09090197 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10160 PARK CIRCLE WEST APT 1,2,3,4 CONTRACTOR:NEWPANECOM PERMIT NO:09090197
OWNER'S NAME: PARK CIRCLE LLC 340 INDUSTRIAL WAY STE T DATE ISSUED:09/28/2009
r ER'S PHONE: 5104321356 DIXON,CA 95620 PHONE NO:(707)678-9970
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Clas ` Lic.#��490 �—2 MECH[_ RESIDENTIAL COMMERCIAL
Contractor �� a(�Eyr�l Date �(5/ JOB DESCRIPTION:SUPPLY&INSTALL NEW VINYL WINDOWS&
I hereby affirm that I am licensed under the provisions of Chapter 9 SLIDING PATIO
(commencing with Section 7000)of Division 3 of the Business&Professions DOORS(SEE 09090195 FOR FEES)
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.
1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$8000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:32632019.APTS 1-4 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 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 he Cupertino Municipal Code,Section _�
9.18. �j �0 �J Issued bye!/ ��`– Date:
Signaturt%� Date ( <' 4
[� 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 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 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.
Additionally,should 1 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 O'
Compensation laws of California. If,after making this certificate of exemption,I r ed a
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
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
-unify and keep harmless the City of Cupertino against liabilities,judgments,
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.
Licensed Professional
Signature Date
CITY OF CUPERTINO
CUPEf�TiNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
Building Address: l i -')j 3
G�Y.Ax, . CC.P ,ylb"v CA °I soit.l
Mailing Address (if different from building address): q qS
301J q 9 PIew,�drt> P14fe, i enow� ch 11 1
Are Hazardous Materials being used as part of this project? Yes No
HOA: (Exterior work only) Yes ❑ No If es, provide letter from HOA
Owner's Name: Phone#: _
b4 G`rc� L L Q � I b LI"3'L l 3J 6
Contractor: Phone: 75-?
A�Lw ane, o►r Fax: b 7 8 Gam?
Contractor License#: -7 $Z O7-L
Cupertino Business License
Contact: ,�,
Phone: 7a� -)�
� Fax: 7
Residential Commercial
Job Description: tom.w�p lwe s
New Vl L
1. b
066-0 b bait 6-,0
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ 11/111 B, IV-HT, V-B
Valuation: 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 bel , contact Build it Green at www.builditgreen.org
Revised 07/14/09
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner.
Project address.
Contact person./ `r`Ch4,e i`t Phone.lgL?�- �� J
Fax. .
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
`re there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the project? N
On what floor(s) is work being done? 2
Lit fi !/ �u r t,tl i c>&/a— IL Cir�/ ! a �'�
Brief,description of work. 2 » G
Mee
�9
Code editions:2008 CBC (Y -N)2008 CFC (Y-N)2008 CMC (Y-N)
2008 CPC (Y -N)2008 NEC (Y -N)
Effective 1/1/08 APPROVED
IN ACCORDANCI WITH THE CITY OF
CUPERTINO CODt 5 AND ORDINANCES
DATEfa
This set of plans and specifications MUST
be kept on the lot)at all times and it is
unlawful to make any changes or alterations
on same without written permission from
the Building Department,City of Cupertino.
The stamping of this plan and specifications
SHALL NOT be held to permit or to be an
approval of the violation of any provisions
of any City Ordinance or State law.
Plan Review Process Work Book Page-8-Revised 1/1/08