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13080156 CITY OF`CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19240 TILSON AVE CONTRACTOR:SEARS HOME PERMIT NO:13080156 IMPROVEMENT OWNER'S NAME: BENG-TAK TING 1024 FLORIDA CENTRAL PKWY DATE ISSUED:08/22/2013 OWNER'S PHONE: 4089961690 LONGWOOD,FL 32750 PHONE NO:(925)245-2000 /V LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALII License ClassC 17 / Li,.# 72- 13 7 c! INSTALL 4 RETROFIT WINDOWS& 1 PATIO DOOR,LIKE Contractor �-rJ �(��'iE 41 Date 2 Z 1 3 FOR LIKE(NO SIZE CHANGE) 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 ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6872 rrmave and will maintain Worker's Compensation Insurance,as provided for by Sion 3700 of the Labor Code,for the performance of the work for which this APN Number:37540057.00 Occupancy Type: pit 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 andcounty ordinances and state laws relating WITHIN 180 DAYS QF 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 180DAYS 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 the 2 '3 granting of this permit. Additionally,the applicant understands and will comply Is -3 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 2� 3 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. ❑ 1U<_1'1-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,Sections 25505,25533,and 25534. —�)� Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date 7f 1-Z/ 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 Q ,OMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CtJ P RTtNt (408)777-3228•FAX(408)777-3333•building (Wcupertino.ora ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# 3 O 0 OWNER NAME �� �/� I� /� 796-16 C/O E-MAIL v J �+ �q STREET ADDRESSIU O T/5 * ,�1E clC_(�rT�7i..10 `/�J ?sFAX CONTACT NAME LIZ GONZALES PHONE 916-830-3423 E-MAIL STREET ADDRESS 1200 DEL PASO RD CITY,STATE,zIPSACRAM ENTO,CA 95834 FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 't CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 721379 LICENSE TYPE BUS.LIC# B 2 1 �5�MYNBME IMPROVEMENT PRODUCTS E-MAIL. FAX 407-551-3085 STREET ADDRESS 1200 DEL PASO RD CITY,STATE,ZIP SACRAMENTO,CA 95834 PHONE 916-830-3423 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK i Aj IZC_ -7 (-1_ y c o� ���/O A) S� ` r Nl-.HCl h/7 EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES QA)C OAC. ryPE DES&LRTION S :ET. VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA ...,,.. a 1 BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH .,; ❑ ATTACH x #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEINGADDED? NO ADDITION? NO PRE-APPLICATION ❑❑ YES IFYES,PROVIDECOPY OF PLANNER'SNAME: C� TOTA Vt�.UOI� PLA\TING APPL# NO PLANNING APPROVAL LETTER Svj L �.».. _ ,..,.n... ...«inn. r�.... ,,....�.,... .� By my signature below,I certify to each of the following: I am the property own au rized agent to'act the property owner's behalf. I have read this application and the information I have provided is correct. 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 building construction. I au a representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORNAWOTKEQUIRED PLCHECK3TYP,E., ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for aGTHE-COUNTER BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ��_ E r ss,• rLANNINGPLAN REVEFW W Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E ST-kwARD: PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. I] FIREDEPT. Copy of Planning Approval Letter or Meeting with Planning prior to p mAroR_, El SANITARY sEwER DISTRICT submittal of Building Permit application. EivVIRONMENTALHEAL1,11 B1dgApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19240 TILSON AVE DATE: 08/22/2013 REVIEWED BY: MELISSA APN: 375 40 057 BP#: *VALUATION: $6,872 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION 1GENRES USE: SFD or Duplex PERMIT TYPE: WORK INSTALL 4 RETROFIT WINDOWS & 1 PATIO DOOR LIKE FOR LIKE NO SIZE CHANGE SCOPE Ifeah.Plan Check Phsmb.Pleat Check Elec.Plan(.;heck L1ech.Permil Fee: Plumb.Permit Pee: Elec.Permit fee: FC)zhcr H,ch.Inch. Other Plumb Insp. Other Elec,Insp, D3ech.Itzsh.lee: Plumb. Insp.Tee_ Elec.Insp.lee: NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on therelinuna information available and are on1 an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7ff 11112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F—T-1 # Window/Sliding Glass Door Suppl.PC Fee: (j) Reg. ® OT 0.0 1 hrs $0.00 $418.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction .Tax: F-T_ Administrative Fee: Work Without Permit? ®Yes 0 No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure Travel DocumentationFees: Strong Motion Fee: 1BSEISMICR $0.69 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 001, $1.69 $418.00 $419.69 Revised: 07/01/2013 BEDROOM BEDROOM WINDOW WINDOW z 4606 36 11 x 36 cn CUPERTINO co Building Department BEDROOM � PATIO DOOR o rn AUG 2 2013 50 x 68 BEDROOM BEDROOM LU = U w O O REVIEWED FOR CODE COMPLIANCE Cl Cl- w G`% `Y BEDROOM o Reviewed By: BEDROOM BEDROOM WINDOW U 46x36 0 0 �¢ x cn a A& AVAL w _ 13Y.- LLJ KITCHEN LIVING ROOM g COMMUN DEMOPMENT DEPARTMENT BUILI I YG DMSION-CUPERTINO $IItNTRY APPROVED w o d specifications MUST be kept at the z Q M ENTRY job site during construction, it is unlawful to make ani► 7: 46 x35 changes or elteratrons on same or to deviate z o bwvfrO%Mitlrout approval from the Building Official. > C/)z GARAGEv F= The Stamping of flus plan and specifiesions SHALL,NOT :::c o be held to permit or toroyal of the violation N 0- of or State tar. a' 1�J CUE DATE B"TE 08.12.13 I� ^Z2-1 FLOOR PLAN PST NO 13OR D! �'-6 SCALE NTS DAZE DRAWN BY DKW '08 15985373 KING SCOPE OF WORK: INSTALL(4)RETROFIT WINDOW& (1)PATIO DOOR,NO NEW CONSTRUCTION. 5N� A-1 BLDG. DEPT.