10010071 RTIN O BUILDING PERMIT .
- CITY OF CUPE EARS HOME PERMIT NO.1 oo 10071
CONTRACTOR'S
MENT DATE ISSUED:01/19/2010
BUILDING ADDRESS: 1282 S STEELING RD IMPROVECENTRAL PKWY 1024 FLORIDA C PHONE NO:(925)245-2000
VER'S NAME: BAGALOXE ASTTOK I,ONGWOOD,FL 32750
OWNER'S PHONE: 4088730262 ELECT PLUMB
CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLD COMMERCIAL
MECH
LICENSED CONTRA RESIDENTIAL
License Class DINING
3o Ia TION:INSTALLATION OF RETRO FIT VINYL WINDOWS(
DINING
17 ate JOB DESCRIP
Contractorter 9 /IN-KIND-1 WINDOW
affirm t t ns
er the provisions of Chap RM)
I hereby of Division 3 of the Business&Professions
(commencing w►h Secti 000)
Code and that my license is in full force and effect.
penalty of perjury one of the following
two declarations:
I hereby affirm under
will maintain a certificate of consent to self-insure
Code,for the
I have and Section 3700 of the La
Compensation,as provided for by Valuation:$2258
performance of the work for which this permit
Insurance,as provided for by Sq.Ft Floor Area:
I have and will maintain Worker's compensationOccupancy Type-*
-
I
Labor Code,for the performance of the work for which this 36611107.00
Section 3700 of the APN Number:
permit is issued.
APPLICANT CERTIFICATIONove NOT STARTED
e read this application and state that the abandand state laws relating IF`7`10RK IS
I certify that ation is
I have and county ordinanc PERMIT EXPIRES
1 with all city representatives
of this city to enter IT ISSUANCE OR
correct.I agree to comply authorize rep We agree to save WITHIN igp DAYS OF PERM
to building construction,and hereby W INSPECTION.
the above mentioned property for inspection purposes. ( ) g FROM LAST CALLED
upon harmless the City of Cupertino against liabilities,judgments, igp DAYS FR
indemnify and keep against said City in consequence of the
accrue ag
costs,and expenses which may applicant understands and will comply ..--� Date:,090?
granting of this permit. Additionally,the app Issued by:
source regulations per the Cupertino Municipal Code,Section
with all non-point /
9.18.
Date L
C ature RE-ROOFS:
prior to any roofing material being
installed.If a roof is
pW
-BUILDER DECLARATION All roofs shall be inspected p an inspection,I agree to remove all new materials for
e Contractor's License Law for one of installed on ithout first obtaining
affirm that I am exempt from the inspects
I hereby Date:
the following two reasons: employees licant:
property,or my to ees with wages as theirsale(Sec.7044, Signature of App
1,as owner of the
will do the work,and the structure is not intended or offered for O BE CLASS"A"OR BETTER
Business&Professions Code) clusively contracting with licensed contractors to ALL ROOF COVERINGS
I,as owner of the property,am ex
construct the project(Sec.7044,Business&Professions Code). ARDOUS MATERIALS DISCLOSURE
co HAZ
under penalty of perjury one of the following three
u P hazardous materials requirements under Chapter d 25534.95 of the
1 will maintain
I hereby affirm I have read the ha
declarations: Code,Sections 25505,2553 ,
or the California Health&Safety
Cupertino Municipal Code,Chapter 9.12 and the Health&
will maintain a Certificate of Consent to self-insure • h the C p e hazardous material.
