15040053 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10850 NORTHOAK SQ CONTRACTOR:SGK HOME SOLUTIONS, PERMIT NO: 15040053
INC.
OWNER'S NAME: ZANKICH MARTIN N JR AND MENICHELLI- 3801 CHARTER PARK CT STE B DATE ISSUED:04/08/2015
OWNER'S PHONE: 4082575746 SAN JOSE,CA 95136 PHONE NO:(408)264-6964
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE AND REPLACE(3)PATIO DOORS; (1)WINDOW
License Class !C` '- --Lic. IN
XU7__ BEDROOM TO MEET EGRESS
Contractor Date
I hereby a irm that I am license 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:$5739
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:31641006.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES RK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITfII1�T 180 D OF RMIT 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 FR L CALLED INSP TION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
/is—
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 regu!lptions per the Cupertino Municipal C e, ction
918.
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
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)
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. 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 Cuper ino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Codc,S - ns 5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized/&n 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
CONSTRUCTION PERMIT APPLICATION
111 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildingO-cupertino.org
JI
❑NEW CONSTRUCTION ❑ ADDITION ffALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 31(,
41
'00
OWNERN PH E-MAIL
STREET ADDRES CrrY,STATE,ZIP FAX
CONTACT NAME PHONE E-MAI,
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUTAER ❑ OWNER AGENT ❑ CONTRACTOR NTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME & �® /„ LICENSE LICENSE E/' A < BUS.LIC#
COMPANY NAME j_ LIJ�y E-MAIL �� FAX
STREET ADDRESS ' V ` CITY,STATE,ZIP PHO
�
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# (/,
COMPANY NAME E-MAI, FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK R"
&t"L S V
EIGSTINGUSE PROPOSEDUSW CONSM TYPE I #STORIS
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTIIER
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH ARE I GARAGE AREA: ODETACH
O ATTACH
#DWELLING UNITS: ISA SECOND UNIT ❑YES SECONDSTORY [3YES
BEING ADDED! ❑NO ADDITION! []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESRECEIVED D ., TOTAL VALUA N: i
PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? [3 No ✓ ✓'-
{/
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. I have read this
application and the information I have pr)' ed is co t. I have read the Description of Work and verify it is accurate. I agree to co ply with all applicable local
ordinances and state laws relating to b ' on I authorize representatives of Cupertino to enter the above-ident p rty pection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED PLAN'CHECK TYPE i ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for .THE COiJNTER iuH DnvG PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑; *PRESS G PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ SrANfIARD 11 PUBLIC woRKS
form if any Hazardous Materials are being used as part of this project. n LARGE ❑ irrnE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑„MAJOR ❑ ANTTARY SEWER DISTRICT
Submittal of Building Permit application.
❑ ;ENVIRONMENTAL HEALTH
BldgApp ZOILdocrevised06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10850 n oak square DATE: 04/08/2015 REVIEWED BY: Mendez
APN: BP#: *VALUATION: $5,739
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PENTAMATION 1 GENRES
PRIMARY SFD or Duplex PERMIT TYPE:
USE:
L
ORK remove and replace 3 patio doors 1 window in bedroom to meet egress
OPE
s
x
a a`
I lec.Phm(heck
Ifech. Plan('heck
1'hurrb. 1'lart Check
hleclr.
Permit Fite:
f'Irrmb.Permit F`ee: f=lee. Permir Tee
nfher.Tech. Inep. Other Plumb Insp. Orher�h-Jec.Insp.
Wech. Insp. Fee:
Plumb. Insp. Fee: F;Zec_Insp. Pee:
NOTE: This estimate does not include fees due to other Departments(L&Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These ffes are based on the preliminary information available and are only an estimate. Contact the De t for addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 4431.00# Window/Sliding Glass Door
Suppl.PC Fee: E) Reg. ® OT 0.0 hrs $0.00 $ IWINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee,0 Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
COnstrctction Tax:
,clrnir,jistrative Fee:
Work Without Permit? ® Yes Q No $0.00
Advanced Planning Fee: $0.00 Select allon-Residential
--F=- Building or Structure B
7rrirvel Doettrnenlatio n Fees:
Strong Motion Fee: IBSEISMICR $0.75 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$4
32.75
Revised: 04/01/2015
PLO N HE - '
D BY
DATE2,3
PLANNING DEPTH Z.S
CUPERTINO
Name: Alww� 2_,.,a-D✓1e4C0V
Address: d,2-r'q ey7z_�cSr��,frtY�-'
Ernail: �Yi77•�
Phone: 1iOME SOLUTIONS
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1 2 inch = 1 Foot
Off: 408-264-6964 www.sgkhomesolutions.com. Fax: 408-264-6126
NORTHPOINT HOMEOWNERS ASSOCIATION
PROPERTY MODIFICATION NOTICE
Please indicate below which modification(s)are planned for your property. Provide
brochure(s) if possible and a copy of any proposal(s), including the contractor's
license number. Any modification not expressly listed herein, or not conforming to
the restrictions and requirements listed herein for that modification will require an
Architectural Review Application to be submitted to the Grounds and Architectural
Committee and the Board of Directors for approval. Satellite Dish installation has a
separate form to be completed and submitted for approval.
M_cation at i_orlon and Requirements
Air conditioning unit Unit will be designed for quiet
residential use. Unit will be
located within the enclosed yard
of the property. There will be no
part of the unit visible to common
areas. Installed by a licensed
contractor.
Replacement window/ Must be same size aperture and
Sling door location of existing window or sliding
door. Any necessary touch-up
painting is the responsibility of the
Homeowner. Installed by a license
contractor.
Game door Must be windowless and in conformity
with general architectural style of the
complex. Repainting to conform to
exterior color scheme is responsibility
of the Homeowner. Installed by a
licensed contractor.
Any damages caused to property as a result of modifications will be the homeowner's
responsibility. All prohibitions, restrictions, conditions, and rights of the Association
enumerated under Article V of the amended and restated Covenants, Conditions and
Restrictions of the Northpoint Homeowners Association are applicable to modifications
Contained herein. City permits may be required.
Please Print
Homeowners Name(s): RA Z mac( i e V, c
Property Address: _ 10S" 5 o & Or LOQ.. Phone:N,0e► Zi 7—5 `7 zv- �a
�
Date of Notification: Date of Completion:
Homeowner has 6 months to complete the designated modifications and is responsible for
notifying management upon project completion.
Offs se Only
Notification received by: � ,M fV4- Date: 3 y M
Completion
verified&approved by: 4 a Date:
Form adopted 8110/1999 Revised 5100