11010015 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8191 HYANNISPORT DR CONTRACTOR:ARGONAUT WINDOW& PERMIT NO: 11010015
DOOR,INC
OWNER'S NAME: MCNULTY DANIEL A AND ARLENE D 1901 S BASCOM AVE STE 800 DATE ISSUED:01/03/2011
NER'S PHONE: 4082532459 CAMPBELL,CA 95008 PHONE NO:(408)3784018
❑ LICENSED CONTRACTOR'S DECLARATION
c/ BUILDING PERMIT INFO: BLDG r r—ELECT PLUMB�
License Class - 1-:q- Lic.# e;'K g��b
MECH r— RESIDENTIAL r COMMERCIAL
Contractor_A0�k(1;y1A A .Hate
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACEMENT NON-STRUCTURAL 2 WINDOWS,2 PATIO
(commencing with Section 7000)of Division 3 of the Business&Professions DOORS
Code and that my license is in full force and effect.
I 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 Sq.Ft Floor Area: Valuation:$5990
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:35611024.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and k ess the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and exp es whr h may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting oft his pe it. dditionall a applicant understands and will comply
with all non-point so regul i pe the Cupertino Municipal Code,Section
9.18. '
Issued bDate:
Signature Date
V OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons:
inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
maint ' ompliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Heal &S ety Cod coons 25505,25533,and 25534.
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 Owner or
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
ir' •-nify and keep harmless the City of Cupertino against liabilities,judgments,
c .nd expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
grai.cmg of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: Cx)n -Y yj 7� PERMIT#
OWNER'S NAME: il- L., W OL-k PHONE#
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS:Qob9y Y/ZIPCODE: CU• Y I K�
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL CU NCYIN CTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL UB NT TOR HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
--3 -1. 1
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 8191 hyannisport dr. DATE: 01/03/2011 REVIEWED BY: bobs.
- APN: BP#: *VALUATION: 1$5,990
qPERM,T
TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD Or DU 12X T07-`tt. PENTAMATION 1GENRES
USE: p F1, .4R11.-i. PERMIT TYPE:
WORK re lace 2 windows 2 patio doors non structural
SCOPE
r1.fcch, Plan('ht-(.k 1'l(':rt 1,h", Ph C h,'t N,
x171'1. Permit dee: T"c' tilt c. 1'e,rrrzt 1�,e:
L
ier�,11ech. Tri_). EJII,c�r f'i�tr a IrF;°� tr� ecar�t. Li�h. lnsp. 1,cc' i??ztruh. t ,c: Fce-
NOTE: Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addh7 info.
FEE ITEMS (Fee Resolution 09-051 Eff Z-11,011-01 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 4 # Window/Sliding Glass Door
Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 $380.00F]WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee19 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
('on.sirliction Kl
Acoustical Fee: 0 Yes (E) No $0.00 0
Work Without Permit? 0 Yes (E) No $0.00
Planning Fee: $0.00
Travel I)octnrientation l'
I
Strong;Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.60 $380.00 TOTAL FEE: $381.60
Revised: 12/07/2010
C)/
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CITY OF j j U/
CITY OF CUPERTINO
GENERAL BUILDING
C U P E RT I N O PERMIT APPLICATION FORM
APN# � �� Date:
Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes El No
HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA
If Residential is house an Eichler? Yes ❑ No If yes, needs planning approval.
Owner's Name: Phone#:
Contractor: Phone: 40`S° 3--ICP 1401'9
� 3 Fax: uSS .
Contractor License #: g
Cupertino Business License #: aa� 9D
5 V75
Contact: Phone: r
T `tv ,/' Fax/e-mail:
Residential Commercial ❑
Job Description:
Building Permit Info:
Bldg [i Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ I1/IIIN-A ❑ IUIII B, IV-HT, V-B
Valuation: Square Footage:
a�
Project Size: Counter [ZL- Ex cess ❑ Standard ❑ Large ❑ 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 12/06/10