14080206CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20705 ACADIA CT
CONTRACTOR: HERITAGE DOORS &
PERMIT NO: 14080206
WINDOWS
OWNER'S NAME:
SAN JOSE, CA 95136
PHONE NO: (408) 266-8306
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
REMOVE AND REPLACE (14) WINDOWS AND (1) SLIDING
License Class_ Lic. # 93itso
DOOR; INSTALL STUCCO AT FRONT OF RESIDENCE (240
Contractor 5A m's V4rafthRh Date 10211-+W-1
FT).
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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $8000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32656024.00
Occupancy Type:
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
PERMIT E S ORK IS NOT STARTED
APPLICANT CERTIFICATION
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
WITHIN 18 DAYS OF PE IT 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 ALLED INSP CTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the�7
C'
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
9.18.
II ,L
��,,
Signature Dated (
091
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(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
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
\ `
Owner or authorized agent: � _ Date: J �
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
CITY OF CUPERTINO
NOTE: This estimate does not include fees due to other Departments (�.e. Planning, Public or s, ire, ry ,
l bl and are onl an estimate Contact the De t or addn'l in o.
District, etc). These fees are based on the rehrmna
FEE ITEMS (Fee Resolution 11-053 E . 7 !1!13)
FEE ESTIMATOR — BUILDING DIVISION
a e
QTY/FEE
ADDRESS: 20705 Acadia Ct
DATE: 08/20/2014
REVIEWED BY: Sean
$0.00
APN:
BP#: ,
*VALUATION: $8,000
YPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration /Repair
PRIMARY
USE: SFD or Duplex
$0.00
PENTAMATION 1 G E N R E S
PERMIT TYPE: A
WORK
SCOPE
�R�emov�eand replace 14 windows and 1 sliding door' install stucco at front of residence 240 sg ft).
Siding
ISIDEOTHER All Other
Permit Fee:
$0.00
Suppl. Insp. Fees. Reg. Q OT
0.0
[:hrs:
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
O
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning, Fee:
$0.00
_7777=Building
Select a Non -Residential
or Structure
�
Q
A
]r<n ,f Ikf<u�r[rttfiillun fk°<°a
Strong Motion Fee: IBSEISMICR
$1.04
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
NOTE: This estimate does not include fees due to other Departments (�.e. Planning, Public or s, ire, ry ,
l bl and are onl an estimate Contact the De t or addn'l in o.
District, etc). These fees are based on the rehrmna
FEE ITEMS (Fee Resolution 11-053 E . 7 !1!13)
1n ormadon am
FEE
a e
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
15 #
$574.00
Window / Sliding Glass Door
1 WINREP Replacement
i
Suppl. PC Fee: Q Reg. Q OT
0.0
San ita Sewer District School
NOTE: This estimate does not include fees due to other Departments (�.e. Planning, Public or s, ire, ry ,
l bl and are onl an estimate Contact the De t or addn'l in o.
District, etc). These fees are based on the rehrmna
FEE ITEMS (Fee Resolution 11-053 E . 7 !1!13)
1n ormadon am
FEE
a e
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
15 #
$574.00
Window / Sliding Glass Door
1 WINREP Replacement
i
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
240 s.f.
$431.00
Siding
ISIDEOTHER All Other
Permit Fee:
$0.00
Suppl. Insp. Fees. Reg. Q OT
0.0
[:hrs:
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
O
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning, Fee:
$0.00
_7777=Building
Select a Non -Residential
or Structure
�
Q
A
]r<n ,f Ikf<u�r[rttfiillun fk°<°a
Strong Motion Fee: IBSEISMICR
$1.04
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.04
$1,005.00
TOTAL FEE:
$11007.04
Revised: vii i0/zu iv