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14070104CITY OF CUPERTINO BUILDING PERMIT _ I BUILDING ADDRESS: 10221 ADRIANA AVE I CONTRACTOR: r _ f � ' 1.(— I PERMIT NO: 14070104 -sv OWNER'S NAME: JUDITH & JOHN WEST I I DATE ISSUED: 07/23/2014 OWNER'S PHONE: 4083202392 I , , PHONE NO: LICENSED CONTRACTOR'S DECLARATION License ClassLic. # 'IS2— J Q� Contractor 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 performance of the work for which this permit is issued. 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. 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 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will co;;�,� with all non -point so ce regulations per the Cupertino Municipal Code, Section 9.18. f % Signature %/ Date C Z y ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE (E) SOLARIUM WINDOW & REPLACE WITH (N) rnNVF.NTmNAI. WINDOW UNIT WITH ROOF Sq. Ft Floor Area: I Valuation: $8000 APN Number: 32620051.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 Issued by: INSPECTION Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance witEthe upertino M al Code, Chapter 9.12 and the Health & Safety Code, ctions 5505, 255 and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Is CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(Qcuoertino.oro r- 77 tsv�o nDTl:tTT�T DFR ARTT '_� L NEW CONSTRUCTION LJ ADDI 11UN U A I txv i ivi i i i u PROJECT .ADDRESSZ-CJ A APN / ^ 05 C 1 O 2 I PHO?`O AJL E M — OV TERNP.AZ J �O fy a ZZJ 1� STREET ADDRESS I C! TY, STATE, ZIP I FAS: C NTACT E-MAIL CJ ll- STREET RESS CITY, STA ZIP A 44�F•kX ❑ OR'N ❑ OWNER -BUILDER ❑ OWNcR AGEN r ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARC==CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA RN.AME /_ �f r A ,S ( -�f I LICE�IR�r I LICETTSYPE I BL'S. LiC COMPANY NAME ��,p1�' J�pxJiy/� STREET ADDRESS C;D4 STATE, ZIP , L) o /tum Lam ✓ r7it /� �� 16 P 1 E tb v G 60" ARCHITECTIENGIN'EER NAME LICENSE NUMBER BUS. LIC COMPANY N.4M _ f 12 I i—T E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ICS (C fJ l I p—lJ l` �b EY:.STI NG USE PROPOSED USE CONSTR TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA A90DEL AREA �ATRROOM KITCHEN REMODEL AREA OTHER REMODEL AREA RCH AREA DECK AREA TOTALDECKTOR�HAJI-EA GARAGE AREA: DETACH ❑ ATTACH R DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? ❑NO SECOND STORY ❑YES ADDITION? ❑NO - -—PiE-AYPLICATdON {]-1=E5 ff-]xS.4ROVIDELDPY_OF_1S_I PLA'NNTN'G APPL: ❑NO PLANINLNIG APPROVAL LETTER ELL DG AN I-1 1 t5 EICHLER HONIE^. ❑ - - TO VALUATION: MIDO By my signature below, I certify to each of the fol Iowing: I am the property owner or authorized agent to act o roperty ovmer's behalf. I have read this application and the information I have rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state I .\7 relating to lding cons tion. I authorize representatives of Cupertino to enter the above -identified roperty for inspection purposes. Signature of Applicant/Agent: ` Date SUPPLEMENTAL II�IFO TION REQUIRED � � �" -�•.� -: Lai-' CHECK TYPE y �w � ROU3I�G IP �` � ; i New SFD or Multifamily dvx ellings: Apply for demolition permit for Demolition is required to issuance of building �� te o\ER TAIICOUI T£R "� Buu� GPEM r 3a a • sr E�s �r existing building(s). permit prior R permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure � E� P �'I.t;rL�n �'71 ��sy �kSTAODARDr +� uBLTC yORhS _ form if any Hazardous Materials are being used as part of this project. ❑� 'ARG � � ��.S�x#��c. �•a- �D `� T *�� ,�. Copy of Planning Approval Letter or Meeting with Planning prior toy ' #IznR s�RDISTFIC _ submittal of Building Permit application. h rh1. RN _ a•EI. oTI.ZEI:r xE;>3Zx .-.�s Bldg4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO lwlw V Ia cTnvr a TnR — RI i11,DING. DIVISION tac. - P. o , -. " NOTE: This estimate does not tnctuaefees aue to otner uepurunena (t.e. We -5, � »�••� •• �• - • �� - - � - - - - - - .�_ Contact the Dent for addn'l info. Distrtet, etc. . inese fees ure ou3eu vu tree ,r„„z,,—, FEE ITEMS (Fee Resolution 11-053 UL 71/132 ... �,,,•»••�.• ».».. FEE - - QTY, - - MISC ITEMS ADDRESS: 10221 adriana ave DATE: 07/23/2014 REVIEWED BY: melissa Window / Sliding Glass Door IWINREP Replacement APN: 326 20 051 7, 0129 *VALUATION: 1$8,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex $0.00 PENTAMATION 1 GENRES PERMIT TYPE: i USE: Permit Fee: WORK remove a solarium window & replace with n conventional window unit with roof 0,0 llrs SCOPE tac. - P. o , -. " NOTE: This estimate does not tnctuaefees aue to otner uepurunena (t.e. We -5, � »�••� •• �• - • �� - - � - - - - - - .�_ Contact the Dent for addn'l info. Distrtet, etc. . inese fees ure ou3eu vu tree ,r„„z,,—, FEE ITEMS (Fee Resolution 11-053 UL 71/132 ... �,,,•»••�.• ».».. FEE - - QTY, - - MISC ITEMS Plan Check Fee: $0.00E-1 # $431.00 Window / Sliding Glass Door IWINREP Replacement Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. Q OT 0,0 llrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 O O Work Without Permit? ()Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure O O Strony Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.04 $431.00 TOTAL FEE: $433.04 Revised: 07/10/2014