09090123 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10610 E ESTATES DR CONTRACTOR:ARGONAUT WINDOW& PERMIT NO:09090123
DOOR,INC
� "1ER'S NAME: SCHAEFER THOMAS J
1901 S BASCOM AVE STE 800 DATE ISSUED:09/16/2009
UrrNER'S PHONE: 4082577734
CAMPBELL,CA 95008 PHONE NO:(408)378-4018
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB
License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL
Contractor Date
JOB DESCRIPTION:WINDOW REPLACEMENT,LIKE FOR LIKE,
I hereby affirm that I am licensed under the provisions of Chapter 9 NONSTRUCTURAL
(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 Valuation:$3880
performance of the work for which this permit is issued. Sq.Ft Floor Area:
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 APN Number:36925022.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 Issued h Date:
with all non-point source regulations per the Cupertino Municipal Code,Section �!
9.18.
gture Date
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 I am exempt from the Contractor's License Law for one of inspection.
the following two reasons: Date:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the California
I have and will maintain a Certificate of Consent to self-insure for Worker's compliance lwi h the Cupertino ealth&Safety dMunicipal Code,Sections e,Chapter r 9 1 h 2 and the Health&5,25533,and 25534. 1 will fain
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material.
performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air
1 have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will
Section 3700 of the Labor Code,for the performance of the work for which this 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,I shall thoriz nt:
r
not employ any person in any manner so as to become subject to the Worker's Q
�oj� �^ Date:
Compensation laws of California. If,after making this certificate of exemption,I
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 Lender's Address
to building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save
.mify 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 Licensed Professional
9.18. �(
Signature � �— Date N
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36925022 . 00
DATE ISSUED. . . . . . . : 09/16/2009
RECEIPT #. . . . . . . . . BS000008697
REFERENCE ID # . . . : 09090123
SITE ADDRESS 10610 E ESTATES DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SCHAEFER THOMAS J
ADDRESS 10610 E ESTATES
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4509
RECEIVED FROM THOMAS SCHAEFER
CONTRACTOR CHRIS ETTEMA LIC # 22820
COMPANY ARGONAUT WINDOW & DOOR, INC
ADDRESS 1901 S BASCOM AVE STE 800
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE (408) 378-4018
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 3, 880. 00 1 . 00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 3, 880 . 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 #945
---------------
TOTAL RECEIPT 381 .50
0q o� )-/5s CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# � Date:
� . � � -1116101
Building Address:
10610 EsT0,T E.S- —DR Cup e:RT►N0
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes El No a
HOA: Exterior work only) Yes ❑ No [" If yes, provide letter from HOA
Owner's Name: Phone#:4 0 R a5-7 —7 3µ
�h0Mr(tr
Contractor: Phone:
�� a�w�" �,l��.da +�1 aor Fax: 0-0 �Oq 1lfOG
Contractor License#: ?5F0 SF
Cupertino Business License#:
Contact: Phone: 6V q4L�
V� Fax:
Residential Er Commercial
Job Description: (,-,0 vxdaW r-e�C 4 c C KC Kt tl lie s Ick r 0-h14Y,C�, A
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 G-
Valuation: `3 Square Footage:
880
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
CITY of GENERAL BUILDING APPLICATION
CUPEkT1NO 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
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1 PLMBLNCK 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
IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
I TYPES
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVDOC Travel &Documentation B
1 BUSLIC Business License B
5 of 5
� =lip
M.Indoor Air Quallty and Finishes
1.Use LowNo-VOC Paint 1 IAQIHealth pts y=yes 0
2.Use Low VOC,!eater-Based food Finishes 2 IAD/Health pts y=yes 0
3.Use LowNo VOC Adhesives 3 AD/Health pts y--yess0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts yeses 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts Y--yes0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Saf iolebcawd or MDF 4 IAQ/Health. pts = es 0
al aI
B.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 IAWealth pts y=yes 0
D 1 D
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Rapidly Renewable 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 FIDOr 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resourca pts Y--yes0
D e D
Total Points Available: 1
-- 1401 1301 57
Total Points Project Recelved: I 0 0 0
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Community Development
10300 Torre Avenue
'1 ' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
„UPEkTINO
Building Department
JOB ADDRESS: '0 �� ES�as �r PERMIT#
OWNER'S NAME: 'oyn c a PHONE # 8
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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
Owner/Contractor Signature Date