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15100172CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21242 GARDENA DR CONTRACTOR: SGK HOME SOLUTIONS, PERMIT NO: 15100172 INC. OWNER'S NAME: Z F P COMPANY 13 801 CHARTER PARK CT STE B I DATE ISSUED: 10/21/2015 OWNCR'S PHONE: 4082452795 1 SAN JOSE, CA 95136 1 PHONE NO: (408) 264-6964 1 7 CENNSED/ ONTRACTOR'S9DECLARATION License Class . JCS 1 Lic. #? If / Contractor Date I hereby affirm that 1 am licrsed under the provisions of Chapter 9 (commencing with Section 7 00) 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: t. 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. 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, judgmen costs, and expenses which may accrue against said City in consequence �C/ granting of thi rmit. atonally, the applicant understands and viltoco- I v all non -point � re tions per the Cupertino Municipal Code�Secti�rt 9� I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. I, 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) 2. I, 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: i. 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. 2. 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation 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. 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. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REPLACE 10 (E) WINDOWS & 1 SLIDING GLASS DOOR, LIKE FOR LIKE (WILL MEET EGRESS & BE TEMPERED WHERE REQUIRED BY CODE) Sq. Ft Floor Area: Valuation: $6875 APN Number: 32640006.21242 1 OccupancN "lope: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS INSPECTION. 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 Applicant: 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the HealthP&,Safcty�dc, Sections 25505,25533, and 255Owr nt: 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional U-4 CUPERTINO CONSTRUCTION PERMIT APPLICATION COW11UNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA. 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildina(g-=oerlino.org ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT PROTECT PDDRESS )N-4-6�0e,01,4 � k I APN 4 -3 Z7 /O/'S�(�(� V 01A!NER NANM �� //� / / /I P O Q :�i Q .NAIL CrfY, STATE STREET ADDRESS k, i w►'/Z_ fir, U /U CONTACT NAME ( f L j �_ I P 0 (/ ,v % / E-MAIL ((J (� STREET ADDRESS CITY, STATE, ZIP FAX OWNFR Q OWNER -BUILDER ❑ OWNERAGEIT NrRACTOR ❑ CONTRACTOR .AGEN-r ❑ ARC= -CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNANE�/_/ LICENSENUI,QB!? I LICENVpMF BUS. LIC COMPANY NAME /L7Z— E-MAIL �i/J FAX �Jr�CITY, STREET ADDRESS/ 4Ye STATE, ZIP PHONEG ARCHITECT/ENGINEER NAME I LICENSE NUMBER BU'S. LIC 9 COMPANY NAME E-MAIL FAX STREET 16MDPESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 1 �% Sr EXISTING US PROPOSED USE CONSTR TYPE 4 STORIES USE TYPE ( OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTIIER REMODEL AREA REAQODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH I DWELLINGU?TTS: IS A SECOND UNIT 11 YES SECOND STORY E] YES / BEING ADDED? ❑No ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN []YE,%.,, �--C-E:IVED $ AL I N? PLANNnNIGAPPL: ❑NO PLANNING APPROVAL LETTER I EICHLERHOME? By my signature belo%v, I certify to each o he follo�vi _: I am the property ONNmer or authoriz on the propel ly ow ha e read this ' ed ' ect. I have read the Description of « andit is accurat _ ee to mply w' h all app ' le local application and the information I havqfl�toent ordinances and state lays relating t traction. I authorize representatives of Cupertin ove-iden/ti�f Pd perty f ' s Ion purpo ` Signature of Applicant/Agent: Date: (/ SUPPLEMENTAL INTFORMATION REQUI D P c; c 4 ��BLIIIDLNGPL0.NREVIi�V� New SFD or Multifamily dNN,ellings: Applyfor demolit on permit for eaistina building(s). Demolition permit is required prior to issuance of building for new building.�� ❑ O«RTEDrCOU'tTER �� a £fl ® w permit Ex��iEss _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosureL�7 form if any Hazardous Materials are being used as part of this project. AN -M:- �w _ Copy of Planning Approval Letter or Meeting with Planning prior to 2`. 7'-}A3�ITtYR - - 3. •i.. submittal of Building Permit application. MA0R =,� SES ER ISTRI S CPa •�-.s _� r . �..- -�� r,�of�nr_tL-xEALTx; ;. . B1dg,4pp_2011.d6c revised 06/21/11 0 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DNISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 71 /1/13) ADDRESS: 21242 GARDENA DR DATE: 10/21/2015 REVIEWED BY: MELISSA tech. 1"o,7, APN: 326 40 006 BP#: *VALUATION: 1$6,876 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: ;'(limb. Insp. 1'ec; PENTAMATION 1GENRE PERMIT TYPE: WORK REPLACE 10 E WINDOWS & 1 SLIDING GLASS DOOR WILL MEET EGRESS & BE TEMPERED SCOPE WHERE REQUIRED BY CODE) NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 71 /1/13) 11ech. Plan Check 1'hrmb. flan Check Elec. Plan Check tech. 1"o,7, Flom," 1', F(", Permit I ec 1tlter A ech. Insp. )cher Plund) lwj.). Other Elec. hasp. �fech. tnsp. fees ;'(limb. Insp. 1'ec; 1'aec. Insp. Fee NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 71 /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 11 # $574.00 Window / Sliding Glass Door I WINREP Replacement Suppl. PC Fee: 0 Reg. O OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax.- . C171�1t1lS1YUIIPP FCC.' O E) Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure E) i 7i- vel Documentation I ees: Strong Motion Fee: IBSEISMICR $0.89 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.891 $574.00 TOTAL FEE: $575.89 Revised: 10/01/2015 p�� 1 IECIKED BY DATE t. D. CUPERTINO � s,�- Vw S` I 'boo /,- SSL, � -f t 3 z SL. RECEIVED