14020082 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19871 PORTAL PLZ CONTRACTOR:PHILLIP ISAACS' PERMIT NO: 14020082
CONSTRUCTION INC
OWNER'S NAME:
ORANGEVALE,CA 95662 PHONE NO:(916)852-8132
`
/ LICENSED CONTRACTOR'S DECLARATION
/ � 210 7 � BUILDING PERMIT INFO• BLDG ELECT PLUMB
License Class G 1 7 Lic.#
�— MECH RESIDENTIAL COMMERCIAL
Contractor I-E nJ a c pi - Date 2— 3
I hereby affirm that I am icensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions JOB DESCRIPTION.
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: INSTALL 5 RETROFIT WINDOWS&ONE SLIDING GLASS
1 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 DOOR IN PATIO,IN KIND,NO SIZE CHANGE
,ppformance of the work for which this permit is issued.
h ve and will maintain Worker's Compensation Insurance,as provided for by
S tion 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is Sq.Ft Floor Area: Valuation:$5417
;.orrect.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 APN Number:36946001 00 Occupancy Type:
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will omply with
all non-point source regulations per the Cupertino Municipal ection 9 18. PERMIT EXPIRES IF WORK IS NOT STARTED
Signature Date Z 3 `f WITHIN 180 DAY IT ISSUANCE OR
INSPECTION.
❑ O BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1 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 RE-ROOFS:
sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is installed
z. I,as owner of the property,am exclusively contracting with licensed contractors without first obtaining an inspection,I agree to remove all new materials for inspection.
to construct the project(Sec.7044,Business&Professions Code).
Signature of Applicant: Date-
1 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 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. HAZARDOUS MATERIALS DISCLOSURE
2. 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 I have read the hazardous materials requirements under Chapter 6.95 of the California
Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with
permit is issued. the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section
3 I certify that in the performance of the work for which this permit is issued,I shall 25532(a)should I store or handle hazardous material. Additionally,should I use
not employ any person in any manner so as to become subject to the Worker's equipment or devices which emit hazardous air contaminants as defined by the Bay Area
Compensation laws of California. If,after making this certificate of exemption,I Air Quality Management District I will maintain compliance with the Cupertino
become subject to the Worker's Compensation provisions of the Labor Code,I Municipal Code,Chapter 9.12 and the Health&Safety Code,Sections 25505,25533,and
must forthwith comply with such provisions or this permit shall be deemed 25534.
revoked. Owner or authorized agent: Date: f3
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's for
to building construction,and hereby authorize representatives of this city to enter Which this permit is issued(Sec.3097,Civ C)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
posts,and expenses which may accrue against said City in consequence of the Lender's Address
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. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19871 PORTAL PLAZA DATE: 02/13/2014 REVIEWED BY: MELISSA
APN: 369 46 001 BP#: 'EVALUATION: 1$5,417
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 GENRE
WORK INSTALL 5 RETROFIT WINDOWS & ONE SLIDING GLASS DOOR IN PATIO IN KIND NO SIZE
SCOPE CHANGE
;Se•L'sr s .._3(. .°i3dsi=13,I'rtar,•= .e7L'fr'
Lj
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution.1.1-053.F,f: 7,!1/13,) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 $418.00 IWINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. ® OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes (E) No $0.00
Advanced Plannin Fee: $0.00 Select a Non-Residential
/`£'£':5:
Building or Structure 0
�
Strong Motion Fee: IBSEISMICR $0.54 Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC $1.00
$1.54 $418.00 TOTAL FEE: ` $419.54
Revised: 01/15/2014