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09070150 CITY 6F CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 10842 WILKINSON AVE CONTRACTOR:CUSTOM EXTERIORS INC. PERMIT NO:09070150 OWNER'S NAME: BANGERT STEVEN N AND BETH G 140 BOULDER CT STE 400 DATE ISSUED:07/21/2009 ER'S PHONE: 4082558014 "LEASANTON,CA 94566 PHONE NO:(925)249-2280 ❑ LICENSED CONTRACTOR'S DECLARATION 3UILDING PERMIT INFO: BLDG ELECT P PLUMB Class Lic.# 7 6�& MECH RESIDENTIAL COMMERCIAL Contract lLg, w Date – – OdD s 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:R/R 15 WINDOWS SIZE FOR SIZE LIKE4LIKE& NOOD (commencing with Section 7000)of Division 3 of the Business&Professions rRIM, NAIL FIN INSTALL&REPAIR STUCCO AS Code and that my license is in full force and effect. ''RIMS vECESSARY 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 iq,Ft Floor Area: Valuation:$12545 permit is issued. APPLICANT CERTIFICATION kPN Number:35613035.00 Occupancy TypCI– 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non- oint source regulations per the Cupertino Municipal Code,Section 9.18. Date d Issued by:V Date--7 21 )' Signat re4�-� 1 0 N - S L OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of 41,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, Business&Professions Code) Signature of Applicant: Date: 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 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air 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 Cod ections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must OWAiautho a t: — , !_G forthwith comply with such provisions or this permit shall be deemed revoked. Date: / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that 1 have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's correct.1 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 i- unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 6e , nt source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signat Date Licensed Professional CITY OF CUPERTINO 4 ITEMS OF 11 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk.: Lot : APN . . . . . . . . : 35E13035 . 00 DATE ISSUED. . . . . . . : 07/21/2009 RECEIPT #. . . . . . . . . : BSC00008237 REFERENCE ID # . . . : 09C70150 SITE ADDRESS . . . . . : 10E42 WILKINSON AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BAkrGERT STEVEN N AND BETH G ADDRESS . . . . . . . . . . : 10E,42 WILKSON AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4732 RECEIVED FROM . . . . : EDWARD A GREGORY CONTRACTOR . . . . . . . : KEVIN GUNDRY LIC # 23679 COMPANY . . . . . . . . . . : CUSTOM EXTERIORS INC. ADDRESS . . . . . . . . . . : 440 BOULDER CT STE 400 CITY/STATE/ZIP . . . : PLE;ASANTON, CA 94566 TELEPHONE . . . . . . . . : (925) 249-2280 FEE ID UNIT QUANTITY INOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 12, 545 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 12, 545 . 00 1 . 30 0 . 00 1 . 30 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1WINREP EACH 8 1 . 00 380 . 00 0 . 00 380 . 00 0 . 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 424 . 30 0 . 00 424 .30 0 . 00 O o-7 0 [ CITY OF CUPERTINO TY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # 150 3 0 Date: 7 d 610 q Building Address: /e? 8 yz G��Ck .�� ,�IV� Mailing Address (if different from building addresE): Owner's Name: r� ��NG�� Phone#: - Z-6-s-- Contractor: s-Contractor: Phone: Y 3 Y 7-7 eu Fax: V 9- z z e9 Contractor License t 7y s 3 C-17 45,tp - 30- 0-0f, Cupertino Business License#: Contact: / Phone: Fax: Residential Commercial Job Description: 4- LV.S � ,� S' -/1? As�eCc?S.rc:f� 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: / 2 5�/15- Square Footage: Project Size: Express ❑ Standard iW 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 help, contact Build it Green at www.buflditlreen.org Revised 7/01/08 sm"Q-1 CITY OF CUPERTINO ITYOF GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1 STUCOAP Stucco Arplications (up to 400 sf) B additional stucco application I 1WINREP Replacem:,nt windows/sliding glass B door (ea Y windows) 1 WINMEWSTR New Window-structural shear B wall/masonry(includes plan ck'fee) 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanic i1 Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard :31an Check (when no E/M/P) B when not over counter) hourly-stznd alone 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business License B .i of 5 JUL-15-2009 WED 01;46 PM CUSTOM EXTERIORS, INC FAX NO. 9252492290 P. 02 Pen. o IF C3 Floor Plan Drawing; (for Permits only) IS xL2� 2�xR LIQ lob) "� q 4° Rzt 'f x 926 16xy'' "x4a ai[. s XD Pia Ix u p7t+f p 1 6UPERTINO COD )ATE. .- rrI AGNEv t ti,ms MUS'. 1� � � , . �6 x 4 • i his seI zA it is ur ` )e kep — a �ation avrfui t.. ssian fron ,,I SOME. ,c buy, .> rication � I h8 stamp ' , t be •?' ALL. r.rovni ut R F-e-Kjr ek t- v'�-e w sN o i 46 �°xa?3o ax°iR.� CELiL�_glq_ le CA 6okh°,1--� Last Name City Work- ti �� > �e dace wtt�. d, �er C, 0 C. ZD k