13060040CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21433 SHANNON CT
CONTRACTOR: SGK HOME SOLUTIONS,
PERMIT NO: 13060040
INC.
OWNER'S NAME: HEATHER TAGAWA TRUSTEE
3801 CHARTER PARK CT STE B
DATE ISSUED: 06/05/2013
O'*VNER'S PHONE: 8315240099
SAN JOSE, CA 95136
PHONE NO: (408) 264-6964
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
License Class ILic. N
REPLACE 12 (E) WINDOWS & 2 (E) SLIDING GLASS
5/
DOORS, SAME SIZE & LOCATION. (WILL BE TEMPERED
Contractor Date
AND
I hereby affirm that I am lice sed under the provisions of Chapter 9
MEET EGRESS WHERE REQUIRED)
(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
Sq. Ft Floor Area:
Valuation: $10744
performance of the work for which this permit is issued.
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: 36201004.00
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
WI'TIIIN 180 DAYS OF 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 DAYS FROM -AST VALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
.,
granting of this permit. Additionally, the applicant understands and will comply
Is __—
Date:
with all non -point source r ulations per the Cupertino Municipal C de, 5ection
_
"
9.18.
�m.,""�,T"
RE -ROOFS:
Signature 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
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)
1, 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. 1 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Secti 55 5533, 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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
1 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
AD
CONSTRUCTION PERMIT APPLICATION 00
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION v
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
408 777-3228 • FAX 408 777-3333 • buildin fou ouirtino.or
CUPERT1
❑ NEW CONSTRUCTION ❑ ADDI.00N ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS;J L� C-7—
APN N '3 / - _ O /
OWNER NAME /
PHO / DV E-MAIL
(/
S1REl T ADDRESS
CITY, STATE, ZIP/ WFAX
CONTACT NAME
P / �G�/ y'
E-MAEL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ONIRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR N � /
LICENSE NUMBER
LIC E�TYPPy�
^-�
BUS. LIC #
COMPANY NAME / rE-MAIL
FAX
C.•'
STREET ADDRESS / CITY, STATE, Z� `�
i
PHONE 2Z
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING UW
PROPOSEI S 7 CONST
R. TYPE
# STORIES
USE
TYPE OCC.
SQ.FT.
VALUATION (S)
SS''
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
GARAGE AREA:DETACH
❑ ATTACH
N DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
V D BY:
TOTAL VA,LUATIQN;
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? []NO
w " '
�T/(A L
6
By my signature below, I certify to each of the following: I am the property owner or autho ' agent on pe DWner's half I have read this
application and the information I have p vided is orrect. I have read the Description of Work and veri is acc to co . ly with all applicable local
ordinances and state laws relating tol' struction. I authorize representatives of Cupertino to enter the above-iden ` red or inspection purposes.
Signature of Applicant/Agent: Date:
suPPLENEYML IN ORMA N REQUIRED
PLAID CHTkILTYPE
ROVTINGSI IP
New SFD or Multifamily dwellings: Apply for demolition permit for
"
_
existing building(s). Demolition permit is required prior to issuance of building
OVER—THE-Co INTER
HUELDING PLAN REVIEW
permit for new building.
❑ EXPRESS
PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PuBIac wopms
form if any Hazardous Materials are being used as part of this project.
LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FM, --7, FEE ESTIMATOR - BUILDING DIVISION
1AADDRESS:
21433 SHANNON CT
DATE: 06/05/2013
REVIEWED BY: MELISSA
Plan Check Fee:
APN: 362 01 004
BP#: cv
"VALUATION: 1$10,744
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or DuplexPENTAMATION
USE:
l
la+cf�, ?rp, d���"'e;
1GENRES
PERMIT TYPE: A
WORK
REPLACE 12 E WINDOWS & 2 E SLIDING GLASS DOORS SAME SIZE & LOCATION. WILL BE
SCOPE
TEMPERED AND MEET EGRESS WHERE REQUIRED)
MIND—
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
:Vf7"Jl I,,,?til if '<'e"_
Phimb, ��7G'r'Iw i"'o
-I_Ll
/,/c P" v mil i do
1fttC'a' 7(p!' d. (p-?,' r_EI-L-
Ci6wl , ip'`%tomb eaLpI I
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l
la+cf�, ?rp, d���"'e;
,l'hwlb_ r'mv)" 1'('v,Gee-
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Distrirt_ etc ). These fees are based an the nreliminary information availahle and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eft' 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=# Window / Sliding Glass Door
$533.00 1WINREP Replacement
Suppl. PC Fee: (F) Reg. Q OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Supp!. Insp. Fee.e Reg. (:)OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Coklso,,uc.t`ion l(r:a.,
)c%n��xap rt rt�Fec
Work Without Permit? Q Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure
i
Ir Grti"l lraarlrrrt�cr'tr,r��`t�t ,�:
Strong Motion Fee: 1BSEISMICR
$1.07
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
„;
$2.07
$533.00 � ����' �'��"�� ��,,
$535.07
Revised: 04/29/2013
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
WX MAN PERMIT 0 6 o o --to
.
*Our municinal code requires all businesses working in the city to have a City of Cunertino business license
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONY CTORS HAVE OBTAINED A CITY OF CU ERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Si ature Date
Please check applicable subcontractors and complete the following information:
s/
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation"
Landscaping
Lathing
Z
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature Date
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