B-2017-1580 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1580
10810 PENINSULAR AVE CUPERTINO,CA 95014-0100(326 03 047) R&M QUALITY
WINDOWS AND
DOORS
NEWARK,CA 94560
OWNER'S NAME: FARRER DAVID J DATE ISSUED:09/14/2017
OWNER'S PHONE:408-702-8448 PHONE NO:(510)'796-0100
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B1 Lic.#709893
Contractor R&M QUALITY WINDOWS AND DOORS Date 07/31/2019 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
2ND FLOOR-REPLACE EXISTING WINDOW LIKE FOR LIKE;
I hereby affirm under penalty of perjury one of the following two declarations: FRAME;FLASH LATHE FOR STUCCO EXTERIOR
1. I have and will maintain a certificate of consent to self-insure for Worker's
tf1✓ Compensation,as provided for by Section 3700 of the Labor Code,for the
rmance 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. Sq.Ft Floor Area: Valuation:$7500:00
• 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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 03 047
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally;the applicant understands and will comply with all non-point
source regulations er the upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
4.00gre Date 9/14/2017 Issued by:Abby Ayende
Date:09/14/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r: I,as owner of the property,or my employees with wages,as their sole installed without first obtaining an inspection,I agree to remove all,new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/14/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle,hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
or authorized agent:
APPLICANT CERTIFICATION 41. D ate:9/14/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature . _ Date 9/14/2017
Professional
F , CONSTRUCTION PERMIT APPLItATION ,1:
'' ' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING.DIVISION _
,,,4041:4,.:;„;;.:, 10300 TORRE AVENUE•CUP.ERTINO, CA 95014-3255 ��
(408)7773228 FAX(408)•777-3333•buildinq(a cupertino:orq S g
�UPERT.tNO. �1 ' .,,, �, .
' Li NEW.CONSTRUCTION_-,`. 0 ADDITION ❑ALTERATION I TI ❑ REVISION./DEFERRED. . 'ORIGINAL PERM #IT ,-<.
PROJECT ADDRESS
10810-Peninsular Avenue' : 32603-047 '
OWNER NAME : , PH NE E-MAIL
Liz'Ude -' .. • • _ , • ' ' • - 408-702-8448 liz udeayahoo.com.
REET ADDRESS • - CITY,•STATE,ZIP FAX
SAME AS.PROJECT':ADDRESS •• : -
CONTACT NAME PHONE E-MAIL.
, STREET ADDRESS . • CITY,STATE,ZIP FAX
IDOWNR :'O
E ' 0WNER•-BUILDER .S ❑ OWN'ERAGENT;.r- ❑ COIYIRACTOR: ID - �'•❑ ARCHater :❑ENGINEER ❑ :DEVELOPERS El'TENANT'. 4
CONTR OR NAME ' . - LICENSE E NUMBER, • LICENSE TYPE BUS LIC'#
Ronal Rael 709$93 B1 �O b�:; (� 18
COMPANY NAME .' �.E-MAIL,
• _ R&M Quality Windows and Door:. ,', ' . ,. ron& rnmwindows.com ';51:0-796-0177
5588 Central Avenue.Suite A : Newark.CA 94560 ,,'510 79.6 0100 '
ARCHITECT/ENGINEER NAME' LICENSE NUMBER BUS.LIC:
COMPANY NAME; ' . E-MAIL • FAX:'
• - •_ .
- .... CITY,STATE,ZIP . . . - . . PHONE.. .. .
STREET ADDRESS,
•
DESCRIPTION OF WORK .
•
Frame to accept new 8'x 5'XOX Vinyl Window meeting T24 Compliancy. Flash and lathe for stucco;exterior.
EXI IND US PROPOSED USE"..• CONSTR.TYPE #STORIES - +
USE TYPE OCC SQ FT VALUATION(
AXI
EXISTG EW FLOOR : EOTOTAL .: ,
. .
•
AREA.. -AREA NET AREA .; .
,
• BATHROOM- ... KITCHEN ` .' ".- OTHER
.. REMODEL AREA- : :REMODEL AREA. . REMODEL AREA • -
•
' PORCH AREA`-.- DECK AREA TOTAL DECK/PORCHAREA GARAGE AREA: ❑DETACH •
- - ❑ATTACH
ftDWELLINGUNITS: IS•ASECONDUNIT OYES,• 'SECOND'STORY DYES
BEINGADDED? ANO ADDITION? 0N
PRE APPLICATION ❑YES IF YES,PROVIDE•COPY OF 'IS TrIE BLDG-AN ❑YES REC+I . ® 3 ✓ t ,u;'l sd �z TOTAL VALUATION i
• PLANNING APPL E ❑NO ' PLANNING APPROVAL LETTER: EICHLER HOME? ❑NO t s ''u, IQ' — O ,
B i m«sI nature,below I certi to each of the following: T am the ro-e owe eror authorized a•entto act on`the ro`e owner s behalf L have read this
,Y 3 g �" ,g P P rh';. P P rh' �„ ,,
ppinformation I have provided is correct:•I have read,the Description of Work andverify it is.accurate. I agree to comply with all applicable local
application and the inform.
ordinances and state laws."relating to b ing nstruction. I authorize representatives of Cupertino to enter the abov e=identified property for inspection`pui ores " ,,
Signature of Applicant/Agent: • . Date: (?---1. "
SUPPLEMENTAL INFORMATION REQUIRED -
a PLAN CHECK,TYPE n`;r. r, * $OUTING SliIP
New SFD'or Multifamily dv ellings.'`Apply for.demolition permit for o 0� THE nTER _ xp 'it
existing building(s). Demolition permit:is required prior toissuance of building 5 _,,, c R. �OI ,.i a._ a�,BUII. IlS �PLAI�'RE"'IES3�' i,
a
permit for new building• • - ::9'EAPREss z;i r a 9 PL�ANNIN L'AAN"IZE1 '1
Commercial Bldgs:•Provide a complete•..d Hazardous-Materials Disclosure sTANDARnk i' r t I0 rtn3LICWORES t f v, ', ,. •
form if any Hazardous Materials are being used as part of this:project. LARGES i r it g FYitf}�AEPr 4p; ,+ ;{{r...
Dopy of Plaiutmg Approval Letter of.Meeting with Planning prior to ' tiaj Rk0d `D SAISirri* sCWCRtDi3Ti2tC'E L ,
submittal of Building Permit application. - - t Y , r it -rr
. -._' . . ...._s._ ..._
"-' 3 r a„ i�� NVIIZol.tf_IE s:i*,.#IEALTH ='
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. . BIdgApp 2017:1oc revised 06/2IL11 ;