12040161 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19751 DRAKE DR CONTRACTOR:AMERICAN VISION PERMIT NO: 12040161
WINDOWS INC
OWNER'S NAME: SHETTY NAVINKUMAR 365 REED ST DATE ISSUED:04/27/2012
OWNER'S PHONE: 6507994119 SANTA CLARA,CA 95050 PHONE NO:(408)617-0901
❑ LICENSED CONTRACTOR'S DECLARATION 3OBDESCRIPTION: RESIDENTIALCOhIDIF.RCIAL
License Class-�UJLic.q REPLACE WINDOWS, 1 DOOR,MODIFY/LOWER
n � WINDOWS IN
Contractor At (CiC-J& VNt&A (J"" 'pete -C '!'Z `�Z . ; BEDROOM TO MEET EGRESS REQUIREMENTS
I hereby affirm that 1 am licensed under the provisions of Chapter9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penally of perjury one of the following two declarations:
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 whichthis permit is issued. Sq.F1 Floor Area: Valualion:57184
1 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
APN Number:31632038.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and stale laws relating WITHIN 180 DAYS OF PERMIT 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 FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /�
costs,and expenses which may accrue against said City in consequence of the Issued b �E�'� /�/G� Dale:
granting y'
oft ermi . AdBiti el�j,the�plicant understands and will comply
with all point sour r gut rims o Municipal Code,Section
V/� Z
RE-ROOFS:
Sig ♦lure Date (�/ Z inspected an
All cools shall be inected prior to y roofing material berg installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exemptfrom the Contractor's License Lew formic of
the following two reasons: ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER
I,as owner of the properly,or try 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)
1,as owner of theproperty,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE.
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penally 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(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 1 rlino of e,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code clions OS
Section 3700 of the Labor Code,for the performance of(he work for which this ?�/1
Owner or authorized eg Dale:
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 my mariner so as to become subject to the Worker's
Compensation laws of Cal ifomia. If,after making this certificate of exemption,I CONSTRUCTION LENDING AC.F.NC.1'
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 1 have read this application and state that the above information is
correct.1 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 properly for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCIRTF.CT;S DECLARATION
costs,and expenses which may accrue against said City in consequence of the 1 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,Sectim Licensed Professional
9.18.
Signature Date
J
® American 2125-A North Madera Rd. i Slml Valley,CA 93065
■■
Vision
PH E105.582.1833 I FAx805.915.1283
�/ Windows
i
i
To Whom It May Concern:
Re:Building Permits.:
i •
Richard Amato, employee of American Vision Windows, Inc is in possession of this
letter,a color copy of your city's business license(if required),our workman's comp and
i insurance and.a color copy.of our contractor's license and bond may obtain a building
permit in our name.
i This permit'-shall be solely.for the job address listed on the contract (between the
homeowner.and American Vision Windows, Inc) in our technician's possession, and the
F work shall be performed according to your Building and Safety codes.
If you have any questions please feel free to contact me directly.
Sincerely,
l P1E C F11vE;E)
American Vision Windows,Inc
APR 2 7 2012
By:
BY:
William Herren
Owner
AMERICAN VISION WINDOWS,INC
I
i
i
r
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 19751 Drake Drive I DATE: 04/27/2012 REVIEWED BY: Sean
APN: I BP#: *VALUATION:
*PERMIT TYPE: Building Permit �PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFID or Duplex PENTAMATION 1GENRESJ
USE: I PERMIT TYPE:
WORK Remove and rep'lace (7) windows and (1) door. Modify/lower windows in bedrooms to meet egress
SCOPE requirements.
a
.11ech. Phw Che.k Pluwh.Phut Chec;. E/vc. Plan Chvcf,
Mcb.Pe,mi! ea: F11 himb.Pomit Pee: F,rlet. Ponlif I Cr
imj / e, 13,c.Imp.
I'll, Oihei Phb fns� 0h
Li Li
h1q).l"e. Plumb.Insp. Fcc: Elec. fj?aP_ lee:
NOTE: This estimate does not includefees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information nvnilable and are only an estimate Contact the Dent for addn'l info.
FEE ITEMS LEct,Resolution 11-053 kff' 71111 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F-8_� # Window Sliding Glass Door
Suppl. PC Fee: 0 Reg. () 076-5 T—hrs $0.00 $392.001 1 H7AIREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feed Reg. 0 0TT0_
.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
011 7,0A.
