com K'o Nv X cir er rj jr c iU 12 2�1 0 t: Bentson Enterprises Windows • Doors * Firepiace� �I �C77FOCK Win! i r piofess►oiialIiistallation Ccl#926196 taU7im Bentson u ^eTf 408��`537 1�2$ �, (� Office 448 866-6736 Fax:4OS•866.•8867 ; hes.net Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# 6 . OWNER'S NAME: YZ&-,r * MZ -1 Lo PHONE# YO -.2 GENERAL CONTRACTOR: - rS6 BUSINESS LICENSE# ADDRESS: l p-I- r-1 C QSBp TY/ZIPCODE:.0 )*-X C* YME"- *Our municipal code requires all blAinesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S), WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owneraon6tor Signature bate