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09090195CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10195 PARK CIRCLE WEST APT 1,2,3,4 CONTRACTOR: NEWPANECOM PERMIT NO: 09090195 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 CONTRACTOR'S DECLARATION V BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C' 17Lic. # �� 5�_ COMMERCIAL ` ' MECH RESIDENTIAL Contractor��ue�ifl re. G�+r4- Date off- I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SUPPLY & INSTALL VINYL WINDOWS & (commencing with Section 7000) of Division 3 of the Business & Professions SLIDING PATIO Code and that my license is in full force and effect. DOORS 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: $35000 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. APN Number: 32632014.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 so e r gulations per the pertino Municipal Code, Section _ 9.18. 4' r�4 Signature d� Date �'>`✓ Issued b : Dater RE-ROOFS: L OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed. If a roof is 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 constrict the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 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 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. Section 3700 of the Labor Code, for the performance of the work for which this Additionally, should I use equipment or devices which emit hazardous air 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, Section 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 r zed age 2�� become subject to the Worker's Compensation provisions of the Labor Code, I must Date: ( e 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 1 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 -tnify 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 PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 3 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32632014.APTS1-4 DATE ISSUED ....... : 09/28/20096 RECEIPT #......... 09090195 76 REFERENCE ID # ••• REFERENCE NUMBER AMOUNT METHOD OF PAYMENT -------------------- ----------------- CHECK 2,399.50 #1376 --------------- TOTAL RECEIPT 2,399.50 SITE ADDRESS .....: 10195 PARK CIRCLE WEST APT 1,2 SUBDIVISION •••... CITY ............ CUPERTINO IMPACT AREA ....... OWNER ............: PARK CIRCLE LLC ADDRESS ..........: 39548 PLATERO PL CITY/STATE/ZIP ...: FREMONT, CA 94538 RECEIVED FROM •' p,NDREWARK IKING,LLLIC # 28253 CONTRACTOR ...... COMPANY NEWPANECOM 340 INDUSTRIAL WAY STE T ADDRESS ..........: CITY/STATE/ZIP ...: DIXON, TELEPHONE ......... 67C�A99955620 70 QUANTITY AMOUNT PD -TO -DT THIS REC FEE ID UNIT ---------------- --- --NEW-BAL- 1BCBSC -------------------- VALUATION 35,000.00 2.00 0.00 0.00 2.00 3.50 0.00 0.00 1BSEISMICR 35 3.50 VALUATION ,000.00 2394.00 2394.00 1INSPPAR HOURS 19.00 ---- ------ - 2399.50 0.00 2399.50 0.00 TOTAL PERMIT REFERENCE NUMBER AMOUNT METHOD OF PAYMENT -------------------- ----------------- CHECK 2,399.50 #1376 --------------- TOTAL RECEIPT 2,399.50 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. !"cin t"; �%` )—c Project address. J0 fc,�-rf j t,� J� S e I r 4 dCA!� Q l,1f Contact person. /AI Phone. I—gad 61 Fax. I0 Net square footage of lot. Existing prop CCORDAPPROV ANCE WITH THE CITY OF Square footage: First floor: RTINO CODES AND ORDINANCES Second floor: GATE D Garage: TOTAL: This set of pians and specifications MUST times and it is wful to make any changes or alterations `re there at least two 10 foot by 20 foot clear spaces inside the garage? Y on illda without written permission trop, !9 Department, City of Cupertino The st o this plan and specifications Is privacy protection planting required for the project? N SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law.On what floor(s) is work being done? '.)— Brief description of work. t ,; Code editions: 2008 CBC 2008 CPC EJ34- Q1W i.T , rN SEP 2 8 2009 BY: r. �- N)2008 CFC (Y - N)2008 NEC (41J wi (,IrJe q; f, S ItC/rrl7,k 0or ; 7, 0, � �, -.7- (30c, (V - Mz�flCMC (Y- N) W 'N011of1H1SN0�:Sim Mira SMIJ 11v lb eor 3H� NO NIVY08lidc%&Y 11,V1S Nrd S1H1ZF-Muu T Plan Review Process Work Book Page -8-Revised 1/1/08 C) µ CITY F P C O CU ERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # 3 ;z� 3A 1 L� • P X51 — , L Date: 22 O°l Building Address: j I Qa (� CIYL Gu ,r�tia 1L/� �S"b1 Mailing Address (if different from building address): ✓ 301 J 4 1 f �G►,kt-xa L rf-Q vw �'� `x Are Hazardous Materials being used as pareof this project? Yes ❑ No XL HOA: Exterior work only) Yes ❑ No If yes, provide letter from HOA Owner's Name: Phone #: Contractor: Phone: 7 67 7-9 g A 7 b %vel P CA Fax: 73 Contractor License #: V 7 g Z a --)--Z, Cupertino Business License #: 2- J Contact: m 1 Phone: 7 bi 7 70 •7 �i �f Fax: b� $ Residential Commercial ❑ Job Description:_ cvk , V"4' J0b6t{ Building Permit Info: Bldg U,- 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 L J R^ Z 2 Valuation: p/b �+ ob Square Footage: Project Size: Express Ejl-�tandard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Budding/LEED Checklist & attach it t? a application or if applicable, include in plan set & the sheet index. Points Achieved:ot For help, contact Build it Green at www. Revised 07/14/09 CITY OF CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 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 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 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 iw ;5 CITY OF �UPEkTINO I am not using any subcontractors: Buildin Signature Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 artment ;,, fr►rma ti nn Date Date owner/ Contractor Signature