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13100022 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10778 E ESTATES DR CONTRACTOR: 4,9-12 y PERMIT NO: 13100022 "n�!//Lf>isS cCwsJh�cn drt� OWNER'S NAME: RENA TAKAHASHI DATE ISSUED:10/02/2013 OWNER'S PHONE: 3238042038 PHONE NO: LLICENSED CONTRACTOR'S DECLARRATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class U Lic.-# 1� I / REPLACE 10(E)WINDOWS,LIKE FOR LIKE(WILL MEET (� i9 6S §r..) 3 EGRESS&BE TEMPERED WHERE REQUIRED BY CODE) Contractor�7C.i� �"� 5 Date �Pl/:� I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 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:$6000 have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36922014.00 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 T 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 DAYSO 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 r Date l�. Z�i 3 granting of this permit. Additionally; applicant understands and will comply with all non-po source regul ion the Cupertino Municipal Code,Sectio 9.18. RE-ROOFS: Signature Date -713 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. 113 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 1,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 levices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area it ality Management District I performance of the work for which this permit is issued. will maintain compliance with the upertino icipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5505, ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this ^t 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 CO RUCTION 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 rr``Vv 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ` vo CUPIE RT1[�I4 (408)777-3228•FAX(408)777-3333•buildincia-cuoertino.org i ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED `ORIGINAL PERMIT# PROJECT ADDRESS/ Esim)-es APN# �i _ O t OWN �� I 04 O E-MAIL 5 STP,EE,T ADDRESS c TCZA E,ZIP C�) q{0 141 FAX CONT _NAME PH43x I V E �-`.V 1 1� C LC JI�GCi . e TATE, ZIP 461c5 09 l W,3" FAXW M y El OWNER ElOWNER-BUILDER ❑ OWNER AGENT CONTRACTOR 11 CONTRACTOR AGENT El ARCHITECT `❑ENGINEER ❑ DEVELOPER ❑ TENANT RACTO TV SEffk LICENS PE BUS.LIC# 1 5 MP N r 1 16 S Qi F J 4 7 SIRE SS C ST0,Z CA CSA- / P AE ARCHITECT ENGINEER NAME LICENSE NUMBER U BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 1 L 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 REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YETOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NC By my signature below,I certify to each of the following: I am the property owner or authorized agent a e property owner's behalf. I have read this application and the information I have provided is co 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 build' co c' n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Age Date: SUPPLE TA INFORMATION REQUIRED ' .PLAN CHECK i YPE ROUTING SLIP, New SFD or Multifamily dwellings: Apply for demolition permit for OYERHRUUNTERI BUILDING PLAN REYIEW a existing building(s). Demolition permit is.required prior to issuance of building y RE- permit for new building. ❑ EXPRESS O �Z LANNIIdG PLAN REYIEw : z _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CIxANngRu - ❑ PiICwoRKs ; form if any Hazardous Materials are being used as part of this project. "y DEPT. Copy of Planning Approval Letter or Meeting with Planning prior to pX&IA oR © SANITARY SEWER DI STRiC submittal of Building Permit application. , w >i,N VIRONMENTAL HEALTH.��o BldgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10778 E ESTATES DR DATE: 10/02/2013 REVIEWED BY: MELISSA APN: 369 22 014 BP#: `VALUATION: 1$6,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: WORK REPLACE 10 E WINDOWS LIKE FOR LIKE WILL MEET EGRESS & BE TEMPERED WHERE SCOPE REQUIRED BY CODE) g -r �5 t,TM,�✓°"".: _u.' e ,. .. a#A�s Y� 4 trr -3,„�;`-a ��' rr ALlech. Plan Check Plumb. Alan Check Elec.Plan Check Leech.Pera it Fee: Plumb.Permit Fee: Elec. Permit Fee: Other iv9ech.Insp. tither Plumb Insp. Ll Ocher Elec_Insp. .11ech.Insp.Fee: Plumb. htsp. Fee: 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 ees are based on the relimina in ormation available and are onl an estimate- Contact the Det or addn'1 info, FEE ITEMS(Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F i 6_1 # Window/Sliding Glass Door Suppl.PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $557.00 I WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consir uction Tax: ,4drninistratl ve fi'ee: Work Without Permit? ® Yes (E) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fees: I Building or Structure Strong Motion Fee: 1BSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ggv ( L $558.60 Revised: 08/01/2013 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: D)7 01— PERMIT 2 2 OWNER'S NAME: G S PHONE# '1i,2 V Lf— Z0" GENERAL CONTRACTOR: 15 S BUSINESSLICENSE#" . N C d Z ADDRESS: c Cti CITY/ZIP.CODE.Lca *Our municipal code requires all businesses working in the city to have a:City of Cigperti usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY IN PEC IONS) WILL BE SCIEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU CONTRA. O -HAVE OBTAINED1A_CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: S' ture Date Please check applicable subcontrac rs and complete the following information SUBCONTRACTOR BUSINESS NAME �SINESS LICENSE# Cabinets & Millwork 4 `n Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering e k- Plumbing t Roofing Septic Tank t Sheet Metal Sheet Rock Tile Owner/Contractor Signature N Date mo ja ,ICCe, 4C)-TN L e'� :�— / v go �o c+a 3r* COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTiNO APPROVED This set of plans and specifications MUST be kept at the o P Job site during construction. It is unlawful to make any \d changes or alterations on same,or to deviate - �. therefrom,without approval from the-Building Official. � LaG Tb� ld to � ping of this plan an !cations SHALL NOT rovis o be anoval of the violation C'Qp ance or State Law. ba� DAT /v 2 3 PERMIT NO. / S/O O 0 w'o� o sb. avaa d0jb d .J°3° SZ' CTrIECKED 2 ��� ;D: y ANNING D By ceT T►r. nFpT �- ,