13010034 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11501 SUNRISE SPRING CT CONTRACTOR:SGK HOME SOLUTIONS, PERMITNO:13010034
INC.
OWNER'S NAME: FERGUSON CATHY 3801 CHARTER PARK CT STE B DATE ISSUED:01/04/2013
OWNER'S PHONE: 4082097247 SAN JOSE,CA 95136 PHONE NO:(408).264.6964
13 - -LICENSED CONTRA R' DE LARATION JOB DESCRIPTION:.RESIDENTIAL COMMERCIAL
License Class C Lic.4 REMOVE&REPLACE 9(E)WINDOWS&2(E)SLIDING
DOORS
Contract r to
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.
1 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:$10000 -
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 pPN Number:36652006.00 Occupancy Type:
permit is issued
-APPLICANT CERTIFICATION
I certify that I haveread 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 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 F AST CALLED INSPECTION.
indemnify and keep 'ss the City of Cupertino against liabilities,judgments,
costs,and expenses which
may accrue against said City inconsequence of the
granting of this permit. Additionally,the applicant understands and will com ly Issued by: e: l
with all non-point source re lations per the Cupertino Municipal -
9,18.
RE-ROOFS:
Signature Date / 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-B(JILDER DECLARATION
Signature of Applicant: Date:
1 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 _
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
1 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 1 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 providedforby Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 nd
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec'o s 2 Vg,25533,and 25534.
Section 3700 of the labor Code,for the performance of the work for which this
Owner or author
Date-
permit is issued: ized agent Date:
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person inany manner so as to become subject to the Worker's
Compensation laws ofCalif imia. If,after making this certificate ofexemption,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
APPLIC? NM'CERTIFICATION Lender's Address _
I ccrtirj that I have read this application and state that the above information is - -
correct.d 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 (� 7
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �`
CUPERTINO (408)777-3228• FAX(408)777-3333•building(cDcuoertino.ore
❑NEW CONSTRUCTION //❑\� ADDITION ❑ ALTER ATION/TI ❑ REVISION/DEFERRED ORIGINALPERMIT#
PROJECT ADDRESS -
APN# - 5'-2-- 006 O b
/
OWNERNAME `PHO E-MM���AIL
STREET ADDRESS /� / \ ' r CITY, TE,ZIP /r %Q7/1/ FAX
CONTACT NAME (. / J PHONE l�' &MAIILL//
STREET ADDRESS e ITY,ST TE, IP 050 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONrRACTOR AGENT ❑ ARCHITECT /1:1 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NA((M---E----��� LICEN � � SETYPEi, BUS.LIC#
COMPANYNAME t E-MAIL FAX
STREET ADDRESS f: TY,STA
ARCHITECT/ENGINEER NAME LICENSENUMBER C BUS.LIC# (Q
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
EXIST PROPOSED USE CONSTATYPE 'STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO V�JTOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER liC/
REMODEL AREA REMODEL AREA REMODELAREA
PORCH AREA DECK AREA TOTALDECKNORCH AREA GARAGEAREA: LIDEIACH
ATTACH
#DWELLINGUMTS: IS A SECOND UNIT 11 YES SECONDSTORY OYES
BEINGADDED? OHO ADDITION? ANO
PREAPPLICATION C]YES I YES,PROVIDE COPY OF ISTHEBLDGAN [I YES 'RECEIVED TOTAL VALUATION
PLANNING APPL# 2NIT PLANNING APPROVAL LETTER EICHLER HOME? ,O-NO - /. /O
By my signature below,I certify to each of a following: 1 am the property owner or authorized agent to act on/the property owner's behalf I have read this
application and the information I have pr ided is correct. I ha read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to 'dingy t I thorize representatives of Cupertino to enter the above-identified pro rty fl
o i pectlog pins.
Signature of Applicant/Agent Date:
SUPPLEN E14TAL INFORMATI N RE UIRED Pt�cri CHECK rrr`E= xournvc si.0
New SFD or Multifamily dwellings: Apply for demolition permit for ` t +
_
existing building(s). Demolition permit is required prior to issuance of building OVER-THE•COUNTEH BUILDDVG PLAN REVIEW ,
permit for new building. D.EXPRESS ,❑ PLANNING PLAN REVIEW;-
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1:1STANDARD '❑ Puac�cwoRxs'
form if any Hazardous Materials are being used as part of this project.
❑ LARGE, ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ aL+.rtiI ❑ SANITARY IITAI SEWER msT':1 r,
submittal of Building Permit application. -
El
ENVIRONMENT41,HEALTH
BldgApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 11501 SUNRISE SPRING CT DATE: 01/04/2013 REVIEWED BY: MELISSA
APN: BP#: *VALUATION: $10,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFDOrDUleX PENTAMATION
USE: pPERMIT TYPE: 1GENRES
Al
WORK REMOVE& REPLACE 9 E WINDOWS &2 E SLIDING DOORS
SCOPE
f1337Y .�i. `.^`2• �i�
Xlcch. Plan Check Plumb. Plan Check Glee.Plan Check
Mech. Peron!Fee: Plumb.Permit Fee: Glee. Permit Pee:
Other Mech. Insp. Other Plumb Insp. ED Other Elec. Insp.
,I-Tach. hap.Fee: Plumb. hap.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(1 e.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc.). These fees are based on the prelindna information available and are only an estimate. Contact the Dept for addn 4 info.
FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 11 # Window/Sliding Glass Door
Suppl.PC Feer Q Reg. Q OT 0.0 hrs $0.00 $533.00 IWINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. 0, 0.0 $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consnzletion Tax.
Administrative Fee:
Work Without Permit? O Yes G No $0.00
Advanced Plannine Fee: $0.00 Select Non-Residential Q
Travel Documentation Fees: Building or Structure �
Strong Motion Fee: IBSEISA11CR $1.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$2.00 $533.00 , ,t 1, OTALeFEE ' $535.00
Revised: 10/01/2012
JAN U 4. 2013
BY: �
Name: A✓ `�F�K,I/ ✓� P1(jA I>�D✓�
Address: T
Email:
Phone: tonne soLvrloNs
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Name: AJA►LkjAV1VX -�(!Jk&SO%A
Address: IISOI Suvnr;sk Spci(Aa C- -C_u_w-kiytz)
Email:
Phone: HOME SOLVTI )NS
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
CUPERTINO "y Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: '' PERMIT#
OWNER'S NAME: . PHONE# 1,41
GENERAL CONTRACTOR', BUSINESS LICE SE#
ADDRESS: j CITY/ZIPCODE: 3
*Our municipal code regmin the city to have a City of Cupertino business license.
NO BUILDING FINAL 'OR OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR ANW ALL SUBC TRACTORS HAVE OBTAINED A CITY O CU RTINO
BUSINESS LICENSE
I am not using any subcontractors:
ignature ate
Please check applicable�snlicoaitractors�and complete the following information:
SUBCONTRACTOR'- 'BUSINESS NAME BUSINESS LICENSE #
Cabinets &Milb ork;;
Cement Finishing ,
Electrical
Excavation
Fencing
Flooring/Carpeting ;
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpapei
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor;Siguature Date