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12010145 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10870 KESTER DR CONTRACTOR:MAHONEY ORRIN PERMIT NO: 12010145 TRUSTEE&ET AL OWNER'S NAME: MAHONEY ORRIN TRUSTEE&ET AL 10870 KESTER DR DATE ISSUED:01/24/2012 OWNER'S PHONE: 408725 1'767 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION rr --- BUILDING PERMIT INFO: BLDG ELECT = PLUMB License Class Lia# r-•-r. ...:.. MECH'' RESIDENTIAL } COMMERCIAL Contractor Date I hereby affirm that.I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 12 WINDOW REPLACEMENT,NON-STRUCTURAL (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. Valuation:$18647 Sq.Ft Floor Area: 1 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 permit is issued. APN Number:35602046.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued Date: Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any rooting material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm tinder penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for W'orker's California Health&Safety Code,Sections 25.505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which(Itis permit is issued. Safety Code,Section 25532(a)should I store or•handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&S yr tions 25505,25533,and 25534. 1 certify that in the performance of(fie work tier which this pernit is issued,I shall not emiploy any person in any manner so as to become subject to the W'orker's Own, or. tht: Compensation law's of t_ahfornia. If,atter making this certificate of exemption,I Date: II become subject to the Worker's Compensation provisions of the Labor Code,I must If t«rthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of w)rk's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permi,Additiona y,the applicant understands and will comply I understand amy plans shall be used as public records. with all non-point• r e regu per the Cupertino Municipal Code,Section X1.18. f Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35602046 . 00 DATE ISSUED. . . . . . . : 01/24/2012 RECEIPT #• • . • • • • • • : BS000015823 REFERENCE ID # . . . : 12010145 SITE ADDRESS . . . . . : 10870 KESTER DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MAHONEY ORRIN TRUSTEE & ET AL ADDRESS . . . . . . . . . . : 10870 KESTER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ORRIN MAHONEY CONTRACTOR LIC # *OWNER* COMPANY MAHONEY ORRIN TRUSTEE & ET AL ADDRESS 10870 KESTER DR CITY/STATE,/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 18, 647 .00 1.00 0 . 00 1.00 0. 00 1BSEISMICR VALUATION 18,647 .00 1.86 0 .00 1 .86 0 .00 1WINREP EACH 8 12 .00 522 . 00 0 . 00 522 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 524 .86 0 .00 524 .86 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 524 .86 VISA --------------- TOTAL RECEIPT 524 .86 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(ftugertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS /© -9 7© /�P A r pr APN# 2��k �� Dl!llJJJ111 ,AI'I S P ��11JJ OWNER NAME /�I i /�//Q / PHONE/4 C � E-MAIL ` / e —�. 1 ' A 0/'I �7�� 7 2 J ~fl�C CJs rir N�'n r G o J Nr� c CITY, STATE,ZIP/ ' C C, �{ FAX STREET ADDRESS /CJ O 7 () JCC„` f CONTACT NAME �!/� , /{�/,NI A PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT/A✓` J yfN n✓ ' J ❑SCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 1:1y ENGINEER 11 DE VELOPER TENANT CONTRACTOR NAME LICENSE NUMBER BUS.LIC#/_ �1° OLV1 4/Vt ," COMPANY NAME E-MAIL FAX STREET ADDRESS 2 S� /7M" (31 VY CITY,STATE,ZIP �,✓��p,�/ C y�(� PHONE/ 7-,[ d ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LICA#`� J !: COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK fA//},,�D EXISTING USE PROPOSED USE CONSTIL TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(f) EXISTG NEW FLOOR DEMO TOTAL C AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH ATTACH #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 RECEIVED$y; TOTAL V%16Z PLANNING APPL# NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO