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Permit Information
Permit Number " 09040117
Status' C - Closed _ �✓
Master Number Notes
Project
Apply Date' 04/22/2009
Permit Issue Date 04/22/2009
Certificate Issued 06/02/2009
Certificate Type
Certificate Number
Operator
Operator
Operator
01
Location Information -
Address- 10383 COLBY AVE
City/State/Zip CUPERTINO
APN 31629021.00 - -
Unit
-� 95014
patg j Owner Entity Information
patg Owner Name " JENKINS DALE S AND FRANCESCA G j
[PALM Use Default
[PAL - -
------------ Address Home 10383COLBYAVE +�
City/State/Zip �CUPERTINO CA L 95014-2421 1
Permit ` Property Zoning Applicant i Contractor' 1' Defined Fields
Permit Details
Permit Type'
J1R3SFDREM
SINGLE FAMILY DWELLING REMODEL
Usage Class
II/III B,
11AI1 8, IV-HT,V-B NEW
Applied Value '
6350
SQUARE FT.
0
Calculated Value
Cow
US C-404 Type
—0
434
ALT: RESIDENTIAL —�
Permit Form'
AUTOPERM - PERMIT
Ownership
1 - Private
Project Size
COUNTER - OVER THE COUNTER
lermit issued 04/22/2009
rater the purpose or any special conditions for this permit
Purpose/Special Conditions
REPLC 7 Ti1NDWS &DROP CHIL HEIGHT OF 3(0PENING)
FILMED- 20111
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,'Notes
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CITY OF CUPERTINO
BUILDING DIVISION PERMITQ�h
BUILDING ADDRESS:
PERMIT NO.
10383 COLBY AVE
CUSTOM EXTERIORS INC.
nquo117
OWNER'S NAME:
PERMIT ISSUE DATE
2009
PHONE:
A CONTROL NO.
n
(925)249-2280
ARCHrMCr/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o a o a
LICENSED CONTRACTOR'S DECLARATION
9
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter (commencing
withOd�licenseis
ffDivision3oftheBusincttandProfessionsCode,andmy
2G
License Class � � Lic. N �_r� � �/
REPLC 7 WNDWS &DROP CEIL HEIGHT OF 3 (OPENING)
Date 4 Contrsctor
ARCHI'I1:CT5DECLARATION ! f-1' �,
I understand my plans shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that i am exempt from the Contractor's License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior w its issuance, also requires the applicant for such permit to file a signed statement
conuactofslicense Law 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions or the (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
6 3 5 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
31629021 .00
1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work. and the structure is not intended or offered for sale (Sec.7044, Business
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for ssla ff.
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law.
0 I am exempt under Sea B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations.
❑ i have and will maintain a Certificate of Consent to self- insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
wo or which this permit is issued.
have and will maintain Worker's Compensation Insurance, is required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation insurance carrier and Policy number are:
17
Cartitx !J !.L I/(Ir. eV Policy No:
CF-RTIFiCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the perromrance 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 Workers' Compensation
Laws of Califomia. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ccrificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Coda you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there Is a construction lending agency for the performance of
the work for which this permit is issued (Sea 3097, Civ. C.)
'
Lender's Name
,
Lender's Address
1 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, costs and expenses which may in any way accrue against said City
2c�
in consequen of the granting of this permit.
APPLICA UNDER ST S AND WILL COMPLY WiTH ALL NON -POINT
Issued by: Date 'ex
SOURC U TIO I
47X7c
al
Re -roofs
Type of Roof
Sig to ofAppli on arc
HA7^DOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as dented by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safely
Code, Section 25532(a)? /
-Q No
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future b ilding occupant use equipment or devices which
emit hazardous air contaminants cfined by the Bay Area Air Quality Management
all new materials for inspection.
District?
Yes Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 255W.25533 and 25534,1 understand that if dre building
doa n rrcn!]y have ant, That It is my responsibility to notify the occupant of the
is. MY
req ' me rs hich t et "or nra certificate of Occupancy.
Signature of Applicant Date
Z— d
All roof coverings to be Class'n" or better
Date '
surer or aulho d a