08100161 CITY OF CUPERTINOs„s4rs,
BUILDING DIVISION PERNIIT �CONT"0TQkANF�QRMAT Q�N
. .y.g,
BUILDING ADDRESS: PERMIT NO.
HOLDER22095 T)FAN CT
OWNER'S NAME: FEaMITLSSUEDATE
11-2- DiGHARB AVE 0 CONTROL NO.
408) 496-9960
ARCHITECTtENGINEER: BUILDING PERMIT INFO
-� BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION IOb Description
uF 1 hareby aMon that 1 am licensed under provisions of Chapter 9(commIencing p
-x`uf with Section 700X8 of Division 3 of NO Business aha Profession;Cade.and my license is
^oH infullfancead _ REPLCE EXT WNDWS & PATIO DRS LIKE4LIKE ,W/NEW
�C"a• c tgruwrENERGY EFFCNT VINYL WNDWS& PATIO DRS
` acxITEcrs DEcuaAn
I understand my plans shall W used u public recon
JnU
boot^ Licensed Professional
jI OWNER-BUILDER DECLARATION
I hereby afflon Coad I am emar t from ticContncroel License Law for the
CDC o following renMn(Section 7031.5,Business and Profession Code:Any City or county
3$ which requires a Permit to Construct,ober.improve,dempl W,or repair any uructure
Iy prior to its issuable.me acquires the applicant formats permit In file a signed suthmem
ppssi
that heulicensed pursuant toface provisionoftheConuscmr'sU..Law(Chapmr9 Sq.Ft. Floor Area Valuation
yFg (commencing with Seed.7000)a(Division 3nfde Business and Profession Code)or
that he an axcmpt therefrom and tha basis for the alleged exemption.Any violation of 86500
Section 70313 by any applicator fora permit wbjaw the afflicted to a civil penalty of APN Number Occupancy
Ms more mm five Watched dollen ISM P y Ty�
C]1,as owwsofthe preputy,or my amployea with wager as tler sole Campenadon, 35709035 . 00
willda ded wark.and de structure la sat Intended or offered for sale(Sec.70al Business
and Faofeuimts cone:The contracWrs Liam¢law mer act apply W an owner of Required Inspections
property who wiWswimpmveslheaMuand wMdoessuchwork himsUfor Waugh his
atvo employees,provided outreach improvements art amtimmWed woffesd formic.It.
however,the building or improvement is veld within and year of completion,the owner-
builder will have the wrda of proving thus he did not build or improve for purpose of
sale.).
❑1.as owner of tie property.are exclusively contracting with licensed cenv¢ams an
Construct the pmjm(Sec.7044.Business and Pafessians Cone:)The ConuaesoYs U.
cane law does not apply m an owner of property who builds or improves thereon,and,
who conmcu for such projects with a conwxtor(s)licensed pursuant to the Conuaemr's
Lemma
Law.
❑lameseroptundw See .B&PCfwthis.
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affhm under pantry of perjury,arc of the fallowing declarations:
I have and will msintsin a Certificate of Consent to self-insure for Wmrt .Campen-
an,as provided for by Section 37M of the Labor Code,for the performexe of the
were for which this permit is issued.
❑I have and will maintain Workers Oompertsauan Inwenfe.u required by Section
3700 a the Labor Code,for the peRamuMe of the work For which this permit or Issued.
My Wor}yyr}�pes Compewuon beurana anis and Policy number nc:
Cartler(,Ad O'te oN(.P_ Policy No.: 0007V9a 2,
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Than semen used notbecomplewd if W permit is(won hundred Clothes($100)
or las)
1 ardfy that te the ferformmnce of the work for which this Permit an issued.I shall rut
employ any person in any mareerse u at haom^subject to Can Workers'Compensation
Laws of California.Due
Applicant
NOTICE TO APPLICANT:If,after making Nu Ccniftcaw of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you meso -
.J O forthwith comply with such provisions w thiser
permit mail be decmcd revoked.
y ^" CONSTRUCTION LENDING AGENCY
[-+� I hereby ailm that Wre is a convection lending agency for the Performance of
G� the wort for which lid,pit u Wood(Sce.31197,Civ.C.)
Q Lenders Name
D Z I<onees Adammi
V 0 I Certify drat 1 have raced Was application and cern,that Can allow information is
I2. Coned.I agree to comply with all city and county ordinances and sou laws relating m
'0 building censuuction,and hereby authotion representatives of this city m otter upon We
W move-Woudoned property for inspection purposes
�" Oa (We)agree,m save,indemnify and keep hadmke s the City of Cupertino against
rn liabilities.judgmcros,costs and cutaneous which may in any my mono against mid City
U Z in consegMMe of in Swung of this permit.