I have and w� Section 3700 of the Labor compliance with
Compensation,as provided for by should I store or hand
P Perm is issued. Safety Code,Section 25532(a)
rk for which this p ed for by should I use equipment or devices which eman gement District I will
performance of the wzardous air
o compensation Insurance,as proved Additionally, Area Air Quality
the BayChapter 9.12 and the
I have and will maintain Worker's Comp contaminants as defined by Cupertino Municipal Code,
he Labor Code,for the performance of the work for which this maintain compliance with the Cup
Section 3700 of t I shall Code,Sections 25505,25533,and 25534,
permit is issued. Health&Safety
ance of the work for which this permit is issued,
I certify that in the perform owner r a a ent: /
person in any manner so as to become subject to the
exemption,I Date:
not employ any Pe this certificate
Compensation laws of California. If,after making I must
to the Worker's Compensation provisions of the Labor Code,
become subject this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or P for the performance of worl�
I hereb irm that there is a construction
3097,CnvC)agency
for which this permit is issued
APPLICANT CERTIFICATION Lender's Name
read this application and state that the abovaena state relating
ation is
I certify that I have and county ordinance ty to enter
correct.I agree to comply with all city
authorize representatives of this lo save Lender's Address
to building construction,and herebyauthorize
inspection purposes.(We)agree
the above mentioned property P against liabilities,judgments,
less the City of Cupertino ag consequence of the ARCHITECT'S DECLARATIO
.unify and keep harm ainst said City to
expenses which may accrue ag plans shall be used as public records.
costs,and exp applicant understands and will comply
ranting of this permit.Additionally,the app ertino Municipal Code,Section I understand my
g non-point source regulations per the Cup
with all non-p Licensed Professional
9.18. 10
Date
Signature
CITY OF CUPERTINO
ERMIT RECEIPT OPERATOR: patg
3 ITEMS OF 3
P COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36611107 . 00
DATE ISSUED. • • • • " 01/19/2010BS000009575
RECEIPT # • • " " . ; 10010071
REFERENCE ID # • • •
SITE ADDRESS
1282 S STEELING RD
SUBDIVISION
CITY . • • • . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER BAGALOXE ASTTOK
D
ADDRESS . . . . . . . . . . : 1282 S STELLINCA 95014-5204
CUPERTINO CA,
CITY/STATE/ZIP . • •
JEFF R.AINEY LIC # 23097
RECEIVED FROM : : : : : ALFRED W NYMAN JR - ASST SEC
CONTRACTOR . SEARS HOME IMPROVEMENT
COMPANY • " " ' FLORIDA CENTRAL PKWY
ADDRESS 1024
ITY NGWOOD, FL 32750
C STATE/ZIP . . . : LO
/ ; X925) 245-2000
TELEPHONE . . . . . . . •
PD-TO-DT
THIS REC NEW BAL
IT QUANTITY AMOUNT _ ___
FEE ID _ ___---- ---------- ---------- ----- 0 . 00 ---1 . 00 0 .00
---------- 2, 258 .00 1. 00 0 . 50 0 . 00
1BCBSC VALUATION 0 . 50 0 .00 0 . 00
2, 258 .00 0 . 00 380 . 00
1BSEISMICR VALUATION 1.00 380 . 00 _------- ----------
1WINREP EACH 8 ---------- ---------- 381 . 50 0 . 00
381.50 0 .00
TOTAL PERMIT
AMOUNT REFERENCE NUMBER--
METHOD OF PAYMENT --_--___- _-
_
----------------- ------ 381.50 VISA
CREDIT CARD _______________
TOTAL RECEIPT
381. 50
L)
CITY OF
CITY OF
CUPERTINO
...... . :...
GENERAL ]BUILDING
CUPERTINOPERMI T APPLICATION FOR
Date
APN
# o ►r191o
�, �
C�
Building Address: 7 D 1
1282 S. STELLING ROAD
Mailing Address (if different from building addressj:
in used as part of this project? Yes E] No
E
Are Hazardous Materials be g
Yes ❑ No 0 If es, rovide letter from HOA
HOA: Exterior work only) Phone#:
Owner's Name: 408-873-0262
BAGALOXE ASTTOK Phone: (916) 830-3423
Contractor: Fax: (407) 551-3085
SEARS HOME IMPROVEMENT PRODUCTS, INC.
