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14080280 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20063 LA RODA CT CONTRACTOR:FARBEX PERMIT NO: 14080280 CONSTRUCTION SERVICES OWNER'S NAME: SANDMAN LEONARDO AND MONIKA C 1093 KELLY DR DATE ISSUED:08/29/2014 OWNER'S PHONE: 4089967462 SAN JOSE,CA 95129 PHONE NO:(408)590-5410 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL El COMMERCIAL E] le �8��2 y REPLACE(E)BEDROOM WINDOW TO MEET EGRESS License Class Lic.4 NON _ Contractor FA126i-'?c (f�01VSl Date m 2la STRUCTURAL) � 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1285 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 APN Number:36934028.00 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter — D INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY _ indemnify and keep harmless the City of Cupertino against liabilities,judgments, 91/Z5 / costs,and expenses which may accrue against said City in consequence of the Date: granting of this permit. Additionally,the applicant understands and will co with all non-point sour lations per thgoCupertino Municipal Code,Section 9 18. Z� l� any roofing Si Date 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 Date: Signature of Applicant: 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 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, 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 Cu o Municipal Codchapter 9.12 and the Health&Safety Code,Sect' s 2550 25 3,and 2553 I have and will maintain Worker's Compensation Insurance,as provided for by i � Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date: 29 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting 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 CONSTRUCTION PERMIT APPLICATION VO COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINt) (408)777-3228•FAX(408)777-3333•building0cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION LX ALTERATION/TI ❑ REVISION/DEFERRED ORtI'GINAL PERwMITT## PROJECT ADDRESS „^ APN# O ') X OWNER NAME/ O� 2_Z>(0 S AAlb IMA N PHONI;�O 99,6_7 E-MAIL STREET ADDRESS CITY, STATE,ZIP r FAX 2.006 G-4 20 o c2 CONTACT NAME �`,P-F- opy G.rnio/�owSK/ �y A L3 GoiVSTOZj�(C C I�/C/5� PHO z v,?)5!� --i"f'O ,_Er- _ (C 4`PXSE{ STREET ADDRESS CITY,STATE,ZIP FAX Z 6S S'oZ3?ANYS r^1e4 S� svivv SIG C 4s�2 d' oy ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME C��_V Ry l�N��OvV LICE4�rrS NUM ER LIC SE TYPE BUS.LIC# 1� C.O1Si/lGCG%�ov S-eES b 2�2� // f COMPANY NAME E L g (l'.b S2V /(CPS• C-,Ow- �/rte GavST2G�c?/ �S r cFAX ue STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME N111 LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK t� TG ^�� n '^O�� `� /� hO G•v 4�D�/'J' //D/ hl � C�o Ee!-o _RF 527 EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES Roel-,l USE TYPE OCC. SQ.FT. VALUATION *Or ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH ❑ATTACH #DWELLING UMTS: IS ASECOND UNIT ❑YES SECONDSTORY []YES BEING ADDED? NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF Is THE BLDG AN RECEIVE TOTAL VALUATION: PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? O By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o e pro owner's behalf. I have read this application and the information I have provided is correct. I have read t e Description of Work and verify it is ate. I agree to comply with all applicable local ordinances and state laws relatin�to b In co truction. I authori repre9entatives of Cupertino to enter the above-Ide ified p perty for inspection purposes. Signature of Applicant/Agent: — Date: SUPPLEMENTAL INFORMATION REQUIRED .r,LA%caEcr�TYPE - RouTnvG SLIP m� _New SFD or Multifamily dwellings: Apply for demolition permit for AXF " R_TlcouriTER Fil sinLDlNc PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. D-4XPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ rvsuc woxxs form if any Hazardous Materials are being used as part of this project. I ❑ LARGE ❑ FIRE DEPT - _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ;tNVIRONMENTALHEALTII BldgApp_201 1.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION W-PERMIT DDRESS: 20063 LA RODA 9R' cr DATE: 08/29/2014 REVIEWED BY: MELISSA PN: 369 34 028 BP#: *VALUATION: $1,285 PE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK REPLACE E BEDROOM WINDOW TO MEET EGRESS NON STRUCTURAL SCOPE �9<'e1r. fls:tr=C'i�ccck et1I'17r;1. Pfur "hc7% c 7 ecl 1'ct'tur[fete' J'lumiz f'ennit 1:ec.: )rrtz ; �. trre. fhaerTlunibInsr, L>l_�,�i P/79)1h, IHSI). Fet,; Ic�:C'-h?, f--sc. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the prelimina information available and are onl an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 11-053 E f 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 $431.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cml,Sft'nc!ion Work Without Permit? 0 Yes j No $0.00 1 E) Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure I,p<rcc'l f3c> ttf:rraziuttftt't 1"'4:C's: Strong Motion.Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $` TOTAL FEE: 432.50 miBOTLs:.` $1.50 $431.00 $ Revised: 08/20/2014 I , � I 41v• UP '3 T�din .9 P /►N o rjMLrt E CO Op Nev- we CoL ANCE r �!Z 22,-10" V 10'-101/2"-w31/2" a mN W 02 w A O I� I 1668 3888 N W W A m Ou mori I macro„ I 3omw 2'-15/16" --J3o3 1'-81/2"3'-27/8" 4 3'-11/8" 5'-05/16"�k-3' 3'-63/8" 9'-71/2" 6'-913/16" 10'-4" 11'-611/16" 38,-4„