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13120040
f CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 958 WESTLYNN WAY: CONTRACTOR:BENTSON ENTERPRISES PERMIT NO:13120040 OWNER'S NAME: KOPELS DAVID 535 UNION AVE DATE ISSUED:12/04/2013 OWNER'S PHONE: 4084611195 CAMPBELL,CA 95008 PHONE NO:(408)677-1028 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL APT 1-4- APT 1 REMOVE AND REPLACE 7 WINDOWS AND License Class Lic.0 �• f�� 2 Contractor / /N+ � Date Z � DOORS,APT 2 REMOVE AND REPLACE4 WINDOWS,APT I hereby affirm that I am licensed under the provisions of Chapter 9 3 (commencing with Section 7000)of Division 3 of the Business&Professions REMOVE AND REPLACE 4 WINDOWS,APT 4 REMOVE Code and that my license is in full force and effect. AND 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:$1800 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:35927016.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the aboveinformation 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 DA ST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, 2 costs,and expenses which may rue against.said City in consequence of the Issued by Date: granting of this permit. A 'ro ly,the applicant understands and will comply with all non-point sour reg u perthe Cupertino Municipal Code,Section . 9.18. � RE-ROOFS: . Signature .Date 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 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 devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as define/the Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance werd unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agen 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: A CONSTRUCTION PERMIT APPLICATION a� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTtN4 (408)777-3228• FAX(408)777-3333•building(a)cugertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# OWNER NAME `p r PHONE v v �' /✓/G� ` �i•E-!MAIL STREET ADDRESS / )_r i CITY, STATE,ZIP O(W oe l�r/ FAX CONTACT NAME J PHO .0 cam. /C/ /!�� E-MAIL STREET ADDRESS i ` �/ CITY,STATE,ZIP 15 OeV 9_�o1 FAX 11OWNER ElowwNER--BuiLDER ❑ OWNERAGENT ❑ CONTRACTOR 11CONTRACTOR AGENT El ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME /AA G^ B LICENSE NI?AR/ ( LICENSEDE BUS.LIC# COMPANY NAME �/,�! /3C��j v/✓ E-MAIL (�/� 6`AC / F d SY STREET ADDRESS /� � / //!� �/� C1TY. "��(•_ /W� � �V���° PHO 'Q ARCHITECT/ENGINEER NAME (/ LICENSE NUMBER /G BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR-TYPE 1 #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 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 ❑YESR`ECE ED.BY PLANNING APPL# ❑NO PLANNING APPROVAL L EICHLER HOME? E]NO r-_✓ xx $'�` rr TO A , < By my signature below,I certify to each of a fol in 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 pr ide co rr . I have read the Description of Work and verify it is accurate. I agree to In Lyall applicable local ordinances and state laws relating to b din I authorize representatives of Cupertino to enter the above-iden ed insp 'On ju3ses. Signature of Applicant/Agent: Date: " S SUPPLEME INFO ION REQUIRED _New SFD or Multifamily dwellings: Apply for demolition permit for u ` ' existing building(s). Demolition permit is required prior to issuance of building- g Tt CotmzER ❑ rL 4N REViEw p 9 P vg permit for new building. XPRESS ❑ GrrxEVIEw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ST NDARD4 CxiJsilCwoRxs Form if any Hazardous Materials are being used as part of this project. ❑ ��iRG�� �� � '❑FIRE DEPT xs � '�` � � Copy of Planning Approval Letter or Meeting with Planning prior torrAIIYSE��R IST CT ` submittal of Building Permit application. `may n ` 3 ❑�-EIVVIR01\71�ENTAi;•HEALTH ..•,.. BldgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 958 Westlynn way DATE: 12/04/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: $1,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION 1GENRES USE: SFD or Duplex PERMIT TYPE: WORK a t 1-4- apt 1 remove and replace 7 windows and 2 doors apt 2 remove and re lace4 windows apt 3 SCOPE remove and replace 4 windows, apt 4 remove and replace 5 windows to meet egress in bedrooms.. SON, C t llech.Plan(.'heck Plumb.Plan Check Elec_Plan Check Nle-ch.Permit Fee: Plumb.Permit 1%ee: Elec. Permit Fee: Other•rblech.Insp. 011ier Plumb Insp. Other IYee.Insp. Li lace.Insp. Fee: tleeh.Insp.Fee: Plumb. Insp.fee. NOTE:This estimate does not include fees due to other Departments(i c Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 E . 7f /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.0023 # Window/Sliding Glass Door Suppl.PC Fee: (E) Reg. ® OT 0.0 hr's $0.00 $696.00 I WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee:Q Reg. ®OT Fo7o hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 77 Administrative.Fee: Work Without Permit? ®Yes (E) No: $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Travel Documentation Fees: � Stroniz Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 x Gq.r� $1.50 $696.00 $697.50 Revised: 10/01/2013 s � P&YD —t ��N f a N 09 c� C Ir a � t � SUP£, D�af No -; � f .�, rtmeRt LI 2ft? review UdE CC)MPLtpNCE edUP . . 1 I+ VLOT PLAN S CHECKED BY z �0 95 Y DEpDEPT, COM BU LDING SIONECUPERTIA ��T APPROVED AT This set of plans and specifications MUST be kept at the _- 13G• DEPT. � job site during construction. {t is unlawful make any d changes or alterations on same, or to deviate therefrom, without approval from the Building Official. +C4 S The Stamping of this plan and specifications SMALL NOT be held to permit or to be an approval of the violation cfany rovisi s of any City Ordinance or State LawEY . 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