LL//v¢ 6 / By my signature below,I certify to each of th followin I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have p d is co I have read the Description of Work and verify it is accurate. I agree to c mply with all applicable local ordinances and state laws relating to bI In co I I authorize representatives of Cupertino to enter the abo�-id fie p pew for inspection purposes. Signature of Applicant/Agent: Date: ( [-- SUPPLEMENTAL INFORMATIO UIRED PLANCRECKTYPE _New SFD or Multifamily dwellings: Apply for demolition permit for &,a„py-TEM-COUNTER GPLAN UVMW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLAMMGS' -1WVMW` _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAIMMM 0 Puwwwom 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 0 MAJOR 0 sAtltl3'uy SEWEYtill€i4num submittal of Building Permit application. ❑; Et�cartMEnTAL.�ALTi� BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION Eig 3gm'sm ADDRESS: 10870 kester dr. DATE: 01/24/2012 REVIEWED BY: bobs. APN: BP#: VALUATION: $18,647 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK 12 window replacement non structural. SCOPE F Ll Ll I ROTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the relinina in ormation available and are onl an estimate. Contact the Det or addh7 info. FEE ITEMS I1-0EE?111; FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 12 # Window/Sliding Glass Door Suppl.PC Fee: Q Reg. Q OT Q.0 hrs $0.00 $522.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. Q OT Q.Q hrs $0.00 ---TPME Unit Fee: $0.00 PME Permit Fee: $0.00 LJ I 0 Work Without Permit? 0 Yes Q No $0.00 ,W.1bancto 3 :amrqr Fc,. $0.00 Select a Non-Residential { Building or Structure 0 Strong Motion Fee: IBSEISMICR $1.86 Select an Administrative Item E1 'c$ _�°�,rnmissic n ire: IBCBSC $1.00 SUBTOTALS: $2.86 $522.00 TOTAL FEE: $524.86 Revised: 1/19/2012 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 GUPERTINC? (408)777-3228•FAX(408)777-3333•buildin-ga-cuoertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 1 V 97o e5 P✓ Dt, APN OWNER NAME 0 �r `fJO A C� OWNER ADDRESS /��s 7d !'�S�C�� /Jr, l � �•�T,;�`, DESCRIPTION OF WORK: Lf/oo. t.+ ! �c.� We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision,signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) G/1��/1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Cl'"2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 144 13. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. (//"14. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. (I/f 1�. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars($500), including labor and materials, I may be considered an"employer"under state and federal law. (),/K 1 understand if I am considered an"employer" under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject /m/e/ttooJ serious financial risk. 17.I understand under California Contractors'State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work performed under contract with a licensed general building Contractor. ib/N. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 Dec 19 2011 8: 34PM HP LASERJET FAX P- 2 r 0 01 ^ Sof r G` Oa C G �_ -- Co Ch oo G G wic �o x 9 � 00 ru A Qo �° ° vs, -�l► * n W O to COi�lt;9l. n.11 i Y GSE L.C�P�.rENT DFPARTME: W 'M P M% BUILDING a':JI',GN-CUPERI iNO !U APPROVED V Ito � 3 c�sPt.of tars ands F^ifications MUST he kept at the p p ., � LPN .... R.JGti:Sit,.,!f L!'i(1C;GOnStr:1G'tlOn. it is UnlaWiUl fo n"laKB any r'.es Jr alterat',Dn`3 on same.,or#O UE;ViJ':G' .A therefrom,withiout approval from the Building Official. The stampin+�of this planand sPecifirations:�HAI..L NOT rriit or to be ;pprovai of thea violation oo p of any provisions of any City Ordinance or:7tate Law. 9 BY 0 DATE - I x v PEriMIT NO 75W1 \O Ix 41 o MX � A � n O. O �p a v► Go T � s A z 1\ Q =r C x � iG C,r -tet Dec 19 2011 8: 34PM HP LASERJET FAX P- 2 am go ab w 3 C30 o x MEW 6009 c el � c C C C O Na o3 2 n 0 r� ao � —� � o a w c w t° o t0 -t 3 c m . a' o tD oo p � � 3 x � A4 x SSSS ; V Ch ;R A OR CO fA OD � C3 al � c x aG