14100078 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19520 HOWARD CT CONTRACTOR:SGK HOME SOLUTIONS, PERMIT NO: 14100078
INC.
OWNER'S NAME:
JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
— REPLACE 25(E)WINDOWS& I (E)SLIDING GLASS DOOR,
License Clas Lic.# / NONSTRUCTURAL
Contractor Date /
I hereby affirm that I am h eased under the provisions of Chapter 9
(commencing with Sectio 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:$20765
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:36916030 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 + IT 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 SFR T CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
z/
costs,and expenses which may accrue against said City in consequence of th
granting of this permit. Additionally,the applicant understands and will comply I Date: �Q
with all non-point ource r gulations per the Cupertino Municipal Code,S ction
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)
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 Cupertin Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectiq 270 10
P3 1
5533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19520 HOWARD CT DATE: 10/14/2014 REVIEWED BY: MELISSA
APN: 369 16 030 BP#: *VALUATION: 1$20,765
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE:
WORK REPLACE 25 E WINDOWS & 1 E SLIDING GLASS DOOR NON STRUCTURAL
SCOPE
T s ,,
e r,
Stich. f'a'un t"�rr'c°h Phw1b. Plcapt('hec°l,
/tech. Pr>tntil Fee: Phimb.Permit Fee.
Other PlumbInsr)_ C3 (3tf'e�`i'�t;c.1ns'c"
Ll
14zch. fospz 1,17110. hasp. Fee: 1=iee:. Inst:>. P,ee.
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the rema informaion availaban
estimate Contact the Dept or addn1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 26 # Window/Sliding Glass Door
Suppl. PC Fee: (F) Reg. ® OT 0.0 1 hrs $0.00 $860.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
'_.Ul2Si?'tlC1t�12 �tEl"":
Work Without Permit? 0 Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
Itltr el 1.Jr,curYe ntrztrt,trr
Fees: �
Strong Motion Fee: IBSEISMICR $2.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$3.70 $860.00 t - ;
TO AL FEE: $863 70
Revised: 08/20/2014
CONSTRUCTION PERMIT APPLICATION
�b
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(cDcupertino.or4
❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS % n APN# (_ /� C)
7,5 ,9-19 r T . 0
OWNER NAME [MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER BUILDER ❑ OwNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ^ LICENSE NUMB LICENSE I BUS.LIC#
COMPANY NAME E-MAH. FAX
STREET ADDRESS CITY,STATE,ZIP PHON ee e_,�
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# C1
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK ,
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL (.�;
AREA AREA AREA NET AREA /n J
BATHROOM KITCHEN OTHER (f/
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
BEINGADDED? []NO ADDMON? []NO
PRE-APPLICATTON ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑ BY- TOTAL VALT�IA'f�O
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? O 22 /�/v J\
By my signature below,I certify to each of the following: I am the property owner or au rized a o act on the property owner's ehalf. I have read this
application and the information I hav r vi s correct. I have read the Description of Work and verify it is accurate. I a ee to ly wi all applicable local
ordinances and state laws relating onstruction. I authorize representatives of Cupertino to enter the aboven yed p inspection purposes.
Signature of Applicant/Agent: Date: /
SUPPLEMENTAL INFORMA ON REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building- ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑'STANDARD ElPUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT
❑ iNVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06121/11
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO
APPROVED
This Get of plans and specifications MUST be kept at the
;ct.,site during construction. It is unlawful to malte any
changes or alterations on same,or to deviate J
tt; efrcim,without approval from the Building Official.
s''•^rnoina of this plan and specifications SHALL NOT 0�1 pfd rf—SJYr/C�J�
_!d to permit or to _ ai of the vio;ation
c. ?Y Pro''' rdinance or S*a.e Law.
Name: �
Address:
Phone: / (iOME SOLU�rjoris
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