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09090198 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10162 PARK CIRCLE WEST APTS1,2,3,4 CONTRACTOR:NEWPANECOM PERMIT NO:09090198 OWNER'S NAME: PARK CIRCLE LLC 340 INDUSTRIAL WAY STE T DATE ISSUED:09/28/2009 ER'S PHONE: 5104321356 DIXON,CA 95620 PHONE NO:(707)678-9970 LICENSED CONTRACTO'�'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT r— PLUMB License Class c` _ Lic.# �� * � MECH f- RESIDENTIAL COMMERCIAL Contractorc�,J/ „ tK. Date ��'� JOB DESCRIPTION:SUPPLY&INSTALL NEW VINYL WINDOWS& I hereby affirm that I am licensed under the provisions of Chapter 9 SLIDING (commencing with Section 7000)of Division 3 of the Business&Professions PATIO DOORS(SEE PERMIT#09090195 FOR FEES) 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:$8000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32632019.APT1-4 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 s rce regulations pert Cupertino Municipal Code,Section �/�� Date–Z,FZM 9.18Issued b Signature G� Date ci 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. 1,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) 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). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 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. 1 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. 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 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 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 Compensation laws of California. If,after making this certificate of exemption,I 6vr ized a Date: 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 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 nify and keep harmless the City of Cupertino against liabilities,judgments, L. 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 0q((A 0199 ISM CITY OF CUPERTINO CUPEkTiNO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: Building Address: a� Oa-L Mailing Address (if different from building address): (-/9 y b �J 1l 1 �kp vv 1 6 Wi I l`�r''�oLt�� Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes ❑ No If es, rovide letter from HOA Owner's Name: Phone#: S 4 3Z 3J Usk CatL, LLC. Contractor: Phone: 7 /1)(7w' Dal Cbz Fax: -79--) 7 Contractor License#: 7 QZ-°7Z Cupertino Business License#: Contact: - Phone: 7a7 i &LiaFax: 70'1 (72Z qR7� Residential , Commercial ❑ r. Job Description: L c 1101�4` hew J lk�\ W '"� <s �7 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 Valuation: d a a'e a Square Footage: Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it tot application or if applicable, include in plan set& the sheet index. Points Achieved: S For help, contact Build it Green at www.builditgreen.org Revised 07/14/09 RESIDENTIAL PROJECT COVER SHEET f Assessor's Parcel Number: Name of owner. A'A G f, Project address. /D/C 2 /�zih c�`./' w e&t C o1q e�-t7N& 9 Contact person. Phone.I— " 6l*— ; Fax. Net square footage of lot. �C 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? ,,-Y IN On what floor(s) is work being done? / Z - B f escription of wo f cE r tv`"Jet"s /r` .`sl �c fi� L)oc�-/ Code editions: 2008 CBC N)2008 CFC (Y -N)2008 CMC (Y-N) 2008 CPC (Y -N)2008 NEC (Y -N) APPHO VED IN AC(;OROAN(;E WITH I HE CITY OF CUPF R1INO CODES AND ORDINANCES Effective 1/1/08 � 2�'.vS DATE SIGNED This set of plans and specifications MUSTl :"` be kept on the fob at all times and it is unlawful to make any changes or alterations �, .";y sy 0 0f on same without written permission from cor> the Building Department, City of Cupertino. VAEOWUMM 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 Onfinance or State law. Plan Review Process Work Book Page-8-Revised 1/1/08 Community Development :;.. 10300 Torre Avenue a{ ;; Cupertino CA 95014 Telephone(408)777-3228 M'av OF Fax(408)777-3333 ,,'UPERTINO Buildin De artment lol JOBS DDR S: PERMI� �vCQ CA OWNER'S NAME: I2 L L G PHONE #1-9,06- GENERAL CONTRACTOR: 1 koJ cY, FAX# /- I am not using any subcontractors: -� Signature Date Please check ap licable subcontractors and complete the following information: 6d 1 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