12080154 CITY OF CUPERTINO BUILDING PERMIT
RUILDING AIIDRESS: 7407 TIPTOE LN CON FRACFOR:ANTHONY I10DDER PERMIT NO: 12080154
CONSTRUCTION
ONPNER'SNAME: LAMPRECHT NANCY WET AL 7504 BOLLINGER RD DA'Z'E ISSUED:08/142012
OWNER'S PIIONE: 4085693244 CUPERTINO.CA 95014 PHONENO:(408)2574317
O LICENSED CONI'RA47FO'R(''S/aDFCLARATIO7N BUILDING PERMIT INFO: BLDC r ELECT r PLUMB r
License Class_ .Lic.9 "1 ` sP f
r r
. / RIECII r RESIDENTIAL COMMERCIAL
Contmao>r `�/�-r-1 J . 3ate _�y
s - I JOB DESCRIPTION:WINDOW REPLACEMENT NON STRUCTURAL,9
1 hereby affirm[hall an licensed under the procisians of Ch pter') WINDOWS
with Section 7000)of Dieision 3 of the Business S Professions'
Code and that my license is in full force and effect.
hereby affirm under penalty of perjure 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.
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 Sq.Ft Fluor Area: Vuluation:$2000
Permit is issued.
APPI.ICANI'Cf,R'I'II'ICA'I'ION ANN Number:35928001.00 Occupaner l\pe:
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 mid state Imes 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and k less the City of Cupertino ngainst liabilities,judgments,
costs,and ex nsesw our,nccrue agninstsaid City inconsequence ofthe WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of is perm'. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all n-point rce re rens per the Cup 0 lunicipal Code,Section
9.18.
Signature ` h Issued by: —Date:
r
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law formic of All roofs shall be inspected prior to my roofing material being installed.If a roof is
the fallowing two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the properly,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sce.7044,
Business&Professions Code) Signature of Applicant: Date:
h as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business& Professions Code). ALL ROOP COVERINGS TO BE CLASS"A"Oil BI:I-1'F.R
hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA/.ARDOUS MA'T'ERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work,for which this permit is issued. California health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance will,the Cupertino Municipal Code,Chaptcr 9.12 and the I lealth S
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contain, meas defined by the tiny Area Air Quality Management District I will
I certify,that in the performance of doe work for which this permit is issued,I shall main m c npliance with the Cupertfn Jluniciput Code.Chapter 9.12 and the
not employ any person in an}•manner so as to became subject to the Worker's I7,n,
h S S fief}'Code ections 25 5, 553,and 25534.
Compensation Imes of Cali fomia. 11,alter making this certificate of exemption.I
become subject to the Worker's Comp rismion provisions of the Labor Code,L must te r a tl w n t l / ^�
AV—
forthwith comply with such provisions or this permit shall be decnmed revoked. t /NZQ/2—
A
L
AI PLP CANT CERTI FICATION CONSTRIICI'ION LENDING AGENCY
I certify that I have read this application and state(bar the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with oil city mod county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
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 ARC1I1TECI"S IIECLAR,%TION
9.l 8. I understand my plans shall be used to public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
2 ADDRESS: 7407 tiptoe In. DATE: 08/14/2012 REVIEWED BY: bob s.
APN: BP#: 'VALUATION: $2,000
*PERMITTYPE: Building Permit PLAN CIIECK TYPE: Alteration I Repair
ENIAMATION
PERMIT'
1GENRE iPRInu2Y SFD Or Duplex
USE: 1
WORK window replacement non structural 9 windows.
SCOPE
Alech. Plan Check Plumb. Plan Check Flo:.Ilan Check
Afech. Permil Fee: Plumb. Permit Fee: Elec. Permit Fee:
Other Alech.Insp. Other Plumb Insp. Oder Elec.Insp.
