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13050164CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:' 10381 MEADOW:PL CONTRACTOR: MICHAELS PERMIT NO: 13050164 CONSTRUCTION OWNER'S NAME: LOUGHLIN J GORDON&CAROL TRUST 707 LINCOLN AVE DATE ISSUED: 05/22/2013 OWNER'S PHONE: 4159310332. • . SAN JOSE, CA 95126 PHONE NO: (408) 292-4999 ❑ LICENSED CONTRACTOR'S DECLpA�R JOB DESCRIPTION: RESIDENTIAL COMMERCIAL /ATION License Class Lie. # 9� r 7 UNITS A & B- REMOVE AND REPLACE 8 WINDOW AND 2 EGt/.P�Lf T 7� PATIO DOORS Contractor. /bl' G6F� Date I hereby affirm that 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. 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. Sq. Ft Floor Area: Valuation: $7580 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 34229019.00 Occupancy Type: 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 PERMIT EXPUZES IF WORK IS NOT STARTED correct: I agree to comply with all city and county ordinances and state laws relating WIT 80 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon'the above mentioned propertyfor inspection purposes. (We) agree to save 180 DA F M LAST CALLED INSPECTION. indemnify and keep harmless the Cityof Cupertino against liabilities, judgments, costs and'expenses, li'mayAccrue againstsaid City in consequence of the , Issued by: Date: granting of this permit. Additi all the applicant understands and will comply with all non-po', o cerag f n ,per the Cupertino Municipal Code, Section RE -ROOFS: 9.18 Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is lK installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION " Signature of Applicant: Date: I re affirm rrn tbatlT am exempt from the'Gontractor's License Law for one of the following two reasons:; ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property :or my employees with wages as their sole compensation, will dothe work,' and the structure.is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as o, er of the roe ion p p rt�;,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby, affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declaraitioi d, I ! I haver1:1►d will maintain Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit.hazardous Compensation as provided for by Section 3700 of the Labor Code, for the ea Ai Quality Management District I air contaminants as defined*ec5 performance of the work for, which this permit is issued. will maintain compliance wno un' 1 Code, Chapter 9.12 and I have and will maintain Workers Cpmpensation Insurance, as provided for by Section 3700 of the,Labor Code for the performance of the work for which this the Health & Safety Code, 2 33 a 25534. W Date: Owner or authorized agent perrnrt isj issued• I certify that in the performance of the worki for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of fowith',comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 #h�elabove;mentioneit properiyfot inspection.purposes..(We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the; City of Cupertino against liabilities, judgments, costs, and expenses iwhich may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit; Additionally;; the applicant understands and will comply Vith all non -point source regulations per, the Cupertino Municipal Code, Section Licensed Professional Date Signature ' CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �d- CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org 0 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS/`�J� `P_H'ONE APN # J OWNER NAME �. ` t S -?-7 - 0 37 Z E-MAIL F/ r 6� [ 79 �.Rcr i✓a STREET ADDRESS ` 0 '3/ �� CITY, STATE, ZIP gyp ,r, d a ?' j%` y FAX A 0A4 CONTACT NAME - PHONE ��f- 2-f f Q>I IZAMyrp-�w�✓1 �r t STREET ADDRESS 7 6 1—'m444) -6 CITY, STATE, ZIPCVV", GL FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT W CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME4 f / G A L tX-M&1 LICENSE NUMBER �'G�La 9 u LICENSE TYPE BUS. LIC # COMPANY NAME l G�/%aLs E-MAII,�A G �/v� �/O t �'AN ,_L �,.