09090106CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19975 PEAR TREE CT
CONTRACTOR: GRANT TERRY L PERMIT NO: 09090106
OWNER'S NAME: GRANT TERRY L
19975 PEAR TREE CT DATE ISSUED: 09/15/2009
ER'S PHONE: 4082573189
CUPERTINO CA, 95014-2318 PHONE NO:
r-
p LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
MECH T_ RESIDENTIAL f— COMMERCIAL
Contractor Date
JOB DESCRIPTION: REFURBISH WINDOWS WITH THERMO PANE TO
I hereby affirm that 1 am licensed under the provisions of Chapter 9
IMPROVE
(commencing with Section 7000) of Division 3 of the Business & Professions
INSULATION (7 WINDOWS, EACH W/ONE JALACY SEGMENT,
Code and that my license is in full force and effect.
PLUS OTHER, SOLID PANES/SLIDERS REPLACE JALACY)
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
Section 3700 of the Labor Code, for the performance of the work for which this
Sq, Ft Floor Area: Valuation: 54400
permit is issued.
APPLICANT CERTIFICATION
APN Number: 31630088.00 Occupancy Type:
I certify that 1 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Issued tly...,`� >-�- - Date:�,-
Signature Date
�. OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Date:
Business & Professions Code)
Signature of Applicant:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
Code, Sections 25505, 25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
California Health & Safety
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
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
Worker's Compensation provisions of the Labor Code, I must
O� or authorized a nt:
9
become subject to the
forthwith comply with such provisions or this permit shall be deemed revoked.
Dater C
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
nify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I my plans shall be used as public records.
9.18.
understand
p
Signature Date v
Licensed Professional
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31630088.00
DATE ISSUED.......: 09/15/2009
RECEIPT #.........: BS000008681
REFERENCE ID # ...: 09090106
SITE ADDRESS .....: 19975 PEAR TREE CT
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER ............. GRANT TERRY L
ADDRESS ..........: 19975 PEAR TREE CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2318
RECEIVED FROM ....: TERRY L GRANT
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: GRANT TERRY L
ADDRESS ..........: 19975 PEAR TREE CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2318
TELEPHONE ........
FEE ID UNIT
QUANTITY
AMOUNT PD -TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
4,400.00
--------------------
1.00
0.00
----------
1.00
----------
0.00
1BSEISMICR VALUATION
4,400.00
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
--------------------
#227
---------------
TOTAL RECEIPT
381.50
SIVKZI CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN #� � � � ` v � Date:
3 1 �p ,� 'I// l o
Building Address: / /q q 7 S1,45--Ag
15 Gr
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes U No
HOA: (Exterior work on Yes ® No U If
Owner's Name:
Contractor:
Contractor License #: '
Cupertino Business License #:
Contact:
Residential ® Commercial
oq 09 v � oto
ide letter from HOA
Phone #:
Phone:
Fax:
Phone:
Fax:
Job Description:
561 r -S .4CF&4 G 07 JAL
Building Permit Info:
Bldg [!r'-
! Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B F-1I1/III/V-A ❑ II/III B, IV -HT, V -B E+ --'7—r-
Valuation: ,// �(d 0 Square Footage:
Project Size: Express [�J- tandard U Large LJ Mayor
Green Building: Please complete relevant portion of the Green Building/LJEED unecxust OL attach iL
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 07/14/09
CITY OF CUPERTINO
ERAL BUILDING APPLICATION
CITY of GEN
CUPE(�TINO FEE SCHEDULE
Quantity/Sf Fee ID
Fee Description
FeeJ'Permit Type
GroGENRES or
GENCOM
1STUCOAP
Stucco Applications (up to 400 sf)
B
additional stucco application
1 WINREP
Replacement windows/sliding glass
B
door (ea 8 windows)
1 WINMEWSTR
New Window -structural shear
B
wall/masonry (includes plan ck fee)
l EPERNIITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit Fee
g
P
1 ELCPLNCK
1 MECPLNCK
1PLMBLNCK
Stand Alone Electric Pin Ck (hourly) E
Stand Alone Mechanical Pln Ck (hrly) M
Stand Alone Plumbing P1n Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly -stand alone
1BCBSC Cal Bldg Standards Commission Fee B
/
1BSEISMICR Seismic Residential B
I SEISMICO Seismic Commercial B
1TRAVDOC
1BUSLIC
Travel & Documentation
Business License
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IN At:Ct PIANO .`:1114 THE CITY OF
0014 WINOA AMU OHDIINNANCES
()Ali.
SIGNM .7 �
This set of plans and specifications MUST
be kept on the job 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 ,)f any provisions
of any City Chdrnance or State Law
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