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12090162CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 862 FERNGROVE DR CON'T'RAC`T'OR: ARGONAUT WINDOW & PERMIT NO: 12090162 DOOR, INC OWNER'SNAME: MOOREDAVIDCIIARLESOANDSARAIiC 1901 S BASCOM AVE S'I'E800 DA'Z'E ISSUED: 09/19/1012 OWNER'S PHONE: 4083003730 CAMPBELL-, CA 95008 PBONENO:(408)378-r018 ❑ LICENSED CONTRACFOR'S DECLARATION License Class Lie. q. g� O Contractor AAGO MA-V'f V !r/d h t✓ Date z /- 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. 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. 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. APPLICANTCERTIFICATION I cenify 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. - A S"7 ue( I Date 1 /I c/ y Oy NER-RUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Lor for one of the following two reasons: I, M 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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 permit Is Issued. I certify that in the performance of tae work for which this permit is issued. I Ands not employ any person in any manner so as to become subject to the Worker's Compensation laws of Cali fomia. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 nn forthwith comply with such provisions or this permit shall be deenmdd revoked. APPLICANT CERTIFIC TION 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 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 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB MECII r .RESIDENTIAL. r COMMERCIAL I✓ JOB DESCRI PTION: REMOVE AND REPLACE (2) PATIO DOORS Sq. Ft Floor Area: I Valuation: $7000 APN Number: 37538037.00 I Occupancy'rype: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN.180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: �� /V >1 1141 !/ Date: RI: 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: Alit, ROOF COVF,RINGS TO BE CLASS "A" OR RI:1-I'ER HAZARDOUS MATE.RIAI S DISCLOSURE have rend the hazardous materials requirements under Chapter 6.95 of the California Ilcalth & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilcalth & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should I use equipnfent or devices which emit hazardous air contaminants as defined by the Ray Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilcalth& Safety Code. Sections 25505, 25533, and 25534. Date: CONSTRUC110,N LENDING AGENCY I hereby aff vin that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ Q Lender's Name _. Lender's Address ARCIIITECI"S DECLARATION I understand my plans shall be used as public records. Licensed -LC)a CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0cuoertino.oro cDl Q0 —2— I I ADDITION F<AI.TF.RATION/TI I I REVISION/DF.FFRRFD ORIGINAI. PFRMITd PROTECT ADDRESS \P2 tl(I 03-7 -7 � es ovF- OWNER NAhF7�rtvte c SMA Hoo PHONE 04-.3 -3730 E-AUIL ooecko ac. co STREET ADDRESS c2 IV b'ER ovs �K.E C Vy STATS ZIP FAX �T1NG CAD/� CONTACT NAME T`lfLeR£ PH E 4ss E -NEVE � /,a9 s w COWI . co STREET ADD SS 5. ��r CO� G ��OO CITY, SI'A u� FAY 13 Egg oss ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR 13CONTRACTORAGENT ❑ ARCIBTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT 13RA(T0 IW 1E/UT_ t`,� rt LICENSE OTD sLICE' ,17 T BUS. LIC4 ,G 2g4 COMPANYY NAME , I E -NAIL leRu o>r!