�k.,��r-Z FAX4VO 99 STREET ADDRESS ` �L®!� [� CTl'Y, STATE, ZIP `p� .,t! J (Jal•PJ �j 6 PHONE ` � X999 ARCHTIECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME ! / ,V E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ' G✓C✓tiWS -Pao" —1zo r 4. J., EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DDETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVE VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER ROME? ❑ NO -J 0 By my signature below, I certify to each o e followin . I am property owner or authorized ent act on the property owner's behalf. I have read this application and the information I have o i is co I v ead the Description of Work and ve it is accurate. I agree to comply with all applicable local ordinances and state laws relating to Cho orize representatives of Cupertino to enter the abov property for inspection purposes. ,field Signature of Applicant/Agent: Date: SUPPLE AL NVORMAVON REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildin VER-TH�COUNTER UH DING PLAN REVIEW permit for new building. ❑ EXPRESS ANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ ME DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to 11MATOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO T. Ti Ti Ti CTTM A Tl1R _ RT TTT .i17Nf' il><VTCT(lN x ADDRESS: 10381 MEADOW PL DATE: 05/22/2013 REVIEWED BY: 10 1 # $533.00 APN: BP#: ''VALUATION: 1$7,580 -1 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY I SFD or Du lei p PENTAMATION 1GENRES PERMIT TYPE: USE:: $0.00 WORK REMOVE AND REPLACE 8 WINDOWS AND 2 DOORS SCOPE $0.00 ,Ltech. Plan Check Plumb. Plan Check Elec..Plan Check Rfiech. Perrnit Fee Plumb. Permit Fee: Elec, Permit Fee: Other-,i9ech: Insp.ET 0iher• Plumb Insp. Other Elec. Insp. 'iech.:Insp. ,Fee: Plumb. Insp. Fee: Dec. Insp. Fee: NOTE: This estimate does not includefees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the prefindna FEE ITEMS (Fee Resolution 11-053 E . 7ff 11/12) Plan Check Fee: Suppl.. PC Fee;. 0 Reg. 0 OT 0.0 hrs PME Plan Check: Permit Fee: Suppl. Insp. Fee Q Reg. ® OT 0,0 hrs PM E Unit Fee: PME Permit Fee: CohSinrction Tax. A:clministrative .Fee Work Without Permit? ® Yes (j) No Advanced Planning Fee: Travel Documentation Fees: Strong Motion Fee:', 1BSEISMICR Bldg Stds Commission Fee: 1BCBSC ,madon available and are only an estimate. uonracr me uepr>or aaan c Elm FEE QTY/FEE MISC ITEMS $0.00 10 1 # $533.00 Window / Sliding Glass Door 1 WINREP Replacement $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Select a Non -Residential Building or Structure i $0.76 Select an Administrative Item $1.00 $1.76 $533.00J $534.76 Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 -- Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: a ! (ZOd6l� „Oti PERMIT # OWNER'S NAME: , PHONE #' 0 7 37- LGENERAL GENERALCONTRACTOR: /Ll CAlif6 rS BUSINESS LICENSE # ADDRESS: 7,P7 4-iA. IW X46- .S. 7 f j'7" CITY/ZIPCODE: ' .-�f.-- ,rA 91.</ Z/. *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS ECTION(S) WILL - BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUNTRAVroHAVE OBTAINED A :CITY OF CUPERTINO BUSINESS LICENSE. f I am not using any subcontractors: 6� Sig t re Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME : BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CUPERTINO Building Department MAY 2 Z 2013 REVIEWED FOR COD COMPLIANCE Reviewed By: IL 134 If NJ f".0 fid60 PL4� PLS$ CMCKKD By DATE51 22 2013 OAT'E Rl T)f:. nF.PT upr-! S 6`s I ra. n�if 1T DEP� T -'is < lSi a� `2k9ftJ � iii � lJi u ��iON - CU. ERYiN� C �; n zt>-�, F- p(r. i is flons MUST be kept at the �or,✓N�s7o00, "IL✓n/SZ1� c n It is unlawful to make any same, or to deviate fro --n the Building Official. s rit �.nd spe�'ifications SHALL NOT to ti:o c , r proval of the violation cf :;T Ci-;/ C cinance or State Law. o r-- �N1=�' -P6�9�e,y