13120055 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10311 S TANTAU AVE: CONTRACTOR:TBS- b B PERMIT NO: 13120055
DEED
OWNER'S NAME: MARIKA WUONO C �� Bch DATE ISSUED:12/05/2013
OWNER'S PHONE: 4084809189 PHONE NO:
13LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class '1 Lic.# D Z REMOVE AND REPLACE 12 WINDOWS,1 PATIO DOOR TO
I MEET EGRESS IN BEDROOMS
Contracto S vn "102 Date
I hereby affirm that I am licensed unde 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:$3000
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:37508014.00 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 LAST CALLED INSPEC ION.
indemnify and keep harmless the City of;Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Issued by 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.
Ria 11 V r7 p p RE-ROOFS:m
Signature J ��yl Date �2• � � All roofs shall be inspected prior to anroofing 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 isnot 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,SectiAqz:
550/5,255 /ander 25534.
Section 3700.of the Labor Code,for the performance of the work for which this Owner or authorized agent G%��/ WI' v1 Date:
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTCNC� �/
(408)777-3228•FAX(408)777-3333•buildingCa)-cupertino.ora �\
\
❑NEW CONSTRUCTION ❑ ADDITION 4ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS P _j—rft V A V& --7
& APN# •-75/ 69' G lW
OWNER NAME M A R,k A W In I ID PHONE. 03 q 8 O l� E-MAIL
STREEET ADDRESS h 'V CITY,Lt E,ZIP / `_�O I FAX
CONTACT NAME '1 PHZ9 1 J E- IL
RI 1. 0 1 �wlo r�DlP WL00 om
STREET,JD 'SS, -I A CITY, ZIP n FAX
ElOR'I.m 11OwNER-BUn,DER El OWNER AGENT CONTRACTOR 11CONTRACTORAGENT /-1 ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CO O N LICENSE NUMBER ®� LICENSE TYPE C._i� BUS.LIC#
COMPANY NAME E-MAILr o^� ��fl f FAX
!n ` 02 t/ UJ Gbh �� • ` 9� t� (j
STREET AWS 1
4 n 4vr`� CITY,STATE,ZIP f A i /�j,i t o + �q 5-a PHONE q 6 f 9 S 1 v
ARCHITECT/ENGINEER NAME LICENSE NUMBER T L G J/`tlY l [�I —I BUS.LIC# 1 Q
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK i,'�V��t_ t�W Lot (t Vka
PC(Q '30 0v, ILI
EXISTING USE PROPOSEDUSE CONSTR.TYPE #STORIES
fts USE TYPE OCC. SQ.FT. VALUATION(S)
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: 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 ❑YES ,T2EC '- �. "�'., T�TION:
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 authorized agent to act on 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 bu" " &cons ctio o e representatives of Cupertino to enter the abovee-iiden(t�ified property for inspection purposes.
Signature of Applicant/Agent: V / T • = Date: tY l•� GJ / -3
SUPPLEMENTAL INFORMATION REQUIREDMy
_New SFD or Multifamily dwellings: Apply for demolition permit for oiRI»co7rER slJr>�Incrn
KN,existing building(s). Demolition permit is required prior to issuance of building r ..
WIermit for new building. � GX LANI2EVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDAItn t LUBVlcvtoRKs ,.
form if any Hazardous Materials are being used as part of this project. £ IR_
a
iDEPT ` z..
_Copy of Planning Approval Letter or Meeting with Planning prior to � '
submittal of Building Permit application. I] �4a01 ANITARY SEWERDISTRICT
. R�aN�• _ ❑PE
VIROn7lNTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10311 s tantau ave DATE: 11/12/2013 REVIEWED BY: MENDEZ
APN: BP#: "VALUATION: 1$3,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Du lex PENTAMATION 1GENRES
USE: P PERMIT TYPE:
WORK remove and replace 12 windows and 1 patio door, to meet egress in bedrooms
SCOPE
- f, _ ?1
=t -
- —
r
o ,ra
Ifec:h.Plan Check Phinib. Plan Check Elec.Plan Check
a9ech.Permit Fee: Plumb.Permil Tee: Elec. Permit Fee:
Other aleck.Insp. Other Plumb Insp. Li
Other 1.7 Insp.
t ech.lnsp.Fee: Plumb. Ins.Fee. Dec.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 ftes are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS Lee Resolution 11-053 Eff. 7111131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl.PC Fee: Q Reg. Q OTJ 0.0 hrs $0.00 $557.00 I WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
T-7
Adininistrative.I'ee:
Work Without Permit? ®Yes (j) No $0.00 1 E)
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure
Travel Documentation Fees: i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
7 "a, . 't
A.s, :.. $55$1.50 $557.00
` a � Nlb .50
Revised: 10101/2013
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CCt`"MU''IT1'DEl�ELOPMENT DEPARTMENT ��1, �2 $ -, 3.S b- �P
-SIN; DIVISION-CUPERTINO t-J 1,-A
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T 1::s set of W.-n-s and specifications MUST be kept at t
ie
,A) P nstrur-'ion. It is unlawful.tom^{< i
.e an i
alterations on same,or to deviate
v„i'hou't approval from the Building Oficial. s �1►
Thos st?. .-ing of this plan and specifications SH- LL N s �`
pta'—it or to be an approval of the violation
e1<< .';'P eflisions of any City Ordinance or State Law.
�
13v (v14-
D,JE �. r �2 S )3
CUPERTINO
'�
PERI'�SIT NO. '51200,;-4— '-�,�,��,�;;�4 Denartrnent
IX
MELC/
Copl�'�;
f, REV1EVVEL' '=UFt s.'r0DE COMPLIANCE
Up" FFICE Reviewed By: `y'