11020041 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21525 MONROVIA ST CONTRACTOR:ARGONAUT WINDOW& PERMIT NO: 11020041
DOOR,INC
OWNER'S NAME: MAYANK VADODARIA 1901 S BASCOM AVE STE 800 DATE ISSUED:02/10/2011
f ,R'S PHONE: 4087811573 CAMPBELL,CA 95008 PHONE NO:(408)378-4018
C� LICENSED CONTRACTOR'S DECLARATIONr
�✓ f , BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class `-' Lic.# �, � :1�
MECH RESIDENTIAL COMMERCIAL
Contractor. ) - lo- n-� LU►
I hereby affirm tRAt I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 12 WINDOW REPLACEMENT&2 PATIO DOORS
(commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL
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 providedf Sq.Ft Floor Area: Valuation:$19080
Section 3700 of the Labor Code,for the performance of the work for whi t
permit is issued.
APN Number:35623.032.00 Occupancy Type:
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 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 keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,ancjpepses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting 1Rf this p@rmit. Aditiona , he applicant understands and will comply
with all nod-1yoint Source r�}ulations pe'11,Te Cupertino Municipal Code,Section
9.18. � \} / Issued by:-- Date:
Signature f Date V
L 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 HAZARDOUS MATERIALS DISCLOSURE
declarations:
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. 1 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
couWm-inAnts as defined by the Bay Area Air Quality Management District I will
permit is issued. nfgintain co phance 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 Healt Safety Co e,Secti 25505,25533,and 25534.
not employ any person in any manner so as to become-subject to the Worker's 11
Compensation laws of California. If,after making this certificate of exemption,I Owner or or ge�tr '
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:__�1 �Q \
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
i• inify and keep harmless the City of Cupertino against liabilities,judgments,
end expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
grauang 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
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35623032 . 00
DATE ISSUED. . . . . . . : 02/10/2011
RECEIPT # . . . . . . . . . BS000012688
REFERENCE ID # . . . : 11020041
SITE ADDRESS . . . . . : 21525 MONROVIA ST
SUBDIVISION .. . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MAYANK VADODARIA
ADDRESS . . . . . . . . . . : 21525 MONROVIA ST
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM MAYANK V VADODARIA
CONTRACTOR . . . . . . . : CHRIS ETTEMA LIC # 22820
COMPANY . . . . . . . . . . : ARGONAUT WINDOW & DOOR, INC
ADDRESS . 1901 S BASCOM AVE STE 800
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 378-4018
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 19, 080 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 19, 080 . 00 1. 91 0 . 00 1 . 91 0 . 00
1WINREP EACH 8 14 . 00 506 . 00 0 . 00 506 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 508 . 91 0 . 00 508 . 91 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 508 . 91 MC
---------------
TOTAL RECEIPT 508 . 91
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 21525 Monrovia St. DATE: 02/10/2011 REVIEWED BY: bobs.
APN: -2z *VALUATION: 1$19,080
R*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK 12 window replacement and 2 patio doors non structural
SCOPE
Meth, Marr Choc 1'I-lt�h. I'� II !'lx cA f iec.f lan t"fr�x�k
>,
Fct',
Wc"h, law, /Lv, I,"r,r_IfzF"IC
NOTE. Theseees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Ef. 7/1./10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 $506.00 1 WINREP
] Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee.e Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes 0 No $0.00
Work Without Permit? 0 Yes E) No $0.00
Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
1T'lfl E'l �)O 'ttlt'!t'f;fCd17t1i7 �'R£',S'_
I
Strong Motion Fee: IBSEISMICR $1.91 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.91 $506.00 TOTAL FEE $508.91
Revised: 01/15/2011
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: 2,1626 kcnrc>-'�aPERMIT# '� �Q
OWNER'S NAME: n10. �(, L PHONE# 06� I
GENERAL CONTRACTO BUSINESS LICENSE#
ADDRESS: _ v CITY/ZIPCODE: 1 tq
*Our municipal code requires all businesses i in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCC PANC INSP TIO {S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU
ON
CT RS HA E OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. �A I
I am not using any subcontractors:
Si a 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
Owner/Contractor Signature Date
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CITY OF
CITY OF CUPERTINO
GENERAL BUILDING
CUPERTINO 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 No
Ej—
HOA: (Exterior work only) Yes ❑ No [ If yes, provide letter from HOA
If Residential is house an Eichler? Yes ❑ No If es, needs planning approval.
Owner's Name: Ph Ph ne#: _
0111oC1a-V\:ia,,
Contract • Phone:
Fax: SS 0
Contractor Lice e #: `6%T O,
Cupertino Business License #: 2 2 $ a-
Contact: Phone: O�
�•e—AL WFax/e-mail: y1,-1
Residential-0 Commercial ❑
Job Description: 41 ,,� (b `� S� r� P i"K3 S `rL
-- x`Sk1 ► U �1-L (_1�(I� 1' O Y�, n
U--) �d t ws rYlc� - res S
Building Permit Info:
Bldg [3-' 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 MI
Valuation: O3 Square Footage:
L9 rO_t-) .
Project Size: Counter E4--lexpress ❑ 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