14100188 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11300 CANYON VIEW CIR CONTRACTOR:SGK HOME SOLUTIONS, PERMIT NO: 14100188
INC.
OWNER'S NAME:
SAN JOSE,CA 95136 PHONE NO:(408)264-6964
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE AND REPLACE 37 WINDOWS(TO MEET
License Class Lic.# (9)0 p EGRESS IN
BEDROOMS) AND 7 PATIO DOORS;REPLACE 4800 SQ FT
Contractor Date OF SIDING
I hereby firm t at I am censed under the provisions of Chapter
(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:$59250
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:35627018.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT E S WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 DAYS 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:F M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the (s
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point soureq regulations per the Cupertino Municipal Co e,Se tion
9 18.
RE-ROOFS:
Signature /M_� 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
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 Cuperti o Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti ns 55 5 5533,and 25534. �
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date/r
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
9 18.
Signature Date
. ........-..........-_
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION u�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building()cupertino.org
CUPERTINO \
❑NEW CONSTRUCTION ❑ ADDITION LTERATION/Ti ❑ REVISION/DEFERRED ORhGIINAL PERMIT#
PROJECT ADDRESS 0 /APN
OWNER NAME
FAX
CONTACT NAME PHONE ---MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER A [],OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NA �rV /� LICENSE NUM L N BUS.LIC#
COMPANY NAME e�*,�/ c ��f E-MAIL FAX
STREET ADDRESS J(/ 1 P CITY,STATE,ZIP
ARCHITECT/ENGINEER NAME 1 LICENSE NUMBER BUS.LIC# tU (J
COMPANY NAME - E-MAIL FAX
STREET ADDRESS ) CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
�.
qepiva
EXISTING USE PROPOSEJUS9 CONSTR.TYPE I HSTOUS
USE TYPE OCC. SQ.FT. VALUATION($)
NEW FLOOR DEMO TOTAL
AREA
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER �y
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH l
❑ATTACH
#DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY [:]YES
BEING ADDED? NO ADDITION? ❑NO K —1
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY TOTAL V¢LUAT
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 t m perty owner's behalf. I have read this
application and the information I have rovide is orrect. I have read the Description of Work and verify it is accurate. I agr to comply with all applicable local
ordinances and state laws relatin to n struction. I authorize representatives of Cupertino to enter the above identi pro e cy in tion purposes.
Signature of Applicant/Agent: Date: /
SUPPLEMENTALINFORMATION REQUIRED PcaEcx T7 ROUTING RouTINc sLiP
New SFD or Multifamily dwellings: Apply for demolition permit for oYCR rIIE couN ER" - ❑ suILDINc PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of buildm
permit for new building. ❑ EXPRESS, ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ ruBLICWVORKS
form if any Hazardous Materials are being used as part of this project.
I LARGE;.'' ❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
stlbinittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201I.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11300 canyon view DATE: 10/30/2014 REVIEWED BY: Mendez
APN: BP#: EVALUATION: $59,250
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE: i
WORK remove and replace 37 windows to meet egress in bedrooms and 7 patio doors; replace 4800 sq ft
SCOPE of siding
,.
IF
L9e<.t I'IrYr C" cc.k 1'l7w;b. Ilam(.heck I'iec, Plan
P erivit Fee: Pernut Fee: Z `er. F'�r , ���<�•
£7ttrcr f'Irvnb Irs/>.
flh uab. 113sp, F'vL :/e�. i s .tore:
NOTE: This estimate does not include fees due to other Departments(i.e.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 De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 LT 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 44 # Window/Sliding Glass Door
Suppl.PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 $1,146.00 1 WINREP Replacement
PME Plan Check: $0.00 4,800 s.£ Siding
Permit Fee: $0.00 $2,796.00 1SIDEOTHER All Other
Suppl.Insp. Fee:Q Reg. ® OT Q,Q hrs $0.00
PME Unit Fee: $0.( 0
PME Permit Fee: $0.00
rZiir�rsterxri�c>tree:
Work Without Permit? 0 Yes No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure
gees:
Strong Motion Fee: IBSEISIIIICR $7,70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $3.00
$10.701$3,94 2.00 TOfiAL FEE: $3,952.70
Revised: 07/10/2014
1 � i
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