10110065 - CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7607 PEACH BLOSSOM DR CONTRACTOR:LOW DENNIS G AND PERMIT NO: 10110065
VIVIAN S
OWNER'S NAME: LOW DENNIS G AND VIVIAN S 7607 PEACH BLOSSOM DR DATE ISSUED:11/10/2010
.NER'S PHONE: 4089962763 CUPERTINO,CA 95014-5248 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT I— PLUMB
License Class Lie.#
MECH r— RESIDENTIAL [_ COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BACK DOOR,REPLACING LIKE FOR LIKE FRENCH DOOR
(commencing with Section 7000)of Division 3 of the Business&Professions WITH
Code and that my license is in full force and effect. A FULL FRAME INSTALLATION.(FRONT SOUTH FACING/BACK
NORTH FACING)CONTRACTOR,PELLA,WILL TAKE OLD
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 provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$500
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:36611142.00 Occupancy Type:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
SiP,nature Date Issued by: ( 't Date:
/v
E4I OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the stricture is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner ora rrz agent:
Date: It—lig—to
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a constriction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
ur---the above mentioned property for inspection purposes.(We)agree to save Lender's Name
it ify and keep harmless the City of Cupertino against liabilities,judgments,
co-...,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
Signature Al"—Z / I understand my plans shall be used as public records.
� Date `������
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7607 Peach Blossom Drive DATE: 11/10/2010 REVIEWED BY: larry s
APN: BP#: *VALUATION: $500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY OVER THE PENTAMATION
USE: SFD or Duplex COUNTER? 0 Yes No PERMIT TYPE: 1 R3SFC3#EM
WORK re lace existing door with same size
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY 0 Yes (F) No PLUMB,HOURLY Q Yes (F) No ELEC,HOURLY Q Yes Q No
Trtgv
NOTE: Thesefees are based on the preliminayUy in ormation available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 09-051 Ef. Til"10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 3 # Window/Sliding Glass Door
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $380.00 1 WINREP Replacement
PME Plan Check: $0.00 =0 # Skylight
Permit Fee: $0.00 $0.00 1SKYL<10SF <= 10 s.f.
Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
ConsIi ction T la
Acoustical Fee: 0 Yes 0 No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 0
Planning Fee: $0.00 Select a Non-Residential 0
li�rl�'t`fkx rttttt�orFcrtt;.rE Building or Structure
Strong?Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldp_Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $380.00 TOTAL FEE: $381.50
Revised: 11/08/2010
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36611142 . 00
DATE ISSUED. . . . . . . : 11/10/2010
RECEIPT #. . . . . . . . . : BS000011967
REFERENCE ID # . . . : 10110065
SITE ADDRESS . . . . . : 7607 PEACH BLOSSOM DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LOW DENNIS G AND VIVIAN S
ADDRESS . . . . . . . . . . : 7607 PEACH BLOSSOM DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5248
RECEIVED FROM . . . . : DENNIS&VIVIAN LOW
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : LOW DENNIS G AND VIVIAN S
ADDRESS . . . . . . . . . . : 7607 PEACH BLOSSOM DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5248
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 500 . 00 1 .00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 500. 00 0 .50 0 .00 0. 50 0 .00
1WINREP EACH 8 1. 00 380 . 00 0. 00 380. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 381 .50 0 .00 381.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 381 .50 #16986
---------------
TOTAL RECEIPT 381.50
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CITY OF CUPERTIlNO
CUPEkTINO GENERAL BUILDING
PER UT APPLICATION FORM
APN # := `T Date: 1 J ./ 6, .J U
Building Address: p ,
���7 4 euJck g(osso,-� DQIve rvo CA `3. D1 `4
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA
Owner's Name: i Phone#:
Contractor: Phone: i o �S
�e:\� -6, �c�o^ S Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
Xesidential Commercial
s n
�,ne, i
Job Description: Re�IG � kc ';17-
-, r
Building Permit Info:
Bldg IN Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-13 ❑ II/HI/V-A ❑ U=B, IV-HT, V-B
Valuation: S—oo Square Footage:
Project Size: Express ❑ 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.
Ants Achieved:
r,or help, contact Build it Green at www.builditgreen.org
Revised 07/14/09