09080097CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1 171 STAFFORD DR
O'WNER'S NAME: VERONICA LAW & WEISIN CHONG
(r ER'S PHONE: 4089962620
❑ LICENSED CONTRACTOR'S DECLARATION
License Class _ Lic. #
Contractor
Date
1 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:
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 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 comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
i( 13 OWNER -BUILDER DECLARATION
' 1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec. 7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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 which this permit is issued.
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
permit is issued.
1 certify that in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to the Worker's
Comper;sation 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. 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
o he above mentioned property for inspection purposes. (We) agree to save
1. iifv 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 regulat'pns per the Cupertino Municipal Code, Section
9.18.
f _ ' �+i /t 2 crd
Signature v/ Date
CONTRACTOR: ARGONAUT WINDOW & PERMIT NO: 09080097
DOOR, INC
1901 S BASCOM AVE STE 800 DATE ISSUED: 08/11/2009
CAMPBELL, CA 95008 1 PHONE NO: (408)378-4018
13UILDING PERMIT INFO: BLDG ELECT I— PLUMB
MECH f— RESIDENTIAL r— COMMERCIAL
JOB DESCRIPTION: PATIO DOOR REPLACEMENT WITH FRENCH
DOOR
iq. Ft Floor Area: Valuation: $4700
%PN Number: 36206026.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
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 Appli
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. I 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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, 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
CITY of
CUPEI�TINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
o�0$00�7
APN # Z�p ,
Date: J /z 00
l
Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes No
HOA: Exterior work only) Yes ❑ No R If es, provide letter from HOA
Owner's NamQ: ,
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Phone #:
(fve) ct - 2 6
Contractor:Phone:
1A e`5 cJ Dot/
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Fax: ( G 6- KEr - c C i I
Contractor License #: ee ,? o f -(e ( 2 0 4,20 - S
Cupertino Business License #:
Contact: ��
Phone: c E 8 r- C d Z C
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Fax: C 6-e G R' 8 b
Residential Commercial
Job Description: PC- _' . :;,��t , { C � 410C
P � �,,;zr �e��4
Building Permit Info:
Bldg Er' Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
Q c'1.re��— is 7 P
1-A 1-B II/III/V-A ❑ II/III B, IV -HT, V• �B 2f/9
Valuation:�� Square Footage:
Project Size: Ex ress ❑ Standard ❑ Lar e ❑ 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 07/14/09
1. Use LowND-VOC Paint
2. Use Low VOC, Water -Based Wood Finishes
3. Use Low/No VOC Adhesives
4. Use Salvaged Materials for Interior Finishes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
6. Use Exterior Grade Plywood for Interior Uses
7. Seal all Exposed Partioleboard Qr MDF
B. Use FSC Certified Materials for Interior Finish
9. Use Finger -Jointed or Recycled -Content Trim
10. Install Whole House Vacuum System
N. Flooring
1. Select FSC Certified Wood Flooring
2. Use Rapidly Renewable Flooring Materials
3. Use Recycled Content Ceramic Tiles
4. Install Natural Linoleum in Place of Vinyl .
5. Use Exposed Concrete as Finished Floor
6. Install Recycled Content Carpet with Low VOCs
11 Q/Health pts y --yes
21 AQ/Health pts y=yes
31AQ/Health pts y=yes
3 1,3esource pts y --yes
61AQ/Health pts
y --yes
1 IAQ/Health pts
y=yes
4IAQ/Health. is
yeses
4 3esource pts
y --yes
1 resource pts
y=yes
3 IAQ/Health pts
y --yes
6 F esource pts
y=yes
4 F esource pts
y=yes
4 F esource pts
y=yes
51 AQ/Health pts
y=yes
4 F esource pts
y=yes
4 F esource pts
y=yes
Total Points Available:
Total Points Project Received:
1401 130 57
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