B-2016-3218CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3218
19863 PORTAL PLZ CUPERTINO, CA 95014-3370 (369 46 025) BAYAREA WINDOW
PROS
BURLINGAME, CA
94011
OWNER'S NAME: NAM PAUL V AND VOCI-NAM CHRISTINE
DATE ISSUED: 12/06/2016
OWNER'S PHONE: 650-862-7179
PHONE NO: (650) 235-1006
LICENSED ONT ACURSDF DECLARATION
BUILDING PERMIT INFO:
License Class ZING Lic. #860441
Contractor BAYAREA WINDOW PROS Date 06/30/2017
X BLDG _ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business
— MECH X RESIDENTIAL — COMMERCIAL
& Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
I hereby affirm under penalty ofperjury one of the following two declarations:
REPLACE (5) WINDOWS AND (1) DOOR
1. 1 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.
z 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
permit is issued'.
APPT I A_NT RTIFTI' n�rr,
Sq. Ft Floor Area: Valuation: $6500.00
_nN
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,,
APN Number: Occupancy Type:
369
and hereby authorize
representatives of this city to enter upon the above mentioned property for
46 025
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the
PERMIT EXPIRES S IT, WORK IS NOT STARTED
granting of this permit.
Additionally, the applicant and rstand'and will comply with all non -point
'rtino
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the G p Municipal Co Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION,
Signature Date 12/06/2016
Issued by: SEAN HATCH
OWNER -B TiT,iIF,R nF.!`r.Al7 emrn,v
Date: 12/06/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
kE_ROOES-
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first inspection,
compensation, will do the work, and the structure is not intended or offered for
obtaining an I agree to remove all new materials for
r
inspection.
sale (Sec.7044, Business & Professions. Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 12/06/2016
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance ofthe work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued, I
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality Management District I
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this
will maintain compliance with the Cupertino unicipal Code, Chapte 9.12 and
the Health & Safety Code, Sectio 5505, 25533, and 255
permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT,CERTMCATILON
1 certify that I have read this application and state that the above information is
Date: 12/06/2016
CONSTRUCTION LENDING NCv
correct. I agree to comply with all city and county ordinances and state laws
A
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARR HITE T' DE RATTt1N
Code, Section 9.18. _
I understand my plans shall be used as public records.
Signature Date 12/06/2016
Licensed
Professional
CUPERTINO
❑ NEW CONSTRUC
PROJECT ADDRE
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777_3333 • buildin
g(a)cupertino orq
s %l ADDITION .ALTERATION / TI ElREVISION /DEFERRED'
ORIGINAL PERMIT # v
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OWNER�)N®B,
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STREET��4D G9 t 5 120 / {�
is � e - CITY, STATE, ZIP
�f�,� �y p� � d FAX
CONTA� s V (e.4 7 6`- L�E-MAIL
PHONE _
STREET, �?DRES� p
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❑ OWAER❑ OWNER-BUIIAER ❑ OWNER AGENT ❑ CONTRACTOR,- CONTRACTOR AGENT ❑ ARCHITECT ❑. ENGINEER ❑ DEVELOPER ❑TENANT
CON CTOR NAME p�
Q i +ti % fy LI7tNUAMERy+� C LIC E 7 BUS. LIC #
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------------------
FAX
�L--)w 14t e -
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
COMPANY NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
DESCRIPTION OF WORK Jr
EXISTING USE PROPOSED USE CONSTR TYPE ` - #STORIES
nAREA(j NEW FLOOR - DEMO. TOTAL
AREA AREA NET AREA
BATHROOM - - KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
HONE
BUS. LIC #
FAX
PHONE
C
- USE TYPE OCC. SQ.FT. VALUATION ($)
❑ ATTACH
41 WELLINGUNrl'S: ISA SECOND UNrr ❑ YES SECOND STORY E] YES
BEINGADDED? [:]NOADDITION? ❑Np
PRE -APPLICATION
❑ YES IF YES; PROVIDE COPY OF IS THE BLDG AN - ❑. YES RECENE Y
PLANNINGAPPL# El NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO ! it �:,� TOTAL VALUATION;
By my signature below, I certify to each of the following: I am the roe
�a
application and the informatlf. I have read s
ion 1 have pro I ed is correct. I have read the Desrty cription f Work er or and verify t isd agent to act oaccuraten the �pI agree toerty eco plyawith all applicathi
ble local
ordinances and state laws relating to bui ' construction. I autho i e representatives Of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent; l
Date:
SUPPLEMENT INFORMATION REQUITMD' 7,
:. PLAN'CHECK TYPE,ROUTJNG SLIP ;
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior :to issuance of building ovER TH><c1INTEr3- ' BUII i3 NG PLAA REYIEV
permit for new building. -
Q EXPRESS PIAIININGPLANRVIEW r
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L3 :3IAlYDARII%
farm if any Hazardous Materials are being used as part of this project. Pre woRxs
_ Copy Of Plamiing Approval Letter or Meeting with Planning prior to II LARCE DEPT
submittal of Building Permit application.
