09090174 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11120 CHADWICK PL CONTRACTOR:HOLDER INC DBA ABLE PERMIT NO:09090174
GLASS
NER'S NAME: KUI GONG 1129 RICHARD AVE DATE ISSUED:09/23/2009
OWNER'S PHONE: 4083168426 SANTA CLARA,CA 95050 PHONE NO:(408)496-9960
❑ LICENSED CONTRACTORR'qg
CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB
License Class 1 C' Lic.# 6 JO II C
q MECH RESIDENTIAL COMMERCIAL r
Contractor Date /'.�-,"0
JOB DESCRIPTION:REPLACE 11 WINDOWS&3 DOORS LIKE FOR
I hereby affirm that I am licensed under the provisions of Chapter 9
LIKE
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 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:$9450
1 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:35617082.00 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save
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 rpplations per the Cupertino Municipal Code,Section Issu0 y —~ Date: .2 31cl
9.18.
ature Date �-27,
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
I hereby affirm that 1 am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,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).
1 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&Safety Code,Sections 25505,25533,and 25534.
1 certify that in the performance of the work for which this permit is issued,1 shall
not employ any person in any manner so as to become subject to the Worker's Owner or ai ed agent: Q
Compensation laws of California. If,after making this certificate of exemption,I Date: -/a
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
n building construction,and hereby authorize representatives of this city to enter Lender's Address
%n the above mentioned property for inspection purposes.(We)agree to save
_.emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,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-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35617082 . 00
DATE ISSUED. . . . . . . : 09/23/2009
RECEIPT #. . . . . . . . . : BS000008747
REFERENCE ID # . . . : 09090174
SITE ADDRESS 11120 CHADWICK PL
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER KUI GONG
ADDRESS 11120 CHADWICK PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4705
RECEIVED FROM KUI GONG
CONTRACTOR HOLDER, ERIC LIC # 22037
COMPANY HOLDER INC DBA ABLE GLASS
ADDRESS 1129 RICHARD AVE
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE (408) 496-9960
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 9,450 . 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 9, 450. 00 1 .00 0. 00 1. 00 0 . 00
1WINREP EACH 8 2 . 00 760 . 00 0 . 00 760 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 762 . 00 0 . 00 762 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 762 . 00 VISA
---------------
TOTAL RECEIPT 762 . 00
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% 7LI1X- CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
�� 70 � v v 9• �33 o
Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No LF
HOA: (Exterior work only) Yes ❑ No ❑ If Yes, provide letter from HOA
Owner's Name: Phone#: ��0-?/
6.
Contractor: Phone: 08j y 9 6 0
DgA- Aide C 04-,Jr Fax: o Y 2,6- p 9 6
Contractor License#: 009/8
Cupertino Business License#:
Contact: �/ziG CO Phone: S
Fax:
Residential Commercial
Job Description: Rep /FCC-" /t IN3 dUclu liticP fait Grke
Building Permit Info:
Bldg [Ver
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 =�
Valuation: Square Footage:
�Yco —
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.buflditgreen.org
Revised 07/14/09
CITY OF CUPERTINO
CITHY ofGENERAL 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)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK 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 Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
5 of 5
M.Indoor Air Quality and Finishes
1.LIMLbonllib-OcRift 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use iowlhb VOC Adh*m 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes
D
0
6.Use Exterior Grade Plywood'for Interior Uses 1 IAQ/Health pts y=yes
7.$*40 f My 4 IAQ/Health. pts y=yes 0
8.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes Mdo
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use dlapidly Flawwable flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
1 1 1
Total Points Available: 1 1401 1301 57
Total Points Project Received: 01 0 0
G:data/progs/greenbuildingguidelines/remodelers/greenpointsfinal2.12.D4protected.xis
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
dUPE�TIN0
Buildin De artment
JOB ADDRESS: PERMIT #
wr c C a ��
OWNER'S NAME: Ku6zte PHONE # (4-0L)
GENERAL CONTRACTOR: f f ix aeg---r-A16 FAX #
I am not using any subcontractors: 9-?3-
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
Tile
127.0
Owner/Contractor Signature Date