15080029A
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21527 ROSARIO AVE
CONTRACTOR: SOUTH BAY WINDOWS,
PERMIT NO: 15080029
INC
OWNER'S NAME: JAIR FRED C HSIA AND MELODY S
2200 LAFAYETTE ST STE 2
DATE ISSUED: 08/04/2015
OWNER'S PHONE: 4082579392
SANTA CLARA, CA 95050
PHONE NO: (408) 654-9410
0/LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL M
REMOVE (E) 11 WINDOWS AND 2 SLIDER DOORS AND
License Class Lic.# 27 YY3
REPLACE WITH (N) RETROFIT (NO STRUCTURAL
W L / r
CHANGES)
Contractor ,�.0 JL&/ k45 Date
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
Sq. Ft Floor Area:
Valuation: $14500
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 35619025.00
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 180 DAYS 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 FROM LAST CALLED INSP TON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
O f�
LO
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regul s per the Cupertino Municipal Code, Section
9.18.
pr
y 1
RE -ROOFS:
Signature Date a
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. 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(x) 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 lity Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupeono M ' ipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio9p 2505,25AVand 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(8-cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT4
PROJECT ADDRESS /�� r✓ O /�
APN k Yj ^ I q OZ.
OWNER NAME /}�j//C Jr %/ 13 2 E-1vLAILe
7 /
' L / PHONE eJ/ 2-57,13921
o
STREET ADDRESS CITY, STATE, ZIP �rG /l� /��O�A/�` FAX
0Sa ,l�O
CONTACT NAME
PHONE E-MAIL
STREET ADDRESS /�CITY, STATE, ZIP
FAX
OWNER ❑. OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME f� LICEI�'SENUA4BER !1' V 7 / LICENSETYP 1i
BUS. LIC
/ �U L
Q//Irj�u�+�
COIvIpANY NAME/ /
d
E-MAIL /rJ
STREET ADDRESS
`f
CITY, STATE, ZIPi. - _y
J
PHONE yV
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('
EERNAME SENUMBER
ACHITECT/ENGINLICEN
A
BUS.
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
1A 11� 44-1- 2 -
EXISTING USE PROPOSED USE CONSTRTYPE
I STORIES
USE
TYPE I
OCC. SQ.FT.
I
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
i
AREA
AREA
AREA
NET AREA
(-
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA 1
TOTAL DECK/PORCH AREA
I GARAGE AREA: El DETACH
❑ ATTACH
i
n DV,'ELLING UNrr
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑YES ffYES, PROVIDE COPY OF
IS THE BLDG AN ❑YFS
TOTAL VALT ATION:
PLANIQING APPL R []NO PLANNII4G APPROVAL LETTER
I
EICHLER HOME? ❑ NO
By my signature below, I certify to each of the followin : I am the property owner or authorized 2- it to act on the property owner's behalf. I have read this
application and the information I have provided i o ct. I ha ad the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state lays relating to building c t tionK orize representatives 'of Cupertino to enter the above -id tife pro for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFO ION REQUIRED
oR$T CO�TER
New SFD or Multifamily d« ellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
.
: LIIID
permit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure,
•.
uBq i
form if any Hazardous Materials are being used as part ofthis project.
— Copy of Planning Approval Letter or Meeting with Planning prior to . . .
submittal of Building Permit application.
w
M.
B1dg.4Pp_2011.doc revised 06121/11
r CITY OF CUPERTINO (�,('j,{( 0
I_ FEE ESTIMATOR - BUILDING DIVISION �v'"'`"'
NUIE: [his 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 nreliminary information available and are nn1v an octimnty_ Cnntart tho Want for addn't info
FEE ITEMS (Fee Resolution 11-053 E,f" TT"13,)
ADDRESS: 21527 ROSARIO AVE
DATE: 08/04/2015
REVIEWED BY: PAUL
Jir
APN: 35619 025
BP#:
*VALUATION: 1$14,500
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: 0 Reg. Q OT
PENTAMATION 1GENRES
PERMIT TYPE: A
WORK
Remove E 11 windows and 2 slider doors and replace with N retrofit No structural Changes)
SCOPE
NUIE: [his 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 nreliminary information available and are nn1v an octimnty_ Cnntart tho Want for addn't info
FEE ITEMS (Fee Resolution 11-053 E,f" TT"13,)
Mech. Plart Check
Phwlb. Plan Check
'-Jec. Plan Check FT
tllech. PermltFee:
Plumb. Permit Fee:
Islec. Perneir
Other Afech. Insp
t)rlier Plarmh Insn
t,trtier Glee Inslz
1 -tech, Iris,. Fee'.
Suppl. PC Fee: 0 Reg. Q OT
c lxtst:. 14�°
NUIE: [his 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 nreliminary information available and are nn1v an octimnty_ Cnntart tho Want for addn't info
FEE ITEMS (Fee Resolution 11-053 E,f" TT"13,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$574.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: 0 Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction 7ax:
Administrative Fee:
0
Work Without Permit? Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Strong Motion Fee: IBSEISMICR
$1.89
Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.89
$574.00J
TOTAL FEE:
$576.89
Revised: 07/02/2015
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Aplo(-/'�
IsCUPERTINO
Building Department
AUG 0 4 2015
REVIEWED FOR CODE COMPLIANCE
Reviewed By: Tow'y (Kui w
C E C %-ew ) P Ni/
- - CR.
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job -e during construction. It is unlawful to make any
h ages or alterations on same, or to deviate
re m, without approval from the Building Official.
The &iarnping of this plan and specifications SHALL NOT
be h4to permit or to be an approval of the violation
of anyiisonso f any City Ordinance or State Law.
BY 'V�-•�
DATE
PERMIT
RECEIVED
AUG 04 2015