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13020013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10465 DEWSTER AVE CONTRACTOR:VINCE MOFFITT PERMIT NO: 13020013 CONSTRUCTION OWNER'S NAME: PROKEY NORMAN T AND BETTY L 379 GHUREHILL PL DATE ISSUED:02/052013 OWNER'S PHONE: GILROY,CA 95020 PHONE NO:(408)427-1417 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class_ Lie.# REMOVE AND REPLACE 12 WINDOWS AND 2 SLIDING (/1/j 2 <3 DOOR, Contractor 1A Date�� REPLACE 1260 SQ FT OF SIDING 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:$11500 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 APN Number:32648011.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I 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 state laws relating WIT 0 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 DA F M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, q costs,and expenses which may accrue against said City in consequence of the Issued by granting of this pe it. Additionally,the applicant understands and will comply : Date: with all non-poin ource regulations the Municipal Code,Section 9.18. Z RE-ROOFS: Signature Date J 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. 13 OWNER-BUILDDECLARATION Signature of Applicant Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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) 1,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. I 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(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 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,Secti s 5505,25 3,a 5534. Z Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Datez` > 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 mannerso as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 h(�b� CUPERTINO (408)777-3228•FAX(408)777-3333•buildino(rilcuoertino.oro �/jb El NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/11 ❑ REVISION/DEFERRED 'ORIGINAL PERMIT# PROJECT DRESS -S/ -M P ,r„ APN# Co q P OT 1 OWNERNA —6951-- WO51-- IJl CL B-MAIL C�STREET DRES/_ Yf�,�^r 76 "•� VJ tom• , T�-Z� c5 _FCA— ~ FAX CONTACT NAME Cl V•, PHONE �r E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OwNER ❑ OWNER-BUIIAER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA NAME -y.,,,.� � LiCEtY, ER r + y}�LIIC'EIN,$^F,.y�7�YgPE{p BUS.LIC# COM ��AME Ur(I, � E' "A)L MQ�I �' Ul(V�/°r1`1L�C/L�/1 AA FAX l STREE ADDRESS r✓/122 690")ZP�` C S /TRAP G�" '�� t?0% �I ul� l ARCHITECVENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME &MAIL FAX STREET ADDRESS CI Y,STATE,ZIP PHONE DESCRIPTION OF WORK *.n /� . 1 e `p/� / /� eGlJ S JY /ICI- �Q C L,Ae o S ��o) •u{� l /r-6/ Z L i W`•v rs booe5 2 z <eD S SctO/10i EXISTING USE PROPOSED USE CONSTR.TYPE #STORWS USE TYPE OCC. SQ.FT. (STJ EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGEAREA LIDSTACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT OYES SECONDSTORY []YES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVE TOTAL VALUATION- PLAHNMGAPPL# ONO PLAKNDIGAPPROVALLEITER EICHLERHOME? ❑NOq, s-O.A v-5 By my signature below,I certify to each of the following: I am the property owner or authorized a en[ o act on the property owner's behalf. I have read this application and the information I have gmv4ed is correct I have d the Description of Work and veiWfy it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to b 1 - constmeti . I an entatives of Cupertino to enter the abov identifie property for inspection purposes. Signature of Applicant/Agent: Date: �� Z SUPPLEMEN INFORMATIO UIREDcxecKTYPE - ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for oven=Tx&cotnvTER `su tNc PLAN xEVIew existing building(s). Demolition permit is required prior to issuance of building , permit for new building. ❑r EXPRESS' - -PLANNING PLAN REVIEW- _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑"STANDARD" ❑ Purim WORKS Tom if any Hazardous Materials are being used as part of this project. ❑ inRGE`- ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to '❑,MAJOR ❑ SANITARY SEWER msrmcT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10465 DEMPSTER DR DATE: 02/05/2013 REVIEWED BY: MENDEZ APN: I BP#: `VALUATION: $11,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY - PENTAMATION SFD or Duplex PERMIT TYPE: 1 GENRES USE: WORK REMOVE AND REPLACE 12 WINDOWS AND 2 SLIDING DOOR REPLACE 1260 SQ FT OF SIDING SCOPE A/ech. Plan Check Plumb.Plan Check Dec. Plan Check hfe& Pencil Fee: Plumb. Permit Fee: Elec. Permit Fee: Other A/ech.Insp. Other Plumb Insp, Li Other Dec.Insp. .11ech.Insp. Fee: - Plumb. hap.Fee: F.lec,Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Ae.Planning,Public Works,Fire,Sanitary Sewer District,School District etc Thesefees.are based on the ggrelimin in ory adan available and are only an estimate Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 14 # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $533.00 IWINREP Replacement PME Plan Check: $0.00 1,260 s.f. Siding Permit Fee: $0.00 $1,000.00 ISmEoTHER All Other Suppl.Insp. FeeID Reg. 0 OTE-o-0hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction.Tar: Administrative Fee: 0 Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fees: Building or Structure 0, Strong Motion Fee: IBSEISWCR $1.15 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 k � " $2.15 $1,533.00 a °', tiTUTALFEE $1,535.15 �" na Revised: 01/01/2013 17 Xv V r Ny 6 I �r 9 x v' clk Widmg 0090ment — —— --- -- - -=---' ru 04 2013 r:`_VIEljvED FOR CODE COMPLIANCE R&vizwcd By: FEB 0 5 2013 fl wn►�ut� �rj� N � Y ds9sS BI doG Vfo'0o 14, s E� G IOP -rr, ° ' z r d o