09090196CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10193 PARK CIRCLE WEST APT 1,2,3,4 I CONTRACTOR: NEWPANECOM I PERMIT NO: 09090196
OWNER'S NAME: PARK CIRCLE LLC
340 INDUSTRIAL WAY STE T ! DATE ISSUED: 09/28/2009
ER'S PHONE: 5104321356 I DIXON, CA 95620 1 PHONE NO: (707)678-9970 I
Er LICENSED CONTRACTOR'S DECLARATION
G GLicense Class_ Lic. #
Contractor Date�Q C
1 hereby affirm t at I am licensed under the provisions of Chapter 9
(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.
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
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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 regulations per th upertino Municipal Code, Section
9.18.
G �1
Signatur Date:9_,�2
1_1 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
1 certify that in the performance of the work for which this permit is issued, I shall
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, 1
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.
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
upon the above mentioned property for inspection purposes. (We) agree to save
i• nify and keep harmless the City of Cupertino against liabilities, judgments,
L 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 regulations per the Cupertino Municipal Code, Section
9.18.
I Signature Date
BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB f—
MECH f- RESIDENTIAL f- COMMERCIAL f—
JOB DESCRIPTION: SUPPLY & INSTALL VINYL WINDOWS &
SLIDING PATIO
DOORS (SEE 09090195 FOR FEE)
Sq. Ft Floor Area:
Valuation: $8000
APN Number: 32632014.APT 14 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued -r- Date: '15--2 at-- i -C
RE-ROOFS:
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
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
2
e t ed J�Date:5�659
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
oq CDR 6i9�p
m �' CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
Date:
v
APN#3� C)IL
Building Address:
10 %01-b
()6k()6kI
1
Mailing Address (if different from building address):
3q.5 4 8 f,&�u2 Q a,�e, w.
Are Hazardous Materials being used as part of this project?
HOA: Exterior work only ) Yes ❑ No If es, rovi
Owner's Name: -
pQ
Contractor:
Contractor License #:
Cupertino Business License #:
ZJ3
Contact:
Residential LZk Commercial
No
C! 4-)' 3
ode letter from HOA
Phone
Phone: 7 67 L7 a
Fax:
Phone: % Ol k -1-a
Fax: -76--) 1 I -1 k13
Job Description: 'S u c
dddV
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
U Class) Occupancy Type:
Type of Construction ( sage
1-A, 1-B ❑ I111111V-A ❑ II/III B, IV -HT, V -B
Valuation:
g b0
Size:
Standard
L'
Square Footage:
o��
Green Building: Please complete relevant portion of the Green 13uucungt1LjnZJJ
to the application or if applicable, include in plan set & the sheet index.
Points Achieved: S
For help, contact Build it Green at www.buildit reen.or
Revised 07/14/09
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner. t'az f C z- �-- � C
Project address. lolo, we4 c4' `4 `01
Contact person. Pc`C 4e -e Phone. 1— Z�J
Fax. O •`
Net square footage of lot./ APPHOVED
,. CITY OF
,.
CUPERTINO CODES AND ORDINANCES
Existing PropgAW
Square footage: First floor:11 - 7,?; A=- 4 9
Second floor: Ibis so* of iA;aq Z2
frons MUST
be kept on e �S6 a t1 times and it is
Garage: - ma Ke any (-hanges or alterations
TOTAL: ssion from
th6 By9ding De rtn lent, Crry of Cupertino.
The st i this plan and specifications
'ire there at least two 10 foot by 20 foot clear spaces inside the garage? 1VIA be her,, }o permit or to be an
approval of the violation of any provisions
of any City Ordinani e or State Law.
Is privacy protection planting required for the project?
On what floor(s) is work being done? - 2
Code editions: 2008 CBC 4W- N)2008 CFC (Y - N)2008 CMC (Y- N)
2008 CPC (Y - N)2008 NEC (Y - N)
Y_
Effective 1/1/08
Plan Review Process Work Book Page -8-Revised 1/1/08