Hech. Insp. Fee: Plumb. hevp. Fee: C•lec.Insp.Fee:
A'07'E: This evinmle Anes not include jeev due to other Departments(i.e. Planinag, Public Works. Fire,Sanitary Seiner District,School
District,etc.). Theve eev are bared on the prefintinan information available and are wdr an estimate. Contact the De f or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E!( 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 9 # Window/Sliding Glass Door
SuppI. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $533.00 111'1,VREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee0 Reg. Q OT 0.0 -its-
$0.00
PME Unit Fee: $0.00
PMH Permit Fee: $0.00
Construction Tar:
Administrative Fee: Q
Work Without Permit? O Yes Q No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fees: Building or Structure
A
Strong Motion Fee: IBSEISAI/CR $0.50 Select an Administrative Item
131dg Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $533.00 TOTAL FEE: $534.50
Revised: 07/01/2012
120 5 y
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 Lao
CUPERTINO (408) 777-3228.• FAX7ALTERATION/Tl
7-3333 • buildingCG)cuoertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ))) ❑ REVISION/DEFERRED ORIGINAL PERMIT N
PROJECT ADDRESS ^ n1 � � A l p APNM
'C/ '/ T'r ` l i
OWNER NA L-61i1
152 I PG 1/ PHONE^/ � ^ 2 q E-MAIL
STREET ADDRES O e / , / CC CITY, .TEJLP(� / J!i v� FAX
CONTACT ' J /' PHONE E-MAIL
STREET ADDRES C-! Y, T
CITATE, ZIP
q5D/ C/' FAX
DOWNER ❑ OWNER-B.U( D
BVER7 ❑^OWNER AGE.Vr ❑ CONTRACTOR ❑COhTRACTORAGENr 11 ARCHITECT ❑YENTEN
ENGINEER ❑ DEVELOPER ❑ ANT
G
CONA ME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY E E-MAIL FAX
STREET ADU SS^`Lf (�� CITY,STATE,ZIP��- I vL J PHONE,/��j-5 YjO
ARCHITECTJENGINEER NAME LICENSE NUMBER ((�-.. �( BUS.LIC'(#- C J ( (
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE-ZIP PHONE
DESCRIPTION OF WORK
/Lt�e( Cher P� Gt; �SGa Zo/o Lr3G .
QCLC-e ( Gu I 't coo w S
EXISTING USE PROPOSED USE CONSTLTYPE STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTALA--,
AREA AREA AREA NE'AREA C� /� I �J( (I/�� /J Q-2
BATHROOM KITCHEN OTHER (i
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKJPORCH AREA GARAGEAREA: UDELACH
❑ATTACH
p DWELLING UNITS: IS A 5ECON'D US Tr DYES SECOND STORY ❑YES
BEING ADDED! ONO ADDITION! ONO
PRE-APPLICATION ❑YTS D YES,PROVIDE COPY OF IS III E BLDG AN ❑YES zRECEIVED BY: TOTAL VALUATION:
PLANNINGAPPL# ONO PLANNING APPROVAL LETTER CICHLERHOME` ONO
By my signature below,I certify to ach o the following: I am the property o lner or authorized agent to act on the property owner's behalf. I have read this
application and the information I ave prq ided is corre9C I have read t c De cription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati g to building N as con. I authorize pr entai•es f Cupertino to enter the above-i entified p C for inspection purposes.
/ /
Signature of Applicant/Agem. 'vC' 1�— Date: D/e2—
SUPPLEMENTALINFORMATION REQ IRED PIAN CHrc 'r fh.. / ROUT[NG SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for �O\Elc- oti�"r``ea nuLT D IfINc i•LkN REVIEW
existing building(s). Demolition permit is required prior to issuance of building - - - _ I ' - .
permit for new building. I❑,'EXP'Ress - ❑ i i.n circ rlv.'.Revu:w,
_Commercial Bldgs: Provide a completed I lazardEl Materials Disclosure nSTAN'DARD - ElPuIILl_c wpuss 1
form if any Hazardous Materials are being used as pan of this project. ❑` LARCF, ❑ FI RF.DEPI'
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANI'1'AR%'SE1i'ER DISTRICT
submittal of Building Permit application. -
❑.ENVIRONMENTAL II E,V;I'11
B1dgApp_201l.doc revised 06/21/11