Contractor License#:
721379
Cu ertino Business License #: Phone: 916-830-3423
Contact: LIZ & BRENT Fax:
Residential 0 Commercial ❑
Job Description: INSTALLATION OF RETRO FIT VINYL WINDOWS (DINING ROOM) / IN-KIND
Building Permit Info:
Bldg ® Elect ❑
Plumb ❑ Mech ❑
Class): Occupancy Type:
Type of Construction(Usage
�7
A I / II B, IV-HT,V-B
1-A, 1-B ❑ II/III/V- Square Footage:
Valuation: $2,258
x
Large❑ Ma'or ❑
Project Size: Express Standard ❑ _
f the Green Building
Checklist & attach it
Green Building: Please complete relevant portion a include in plan set &the sheet index.
to the application or if applicable,
Points Achieved:
For hell), contact Build it Green at www.buildit reen.or
Revised 07/14/09
H CITY OF CUPERTINO
CITY OF GENERAL BUILDING
APPLICATION
CUPEI�TINO FEE SCHEDULE
. Fee Permit Type
• Fee ID Fee Description Group 1GENRES or
Quantity/Sf 1GENCOM
Stucco Applications (up to 400 sf)
B
1STUCOAP
additional stucco application B
. � 1 WINREP
Replacement windows/sliding glass
door (ea 8 windows) B
WSTR New Window-structural shear
1WINME
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical permit Fee E
PERMITFEE Mechanical Permit Fee
M
1M
PPERMITFEE Plumbing Permit Fee
P
1
Stand Alone Electric Pln Ck(hourly)
E
1 ELCP LN CK
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P
CK-(3 Hr Min Standard Plan Check
(when no E/MIP) B
1 STPLN
when not over counter) hourly-stand alone
B ALL PERMIT
1BCBSC
Cal Bldg Standards Commission Fee TYPES
Seismic Residential
B�
1BSEISMICR
SMICO Seismic Commercial
B
1BSEI
DOC Travel &Documentation
B
1 TRAY
B
1BUSLIC Business License
5 of 5
M.InCdiDDr Air Quality and-Finishes I 1AWHea.1th Pts Y=Yes 0
I.U Loaft-voc PgAt 0
2.Use Low VOC,Water-Based WDDd Finishes 21ADJHaaJth pts Y=YBS 0
31AD/Health pts Y=Yes
U§13 jowNo VOG Adelsim .0
4.Use Salvaged Materials for.IntDrilDr Finishes 3 Resource Pts y--yes
5.Use Engineered Sheet GDDds viith no added Urea 6 IAD]Health'pts Y--yes
Formaldehyde I [AQMealth pts Y=Yes DI
6.Use ExtBnDr Grade PIYWDDd for InterlDr Uses 0
JHaalth.pts Y=YBs
ii poWsOW or WF 4 IAQ
0
B.Use FSC Cartified Materials for Interior Finish 4 RDSDurce pts Y=YBs 0
9.Use FlngBr-JDintad or Reoydad-CDntant Trim I Resource pts Y=Yes 0
10.Install Whole HDUSe Vacuum.System 3 IAQIHealth pts Y=Yes
N.Fboring B Resource pts Y=Yes 0
1.Select FSC Cartified WDDd Flooring 4 RBSDUrre PtS Y=YeS 0
2.Use Rapi;IyPanewabla Fbo�rig Mate-dais
4 ReSDUMB PtS Y=YaS D
3.Use Recycled Content Ceramic Tiles 0
4.Install Natural I-InDleUrn in Place of Vinyl 5 IAQ/Health pts Y=Yes
5.Use Exposed CDnDrete as Finished Floor 4 Resource pts Y=YBs
6.Install Recycled Content Carpet v&h LDW VOCS 4 RBSDurce Pts -Y=Yes 0
0 0 0
1401 1301 571
Total PoRts Available:1
01 oi- 01
Points Pr2 Lect Received:1
G:daWpro-osjgr-,enbuildilingnrgliiirdielines rBMDdeler-blgreenpdintsfinaJ2-1,2.04prDieciadxls,
Community Development
10300 Torre Avenue
Cupertino CA 9501
Telephone(408)7773
228
Fax(408)777-3333
r+�
W�
n
CITY OF
_UPE T1N0Bui nt
1 dln
De ar
tme
PERMIT #
JOB ADDRESS.
)3-
L S-�E"i V610 pH NE # D
Z SaK
OV�JNER�S NAME: O �10 FAX #
CONTRACT E � o� �
GENERAL CONT /0
Date
I an,not using any subcontractors: 1 e
c Tete the follow�.n. information:
#
licable subcontractors and BUSINESS LICENSE
Please check a coBUSINESS NAME
SUBCONTRACTOR
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile l 10
Date
ontractor Si ature