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13100027 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10445 DEMPSTER AVE CONTRACTOR:BROTHERS HOME PERMIT NO:13100027 IMPROVEMENT OWNER'S NAME: HERGATT NORMAN K AND JEAN G 2510 DOUGLAS BLVD DATE ISSUED:10/02/2013 OWNER'S PHONE: 8013616422 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class IV, -7 Lic.# OF60' REPLACE 8(E)WINDOWS,LIKE FOR LIKE(WILL MEET —I � ,.n EGRESS&BE TEMPERED WHERE REQUIRED BY CODE) Contractor tv-ti �'M� �iU Date � Z' 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 e nuance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5488 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:32648013.00 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 DAY 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 1p Z granting of this permit. Additionally,the applicant understands and will comply I Date: with all n int source regulations per the Cupertino Municipal Code,Section 9.18. L/•1� 2 RE-ROOFS: Si re Date G!`(t' / 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. ❑ ER-BUILDER DECLARATION Signature of Applicant: Date: I hereby a irm 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 Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,SqRtan,25505 33,and 25534. / y Section 3700 of the Labor Code,for the performance of the work for which this N '4Owner or authorized age • Date: 4/ 1 �l 3 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 CON RU ON LENDING AGENCY become subject to the Worker's Compensation provisions of theLabor 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 0 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ` O 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 I O Ll 14 g571/ ^ iy APN# IZ Z /�, q 3 OWNER NAME ! Q` / • _- -.. - PHONE� ,3W ' / i�n� E-MAIL STREET ADDRESS CITY, STATE,ZIP J '/ln9 G FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME Y.4 wI LICENSE NUMBER //��bo LICENSE TYPE Q (� (n,n BUS.LIC# gACOMPANY NAME 4 „ E-MAIL FAX STREET ADDRESS 4 'V I LICITY,STATE,ZIP PHONE ,/(�/y, ARCHITECT/ENGINEER NAME CENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK /w I - 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 PORCH77 DECK AREA TOTAL DECK/PORCHAREA I GARAGE AREA: Ll DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECONDSTORY OYES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES glysgg. TOT VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO - (� _ .�, u'"'�.. By my signature below,I certify to each of the following: I am the property owner or au orized agent to act on-Me-e-property owner's behalf. I have read this application and the information I have ided is correct. the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to Il in truction. representatives of Cupertino to enter the above-jHent' led property for inspection purposes. Signature of Applicant/Agent: Date: �V/I�Z 41J0� SUPPLEMENTA FO ATI IRED � ft PIa'( ,T'YPEiOU�INGSL_ et _New SFD or Multifamily d in Apply for demolition permit for � z w ° existing building(s). Demolition permit is required prior to issuance of building permit for new building. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting,with Planning prior to submittal of Building Permit application. ' 012 S- SE H D,STI2I.- BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10445 DEMPSTER AVE DATE: 10/02/2013 REVIEWED BY: MELISSA APN: 326 48.013 BP#: *VALUATION: 1$5,488 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK REPLACE 8 E WINDOWS LIKE FOR LIKE WILL MEET EGRESS & BE TEMPERED WHERE SCOPE REQUIRED BY CODE) j Xlech. Plan C'her..k Plumb.Plan Check Elec.Plan Check' 711,h.Permit Fee. Plumb. Permit Fee: Elec.Permit Fee: Other rtlech.Imp. Other Plumb Insp. Other Elec,Insp. Li Wech. Insp.Fee: Plumb. hap.Fee: Elcc.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prefinWha information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl.PC Fee: (E) Reg. ® OT0.0 hr's $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 ('onstr action Tax: Adinl nistrati ve.l-ee: Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential G Travel Documentation Fees: Building or Structure Strong Motion Fee: IBSEISMICR $0.55 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $1.55 $418.00 . $419.55 Revised: 08/01/2013 COMMUNITY DEVELOPMENT DEPARTMENT 0,S(—Al2"-SC)"'J BUILDING DIVISION-CUPERTINO APPROVED I 0q TrDvMPS Sai This set of plans and specifications MUST be kept at t job site during construction. It is unlawful to make an R. 1-414 bre-Au( 6 changas or alterations on same,or to deviate therefrom,without approval from the Building Official. d The stamping of this plan and specifications SHALL NOT g�k be held to permit or to be an approval of the violation of an rdinance or State Law. �(p a BY _ E e0 Z.103 PERMIT NO. 0� Z�` FT 'p I"` y UPS�A(� � N C----------- 0 h ftft ins IcoK _ 0- ;© �'uildirlo n pa��t. D _ REVlE+ -;t CODE COMPLIANCE Reviewed gy; -