13060184 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19773 LA MAR DR CONTRACTOR:FIVE STAR WINDOWS PERMIT NO: 13060184
OWNER'S NAME: BOYLE RICHARD BAND BRENDA S 1450 DELL AVE STE C DATE ISSUED:06/24/2013
OWNER'S PHONE: 4082536134 CAMPBELL,CA 95008 PHONE NO:(408)370-3331
41 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL❑ .
License Class— .–� Lic.# �2. 2J�\ REPLACE 20(E)WINDOWS,SAME SIZE&LOCATION.
h� WILL
Contractorr ,!5� ( Date Co"2L{� MEET EGRESS&BE TEMPERED WHERE REQUIRED
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:$21000
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 APN Number:36910025.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LA LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of theZ
granting of this permit. Additionally,the applicant understands and will comply Iss ate:
with all non-point source re ulations per the Cupertino Municipal Code,Section
9.18.
/��PRE-ROOFS:
Signa Date� "'2('I 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor'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 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 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
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cuper ino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 25533,and 5534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age DatCa2�1
permit is issued.
I 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,I CONSTRUCTION LENDING AGENCY
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
forthwith 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
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which 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
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION ( _��
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION OW
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(a.cupertino.org
[:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN# 7�j /C7 9 _ to
- o-z-C
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OR NAME-ArIN �%1I 0�(J� t7V �Q- PH—lo
L� E-MAIL
STREET ADDRESS C STATE,ZIP FAX
\ate 3 Kc� `bcoveG �t^d
CONTACT NAME AAM ` PHONE E-MAIL
�AK& A-> RS G
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT
OR NAME \\ LICENS E LICENSE JYPE BUS.LIC#
COMBANY NAME E-MAIL FAX
l
STREETI, CTIY�STATE,Z + ^c!v'� SHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER ` (� V Vt/ BUS.LIC# V
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
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 REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA El DETACH
[]ATTACH
DWELLING UNITS: IS A SECOND UNrr []YES SECONDSTORY ❑YES
BEING ADDED? ONO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES " C - 6M g' OTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
By my signature below,I certify to each of the following: I am the property owner or author' agent to act on property owner's behalf. I have read this
application and the information I have provided is orrecI* I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to building cons Iction. I authorize representativ f Cupertino to enter the above-identified property for inspection purposes.,
Signature of Applicant/Agen. Date:
SUPPLEMENTAL INFORMATION REQUIRED
_New SFD or Multifamily dwellings: Apply for demolition permit for u
� AVER THi+<CO � BUII,D,II1ZskL RE
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
�x I,ANl�'ILVG L -YLE _
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure x
�.STAT!IllARD � � - "1��rusr.Ic-woiucs
form if any Hazardous Materials are being used as part of this project. ti
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. � R yQ IT Y srzISTIuc
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19773LA MAR DR DATE: 06/24/2013 REVIEWED BY: MELISSA
APN: 369 10 025 BP#: "VALUATION: 1$21,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Du lex PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK REPLACE 20 E WINDOWS SAME SIZE & LOCATION. WILL MEET EGRESS & BE TEMPERED
SCOPE WHERE REQUIRED
PI„ .,
mi 111ii
Xfech. Plan Check Plumb.Plan Check Elec. Plan Check
iL9ech.Permit Fee: Plumb.Permit Fee: Elec. Permit Fee:
Fh"',h.
Meeh.Insp. Other Plumb Insp. Other Elec.Insp,
Insp.fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onlyan estimate Contact the Dept-for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/11121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F-20-1 # Window/Sliding Glass Door
Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 $666.0011 Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. ®OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
('ons it uclion .Tax:
Adininistraiive Fee:
Work Without Permit? ® Yes (E) No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure
711avel Documentation Fees: A
Strong Motion Fee: 1BSEISMICR $2.10 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
� � � $3.10 $666.00 �r�� T $669.10
ins mat �n y .
Revised: 04/29/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS:kq-7-7 L-& PERMIT# 130661,81
OWNER'S NAME: PHONE# 4- j Z G k S9
GENERAL CONTRACTOR:`} BUSINESS LICENSE#
ADDRESS: (A,50 .L CITY/ZIPCODE: '
*Our municipal code requires all businesses working in the city to have a City.of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL-BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON CTORS HAVE ,O TAINED A�CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 2�—
ignature Date
Please check applicable subcontractors and complete the following informations
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
01 j<Lctt �)v-A)
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BUILDING CUP--R-;INO
This setCfplans end s7-(;,:-ific:�ticnskfflJSTbe kelpt the N, 3 69 10
(41>�Ll$)b SIt0()J'urn--,,9 cons lrEz^Aion. It is unla�.vful to tjr. afjy
--------- Y,0 ch.--IraE':C-or alteration-,on sarne, or to de,,,,Ja,,e
therefrom,without approval from the Building Official.
\'x- The s, aping of this plan and s pecifications SH -f,`
be held to permit o AC7Z
N*&Z
r to be an approval of the violation 0
of any Provisl
I ance or State Law.
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PLOT PLAIS16
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