13070136 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18921 PENDERGAST AVE CONTRACTOR:HOLDER INC DBA ABLE PERMIT NO:13070136
GLASS
OWNER'S NAME: CLAUDIA ZORNOW 850 ALDO AVE DATE ISSUED:07/23/2013
OWNER'S PHONE: 4082552308 SANTA CLARA,CA 95054 PHONE NO:(408)496-9960
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class Lic.# 6' O REPLACE 2(E)BEDROOM WINDOWS,LIKE FOR LIKE.
WILL
Contractor Date MEET EGRESS
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:$1500
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:37533032.00 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 WITIIIN 180 D 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 DA OM T CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 23 3
Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 7-4-3-1 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)
I,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. I 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Seen 505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this ��f
permit is issued. Owner or authorized agent: Date:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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
CONSTRUCTIONPERMITAPPLICATION �\
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 7(
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MO
(408)777-3228• FAX(408)777-3333•building(�cugertino.org `
CUPI=ATINO
❑NEW CONSTRUCTION ❑ ADDMON ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS r ^� APN# •7 '7 5r
OWNER NAME 4(A 70 C E MA1L
STREET ADDRESS FNdm /�j/� Cr?,(,lA v grog ZIP FAx
CONTACT NAME PHONE E-hckm
STREET ADDRESS CITY,STATE,ZIP FAX
Xo)x,1ER ❑ O)AINER•BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
COF • LICNSEE 211 1?R LICENSE TY BFAUXS.
As. LIC#` /
COMPANY NAME
STREET ADDRESS -to A-! DO �� ' CTrT, , /�� PHQl QS r'
ARCHrrECTIENGINEER NAME l• LICENSE NUMB3ERJ L J, BUS`.LIC# `(
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK I /� v / _, ,/^ / l•/C
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 DECKNORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: LS A SECOND UNrr []YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE.COPY OF IS THE BLDG AN ❑YES -_ D__B7 ' "'=` '' _- "'„ TOTAL VALUATION' '
PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO �
- _ a
By my signature below,I certify to each of the following: I am the property owner or authorize to actCZ rty owner's behalf. I have read this
application and the information I have prod on ect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build' ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.,
Signature of Applicant/Agent: Date: —
SUPPLEMENTAL INFORMATION REQUIRED � ovTn csi
��r>�NCHEex�YP �.
_New SFD or Multifamily.dwellings:-Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of bullding
a TJ co n arl R = �sullDmcPL xE
permit for new building. ExP__ p ,IN
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
To—rm.if any Hazardous Materials are being used as part of this project. gam
1 �
_Copy of Planning Approval Letter or Meeting with Planning prior to
MA OR .,' '� _ SAATTAR]'°BE{V.ER"DISTRI 'F *'
submittal of Building Permit application. _ � X, x :
Bld.-App_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 18921 pendergast ave DATE: 07/23/2013 REVIEWED BY: melissa
APN: 375 33 032 BP#: EVALUATION: 1$1,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1GENRE
WORK [Ega!Pce 2 e bedroom windows like for like. will meet egress
SCOPE
r
u
i
;'tech.flan Check Plumb. Plan Check F:lec.flan Check
Fech.Pern-it Fee: Plumb.Permit Fee: Elec. Permit Fee:
other;llech.Insp. Other Plumb Insp. LJ Other Elec.Insp. Li
dtech.Insp.Iev: P1u7778. Insp.Fee: Glee Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the preffmina information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl.PC Fee: (F) Reg. ® OT0.0 hrs $0.00 $418.00 I WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conswuciion Tax:
dininistrative.Fee:
Work Without Permit? Yes (E) No $0.00 1 0
Advanced Planning Fee. $0.00 Select a Non-Residential 0
"1 ravel Documentation F. Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldp-Stds Commission Fee: IBCBSC $1.00
C
u $1.50 $418.00 $
x` 0 �' 419.50
Revised: 07/01/2013
BUILDING UI''dIZ GN
This set of plans and seu;
0 X j job site during consiructio i it i�: U i
cl cang;vs or alter uJoi f'„ 0, r
therefrom,without r;pPr0vul r01+1 t 5 0I _
�. n .,,
The ` .,aping of this clan�,re. . . ,1Ic.,;r�r;-
be held'to permit or to i -
of any pro of
an, ^'rl rlce ur S-: ,>
DA
PERMIT NO. _ 13 610 i3
ONc= S?v� ll He
(N0T 7"v .SG
N CAA YVIWW cS �W 1 S►W l�C� ' " N �,,x._.vc. 1 47� a a t j. I- .
rnGt,Q-cPn- f.P� QLa(c r".Ts�' /p�a.�W
7�Z3
2 2013
DST,. Z
BY.
!�L'Dom. DEPT.
�( Cmc Z`7'1U v . 9 r-OAC
6>( (,4 Ce C'z) T�c�� Ui�N auwc �� CIO moo,, .per
I,-/ Shu C 1W el 01 c�N�N�
�r