^ APPLICANT U ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG _ /^'d2
(� �— V Re-roofs i/
Stgnaturco ppliaHAZARDO Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WiII also n Clapersm future building e.cupmt rare w handle summonmaterial
u de.Sec by 25 CuwruM Municipal Code.Chapter 9.12,and the Halth and Safety
Code.salon zss3z(.)7
❑Yes C-4a" All roofs shall be inspected prior to any roofing material being installed.
Will the appllemt w future wading occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Luh avardous air cmreminanu u deimal by the Bay Mea Air Quality Management all new materials for inspection.
Ct7
❑Yes Nu
I haveread the haardonsm un im requirements under ChapW 6.95ofthe Califor-
nuHcalm&Safely Codc,S¢-6=25505,25533a 25534.1unticrstsnd mreifine wilding
does rat convenaLhar.a tenant thus it u my responsibility he Mary the oupxct Of the
requhcmcnts t be ma psiof to issuatacc of a Ce ul am of Occupancy re Applicant
� Signature Date
Owner or orvs0 spent Dm:.
All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35709035 . 00
DATE ISSUED. . . . . . . : 10/27/2008
RECEIPT #. . . . . . . . . : BS000006462
REFERENCE ID # . . . : 08100161
SITE ADDRESS . . . . . : 22095 DEAN CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BONNIE KUO
ADDRESS . . . . . . . . . . : 22095 DEAN CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2723
RECEIVED FROM . . . . : ABLE GLASS COMPANY
CONTRACTOR HOLDER, ERIC LIC # 22037
COMPANY . . . . . . . . . . : HOLDER INC DBA ABLE GLASS
ADDRESS . . . . . . . . . . : 1129 RICHARD AVE
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . . . . . . . . : (408) 496-9960
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ ----------- ---------- --- - ---------- ---------- ----------
1BSEISMICR VALUATION 6, 500 . 00 0 . 70 0 . 00 0 . 70 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1WINREP EACH 8 1 . 00 367 . 00 0 . 00 367 . 00 0 . 00
--- - ---------- ---------- ----------
TOTAL PERMIT 477 . 70 0 . 00 477 .70 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------- --------------- --------------------
CREDIT CARD 477 . 70 VISA
---------------
TOTAL RECEIPT 477 . 70
Meadows of Cupertino ,
10080 Scenic Blvd
Cupertino,CA 95014
t
October 24, 2008
To whom it may concern:
I
On behalf of the Board of Directors of the Meadows of Cupertino, I have discussed the upgrades
with David and Bonnie Kuo and the Board gives its approval to the planned changes to their
home at 22095 Dean Court.
Sincerely,
I /Joseph Cleaver t
• ���/// Director
(480)446-1818
i
I
OCT 2 7 ypQQ
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• qox3'� �"ox3�a
rsthP�OiD 'T�nPeZor^� E(-J�4n-f
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Cc tur' (Zoog..) 6ioxb•8oK 6 •oxF C Y,
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cDPwitio cots ASCD Q}td nw,m
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SIGNED_ _ 1r
This set plan: .sticns MW
De kept on tho i nd •r is un p
lawful to marc aIle ation• DN P 5171)
on same with uc: n.ssioi fron
the building Do.., ,a hno. (�1 6 o SCA(E) onlp
The stamping of IN, i 1 .pecdi ation
allALL NOT be held tc b reit .,r to e at (((lll
• approval of the violation of any, pro lisior..
if any City Ordinance or .,rarr I sw
Sox3"�
(0)
yR,q'o� ^�-7 0 T 2 71�Q8
—TC4APC�t C°rl a C�5✓ s}° (AJl�P�2 ✓�Q Q(.t r PD
t,_,.. CITY OF CUPERTINO
• CUPERIINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Q L —75 ate: 0?
Building Address:
PC'AN Gl .
Mailing Address (if different from building address):
Owner's Name: Phone
'Ro►1 l'r- KU e t 4o&j IF73
Contractor: (r Phone: �o$) X696. 9 46 o
��IQ ()jfRSC (Nlrl (�tl� Fax: VOV 96- 996
Contractor License#: 6�jog18
Cupertino Business License#: �a J 3"7
Contact: Phone: 14/6- 9,9,6o
• Fax: ll `i6- 5196
-Residentiala Commercial
Job Description: �F nlq EkiJ tulN(2&jwr 10�j no 6UO/-S Li
. p t ((ke li,
y°a ?)'o 000V- c. V
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/IIl/V-A ❑ II/III B, IV-HT, V-B
Valuation: Square Footage:
�.G.C'd 0. d 0
Project Size: Express Q_-Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set & the sheet index.
• Points Achieved:
For help, contact Build it Green at www.builditgreen.org
Revised 10/20/08