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14070116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20041 NORTHWOOD DR CONTRACTOR:BROTHERS HOME PERMIT NO: 14070116 IMPROVEMENT OWNER'S NAME: LEE JAMES B ET AL 2510 DOUGLAS BLVD DATE ISSUED:07/25/2014 OWNER'S PHONE: 4093966091 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680 V1, LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ /�pq REMOVE AND REPLACE 5 WINDOWS,AND 2 PATIO License Class C/ 7 Lic.# `� ( (QDOORS; // Contractor Date 2�. J� TO MEET EGRESS IN BEDROOMS /lDvs' 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6518 61have 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:31637059 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMITEXPWES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 A 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 O AST CALLED INSPEOTIO.i. 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 comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. 7/2 RE-ROOFS: Signature G Date ` y 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 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,Sectio 255 ,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 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 CONSTRUCTION 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 918. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building aC)cupertino.org ` CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 9_66y/ /6,n / W ' , APN 11316a -7 05'f, OWNER NAME 5 1 w P14ONE v0 3Q/ /A9/ E-MAIL�� STREET ADDRESS /f M O w CITY, STATE,(ZIP ((� v/f/_J� � ,0 FAX CONTACT NAME G(J V PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OwNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPEQ /►, BUS.LIC 9 COMPANY NAME E-MAIL J `/ FAX S W. STREET ADDRESS ��- CITY,STATE,ZIP PHONE /f Q 777 ARCHITECT/ENGTNEER NAME LICENSE NUMBER /VIYIII BUS.LIC# G 7 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ,o rt , &a div 1k) 5 Z '7o e t� EXISTING USE PROPOSED USE CONSTR TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH k DIATLLING 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 ❑YESRECEIVED$3Y r "" �*"''"5Es"' TOT VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO - w { _ ,.fes ..,t`' °` - By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. f have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b constructkagELPthorize representatives of Cupertino to enter the above-identified property for inspection purposes. SignatureofApplicant/Agent: Date: 2 SUPPLEMENTA 0 .REQUIRED I ATy�>�cltYr _ L210 New SFD or Multifamily dwellings: Apply for demolition permit for . OVER O:" SER �. existing building(s). Demolition permit is required prior to issuance of building "- al -�'�' �� ,,` --'BUI LDING.P,1 REVIEW permit for new building. xP = xcLAN:>zEVD w ' _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ' form if any Hazardous Materials are being used as part of this project. Q _ Copy of Planning Approval Letter or Meeting with Planning prior to 3, 70 �� ALIT Y�E RDISTRICI submittal of Building Permit application. s`�$;ENVTROJVMENrAL'•'3�EA�I':TFI ��, B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 20041 northwood dr DATE: 07/25/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$6,518 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1GENRE WORK remove and replace 5 windows and 2 patio doors; to meet egress in bedrooms SCOPE Ahj ON I_111 FEE- SRI ak � v Ic cr,. f,,rrr t'Yr<c Phwl"6 Plan t"hc l; 1 f c. ?'<t he )r h qtr?; f'Iu n!". Pz r mir F(e Llirrr:r 1 -c't. I3r:s,3= Other Plunlb Irt,n. othey,Alf,:(_ r1 alnzcr. Ltt.Sp. I° fr phu'v1), Insp. Fee: t 1ec Imp. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the mlimina information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Tee Resolution 11-053 Ef.. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # Window/Sliding Glass Door Suppl. PC Fee: (2) Reg. 0 OT 0.0 hrs $0.00 $431.00 1 WINREP 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 t:t;nso,tic°tion KIV: Work Without Permit? ®Yes (j) No $0.00 E) Advanced P'lannin Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Strong Motion Fee: IBSEISMICR $0.85 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 - S $1.85 $431.00 „{ TOTAL FEE: $432.85 Revised: 07/10/2014 tarc dhoM F70ADqe, 6 CUPERTINO Building Department jJ AUL 2 4 2014 XREVIEWED Foil �;o()E COMPLIANCE tj ujq Reviewed BY: tih C'N rxxjvl� 1+,;"y, DA YLANNING DEPT. ,P"O-VM, F-N,T DATE 6 -DiS-T be w BLDG. j)FPT. at at the njake any Ito cieviate 'a,ne,or 0 B . 04ffirlal- IdIng the t(;atlons NOT Vtolat.Ion Oor state OVV OV Inance ev -No FFI-#%%OE CO wl kv*wo3 u rr b �w--c,�fs•� (��(1�I►2.5 �xo �o CUPERTINO 8tailding Department JUL 2 4 2014 EVIEVVED FOR CODE COMPLIANCE Reviewed Sy: � �U xa