11020025 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22431 CARNOUSTIE CT CONTRACTOR:BROTHERS HOME PERMIT NO: 11020025
IMPROVEMENT
OWNER'S NAME: PAUL FINDLEY&NAOMI KOTAKE 2510 DOUGLAS BLVD DATE ISSUED:02/07/2011
XR'S PHONE: 4082535506 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class ic.# REPLACE 13 WINDOWS LIKE FOR LIKE 2 PATIO DOORS
Contractor e
I 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.
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. Sq.Ft Floor Area: Valuation:$9864
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 t APN Number:35603026.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHI �i PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA �R CALLED INSPE IO
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Issued by: Date:
granting of this permit. Additionally,th applicant understands and will comply
with all non-point source-reations the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date__Z 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.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Njunicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505, 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date
permit is issued.
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 CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
4emnify and keep harmless the City of Cupertino against liabilities,judgments,
�s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
r,ranting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35603026 . 00
DATE ISSUED. . . . . . . : 02/07/2011
RECEIPT # . . . . . . . . . BS000012660
REFERENCE ID # . . . : 11020025
SITE ADDRESS . . . . . : 22431 CARNOUSTIE CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PAUL FINDLEY & NAOMI KOTAKE
ADDRESS 22431 CARNOUSTIE CT
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3949
RECEIVED FROM BROTHERS HOME
CONTRACTOR GENE V. CAVANNA LIC # 27964
COMPANY BROTHERS HOME IMPROVEMENT
ADDRESS . . . . . . . . . . : 2510 DOUGLAS BLVD
CITY/STATE/ZIP . . . : ROSEVILLE, CA 95661
TELEPHONE (408) 295-0680
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ----------
1BCBSC VALUATION 9, 864 . 00 1 . 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 9, 864 . 00 0 . 99 0 . 00 0 . 99 0 . 00
1WINREP EACH 8 15 . 00 506 . 00 0 .00 506 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 507. 99 0 . 00 507 . 99 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------------------
CREDIT CARD 507 . 99 me
---------------
TOTAL RECEIPT 507. 99
Building Department
City Of Cupertino
ELI] 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: PERMIT#
OWNER'S NAME: flaq PHONE # — G
GENERAL CONTRACTOR: v BUSINESS LICENSE#
ADDRESS: rvi q Y A w CITY/ZIPCODE: Z
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO RACTO HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: re ��
Signat Date
Please check applicable subcontractors and complete the following information:
V 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
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caner/Contractor Signature Date
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CITY OF
CITY OF CUPERTINO
GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
//() ?00,E
APN# 03
OP- `66 Date: �2 A
Building Address:
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No [J/ 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:
r- W4rimc
t p Fax:
Contractor License #: gg00q
Cu ertino Business License#:
Contact: Phone:
�PGr Fax/e-mail:
Residential Commerci
Job Description: J.3 w m Go U Jam , 2 Mi-, -Ndr}
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑ ie i mv\(CJ
Valuation: L/ Square Footage:
(9
Project Size: Counter ❑ Ex ress ❑ 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.buildit reen.or
Revised 12/06/10