«!. L FAX 04 b8tl oSS SIRE ADDRESS 9� S X�� v8 &-,w see CITY. STATE, ZIP 9Sa� P NE 63 4S8 ARCHITECT/ LICENSENUN/BER BU COMPANY NAME FAX STREET ADDRESS CRY, STATE. ZIP DESCRIPTION OF WORK Ti a cn2 tt� OP, S,4 @ s z / 7fK/oR Y to / S £s /4-7-C! S E\LSTING USE PROPOSED USE CON'STRIYPE uSTO ffS / IM— USE TYPE OCC SQ.FT. VALUATION (S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA Narr AREA BATHROOM KITCHEN OTHER REMODEL AREA RESIODELAREA REMODEL AREA PORCH AREA DECK: AREATOTAL DECIOPORCH AREA GARAGEAREA: DETACH ❑ATTACH tlDN'EWNG UN'RS: LING ADDED! T ADDITION? "W0 �.-o PRE-AMUCATION ❑YES IF YES. PROVIDE COPY OF PLANNINGAPPLtl G3O PLANNING APPROVAL L.ETIER ISTICEILDGAX Ll NIS F.ICIILF.ROO\IE! RECEIVED BY: 'n - TOTAL VALUATION: _ETCO G/'T'/ •' ODD By my signature below, I certify, to each of the 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 1 have provided is correct. I have re the Dc I' n of Work and verify it is accumte. I agree to comply with all applicable local ^ ordinances and state laws relating to buildm' c tion or rep mi es of Cupertino to enter the above-identifi p pe fo insp�ection/purpous. Signature of Applicent/Agcm: Date: v SUPPLEME TAL P TI QUIRED - PLANCIIECK TYPE - ROUTING SLIP ,LT(./],��BUILDING New SFD or Multifamily dwellings: A ply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building n\.ER-TH6COUpT F.R PLAN REVIEl1'- pernnfornewbulldmg. ❑ EXPRESS 'LJ PL\NNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTANDARU- I _ ' ❑ PUBLIC: WORKS, form if any Hazardous Materials are being used as pan of this project. r , ❑ LARCE ❑ FIREDEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to L w ❑ AI A.IIe* s• ' -' - ❑' S.ANIT ARY SEWER DISTRICI" submittal of Building Permit application. .: ❑ _6NVIRONMFNTAI. HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION i9lADDRESS: 862 Ferngrove Dr DATE: 09/19/2012 REVIEWED BY: Sean Mech. Permit Fee: APN: BP#: 'VALUATION: 1$7,000 *PERMIT TYPE: Building Permit PLAN CII ECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Elec. Insp. Fee: PENTANIATION 1GENRES PERMIT TYPE: WORK Remove and replace 2patio doors. SCOPE $0.00 NOTE: This ertintate does not includejeev due to other Departments (i.e. Planning, Public Works, Fire, Sanitafy Server District, School District, etc.. These eec are based on the relimtnarr information araitable and are onth, an estiuutte. Caruact the Deyajar addn7 info, FEE ITEMS [ree Resoluion 11-053 Ef. 7/1/111 blech. Plan Cheek Plunk. Plan Check Flee. Plan Check Mech. Permit Fee: Plumb. Pernhit Fre: Elec. Permit Fee: Orber Mech. IMT/j. Other Plumb Insp.Ll Other Dec. hhs7l. ,hlech. Insp. ree: Plumb. h,sp. ree: Elec. Insp. Fee: NOTE: This ertintate does not includejeev due to other Departments (i.e. Planning, Public Works, Fire, Sanitafy Server District, School District, etc.. These eec are based on the relimtnarr information araitable and are onth, an estiuutte. Caruact the Deyajar addn7 info, FEE ITEMS [ree Resoluion 11-053 Ef. 7/1/111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $400.00 Window / Sliding Glass Door 1 fI9NRFP Replacement Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeeQ Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consn-netion Tree: Arlininistrative Fee: O G Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fcct $0.00 Select a Non -Residential Building or Structure 0 0 i Trtve! Documentation Fees: Strong Motion Fee: IBSFtSMICR $0.70 Select an Administrative Item E31de Stds Commission Fee- IBCBSC $1.00 SUBTOTALS: $1.70 $400.00 TOTAL FEE: $401.70 Revised: 07/01/2012 m amAO Qm S Z Y E m N m N klik '2 nm Q'O a C w ZO 8'5 oom� Z f. m i a¢ ww a Imo c m « S 0 N E Q'on. N "o ca d a0 wo y [[ = c o f0 a T IN1 T U %2 \ 0Y C7 0 m m ao C D m 00 L 'E o 1 , gm m c m 3 or-, o o o z 0 U 0�� E.° T 0 N Q- m d S Oo o klik i d va J T U m