BldgApp_2011.doc revised 06/21111
0
PORTAL PLAZA HOMEOWNERS ASSOCIATION
APPLICATION TO MODIFY PROPERTY EXTERIOR OR
COMMON ELEMENTS WITHIN OR SERVING UNIT
`Please describe all changes you propose to make to your home or on your lot. Include a
ly establi
scale drawing with top and side views (plan and elevation) as necessary to clearsh
pon of materials,
locations and elevations of any structures. Include dimensions and descriti
and specify color(s) if appropriate. Your drawing should include existing structures and
boundaries where necessary to indicate relative location. Photographs may be acceptable for
some applications. Contractors must be licensed and may be asked to provide acceptable
evidence of insurance. Permits and compliance with building and safety codes are the re-
sponsibility of the owner and may be required. To avoid delay of approval please Include all
the information that the Architectural Committee will need to make a decision. Attach addi-
tional pages if needed. Your application must be signed and dated below and on the at-
tached Acknowledgment of Responsibility. Professional review and/or extensive scrutiny of
contracts and plans may be required for significant or structural modifications.
You may deliver this completed form along with drawings to Grayson Community Man-
agement, 65 Washington Street, Suite 268, Santa Clara, CA 95050, or e-mail as attach-
ment to helodeski nrnvcr,r m
Owner(s): UJ_1y Vi,v /1 Il • II+ -1 5 ,lI)OA —•
Address:_ffAlW r Q/l
Daytime Phone: d V ° • Evening Phone: ---—
Description of proposed modification(s):
by, ukD
1A_)_5
Signature: '� (-�,�y�bate: f T L 1 f
G �
Print Name t F J %I� h ji
V V MUnit Number: I C�Ste
Attachment(s):
1��,Plroduct
ontract ❑ flan set/Elevation
Information V De 11s/Dimensions
potograph(s) / jaY v�1 /i� �
pp// ertiflcate of Insurance
Acknowledgement of Responsibility ❑ Other
The•CC&R's of your Association contain this information for architectural control. Please
read them carefully and refer to them when applying for any architectural modification.
AMRT -Page i
Grayson Community Management
65 Washington Street, Suite 268, Santa Clara, CA 95050
Phone (888) 277-5580 - e-mail helpdcsk@jzraysoncm.com
41
M,
PORTAL PLAZA HOMEOWNERS ASSOCIATION
The Board of Directors has reviewed the proposed exterior changes to your unit as out-
lined above, and grants approval for you to proceed with t
he work, subject to that were submitted, use of a licensed and insured contractor, and the acceptance oflans the
owner's liability for maintenance and extraordinary expenses to the Association, with
Owner assuming full responsibility for its satisfactory and timely completion.
Q Your application has been denied.
Reason:
❑ Your application has been approved with the following conditions:
Conditions:
U Your application Is being returned for additional information.
Information required:
Signed by: E1., /Z o/ ,?o
Date:
Print Name: Title: % fZe j> ---,v7-
Attach signed Acknowledgment of responsibility and all applicable above -referenced docu-
ments. See attached instructions for additional information.
***If applicable, please remember to attach the signed and dated Satellite Dish Installation
Requirements
AMRF — Page 2
Grayson Community Management
65 Washington Street, Suite 268, Santa Clara, CA 95050
Phone (888) 277 -5580—e -mail helpdesk sraysoncm com
42
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Review ua By
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RECEIVED
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