Adirimstrative Pec:
Work Without Permit? Q Yes (F) No $0.00
Advanced Plannini,, Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Dw
octane talion Fees: A
S11-ong Motion Fee: IBSFISAIICR $0.72 Select an Administrative Item
131da Stds Commission Fee: IBCBSC $1.00
!�)
SUBTOTALS:
....... I $1.72 $392.00 TOTALFEE;
1 $393.72
Revised: 04/01/2012
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT .OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31632038. 00
DATE ISSUED. . . . . . . : 04/27/2012
RECEIPT #. . . . . . . . . : BS000016647
REFERENCE ID # . . . : 12040161
SITE ADDRESS . . . . . : 19751 DRAKE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHETTY NAVINKUMAR
ADDRESS . . . . . . . . . . : 19751 DRAKE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM AVW
CONTRACTOR . . . . . . . : WILLIAM ROMANO HERREN LIC # 26864
COMPANY . . ... . . . . . . : AMERICAN VISION WINDOWS INC
ADDRESS . . . . . . . . . . : 365 REED ST
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE (408) 617-0901
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 7, 184 .00 1. 00 0 . 00 1 . 00 0 .00
1BSEISMICR VALUATION 7, 184 .00 0.72 0.00 0.72 0 . 00
1WINREP EACH 8 8.00 392.00 0 . 00 392 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 393 .72 0. 00 393 .72 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 393.72 CHK
---------------
TOTAL RECEIPT 393.72
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 950143255
CUPERTINO (408)7T7-3228•FAX(408)M-3333•buildina(a)cuoertino.ora
IZb�o I c-e
❑NEW CONSTRUCTION ❑ ADDITION �ALITERATION/M ❑ REVISION/DEFERRED ORIGINAL PERMIT N
PROTECT ADDRESS 'L( �L 5`1 Q6aK e \J6 N��S '7 AFN i9,3/l& 3 a a
OWNIIt NAME NCIVr\ V`Ic}� \ Q 1 P�{ /D- / ! 7/ .EAAtAII.
STREET ADDRESS �kA -L� 1` {��16h `( ( CIT(,,ESTATE ZIP/L, ( ; �' �I , FAX
CONTACT NAME ;L�C 1 PHONE Ot�� 1 J—J`G E- �'G) �k 6' f ID�✓W `.L s""
STRFEI'ADDRESS j,'1 l .16, CII �YfA I JP FAX
❑OwNER 11owNttaL-H=ER 13owNERAOEINT ❑ caNrnncroR 61=-- ,,rRAraaACENr ❑ AR�rECr 11ENcaNEEaa 13 DEVELOPER 13Tewrr
CANTRACTORNAME /yV W LICENSE NUMREB7-�83ZG UIMST7 BUS.LIC
COMPANY NAME A v w E-MAIL FAX .
STAEETADDRESS$)D V e J. ew a,c °S k%k211,- C 01
ARCHTTECDFNGINEERNAARE LICENSE NUMBER EUS LIC a
COMPANY NABO E-MAIL FAX
STREET ADDRESS CRY.STATE LSP PHONE
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(7) W1,-17pL06
FVSTIING USES PROPJSED CONSTR.TYPR 03 ySNRyES USE TYPE OCC SQFT. VALUATION(5)
ERISrO l/ NEWFLOOR/- omw TarA1 L/
AREA AREA AREA NET AREA -
EATRRDOM RITCHIN' On(PR
RFMODELAREA RIIHODEL AREA RFMODELARFA
PORCNARPA DEIXARFA TOTALDECR/PORCHARFA I GARAGE AREA: DETACU
ATTACH
R DWELLING UNM: BASECONDUNIT UYES SECOND STORY 0 YES
BMG ADD®r ❑Na ADUTROM ONO
PRE-APPLICATION [I YES IF YF;PROVIDE COPYOF 0TIM aIDG AN ❑YES RECEIVED EY: - TOTALVALUARON:
PI-ANMNGAPPLa ❑NO PLANMNG APPROVAL LETTER SICHLER 30007 [1 NO
By my Sigramre below,I c¢tify m of the Ca I un er M amhonZed agent to act on the pmpertyownces behalf•I have read dus
applicxdon and the mfotmati ve provi dou of Work and verify it is accurate. I agee m comply with all applicable local
andmaaca and scam laws to rlpatmo m cater the ahgyvq r ed erty far mspecdon poxposes.
Signage ofApplirard Dam: ( a�- xT
SUPPLEMENTAL INFO TIONREQUIRID PLANCRECBTYPE ROD'rRSGSLLP
New SFD or MultifRtuly dwellings: Apply for demolition permit fm OVER TIO-1COUNTER ❑ E LmNG PLAN Ezvmw
existing building(s). Demolition permit is required prior to issuance of building /
permit far new building. ❑ EXPRESS ❑ PEANNINGFIANREVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ siumaxD ❑ PDET.ICwOM0
form if aay Hazardous Materials are beige used as part of this project ❑ LARGE ❑ oma burr
_Copy of Plannir Approval Letter or Meeting with Planning prior to ❑ I
aLuoR ❑ SAr(ITARY sxwER DISTRICT
submittal ofl3wlding Permit appGtatiov.
❑ arvLRonMxxrALHRALTa.
BldgApp_ t?11.doc revised 06121171