10010013 CITY OF CUPERTINO BUILDING PERMIT
142 DERBYSHIRE DR CONTRACTOR:ARGONAUT WINDOW& PERMIT NO: 10010013
BUILDING ADDRESS: 1 DOOR,INC
' ' 1901 S BASCOM AVE STE 800 DATE ISSUED:01/05/2010
WNER'S NAME: ANNE KHECHFE
OWNER'S PHONE: 4082536661
CAMPBELL,CA 95008 PHONE NO:(408)378-4018
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
Lic.# INSTALL BAY WINDOW INTO BEDRROOM LIKE FOR
License Class LIKE
Contractor Date
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 Valuation:$5279
performance of the work for which this permit is issued. Sq.F:Floor Area:
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:36221027.00 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
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
d expenses which may accrue against said City in consequence of the Issued by: 'Date• r�
costs,anp
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. RE-ROOFS:
gnature 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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 defin`d,6 he Cupertino Municipale Bay Area Air Quality Management ode,Chapter District
and
will maintain compliance
performance of the work for which this permit is issued. the Health&Safety Co505,25533,an 534.
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 Owner or authorized a=
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 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 ssued Sec 13097 Civ ending agency
for the performance of
� work's for which this permit
forthwith comply with such provisions or this permit shall be deemed revoked. 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
,n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
.mnify and keep harmless the City of Cupertino against liabilities,judgments,
ousts,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.
Sign re
C----TY OF CUPERTINO .
PERMIT RECEIPT OPERATOR: patg
.3 copy #
.......................................
Lot
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-1/07/2010
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ETTEMA LIC # 22820
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CA 95003
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CITY OF CUPERTINO
CITY OFL BUILDING
CU PE TINO GENERA
PERMIT APPLICATION FORM DO 15
[XAPFNC)o Date: ,
Building Address: f
Mailing Address (if different from bui ng address):
Are Hazardous
Materials being used as part of this project? Yes No
Yes ❑ No If es, rovide letter from HOA
HOA: (Exterior work only) pone
Ow er's Name:
Phone: 'YO, -t&-490/0
Contracto • Fax: ' --
n.
Contractor 'cense#: j
Cu ertino Business License#: phone:NN) 00-C11C CAU
�Contact. Fax:
Residential Commercial
LJ
Job Description:
r �
Building Permit Info:
Bldg Elect ❑
Plumb ❑ Mech ❑
ion (Usage Class): Occupancy Type:
Type of Construct ( g
1-A 1-B II/III/V-A ❑ 11/111 B, IV-HT,:V-B 3
Square Footage:
Valuation: ]
ri t
Standard Large❑ Major ❑
Project Size. Express ❑ Stand
portion of the Green Building/LEED Checklist& attach it
Green Building: Please complete relevant po• clude in plan set & the sheet index.
to the application or if applicable, in
Points Achieved:
For hel , contact Build it Green at www.buUditgreen.org
Revised 07/14/09
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEkTINO
FEE SCHEDULE
D Fee Description Fee Permit Type
Quantity/Sf Fee I Group 1GENRES or
1GENCOM
PARTITION WALLS
1 PARTIC
OMM Partition Interior Commercial B 1PARTICOMM
1 PART
IR Partition Interior Residential B 1PARTIR<=30
RETAINING
WALL(CONCRETE
OR MASONRY) B
1 RETSTN Standard (up to 50 ft)
p
1RETSP310
Special Design, 3-10' high (up to 50 `) B
1RETS
P 10 Special Design, over 10' high (up to B
50')
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft)
1 RETCRB> ' Gravity/Crib Wall over 10' high (up to B
50 ft)
SIDING
1SIDES
T/BK Siding, Stone &Brick Veneer B
(interior/exterior)
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
> F
Skylight greater than 10 sf or B
1 SKYL 10S Y
structural
1STAIRS Stairs-first flight/ea addt'1 B
STORAGE RACKS
1S
RACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
-.r7S>8 Storage Racks over 8' high (up to 100 B
st)
4 of 5
..: CITY OF CUPERTINO
GENERALcl TY OF BUILDING.APPLICATION
CUPERTINO FEE SCHEULE
'on
TFe FIGENRIES
mit Type
• f Fee ID Fee Description roup or
Quantity/S
1GENCOM
Applications u to 400 sf) B
1S
TUCOAP Stucco App ( p
additional stucco application B
1 WINREP
Replacement windows/sliding glass
1 door (ea 8 windows) B
EWSTR New Window-structural shear
1 WINM
wall/masonry (includes plan ck fee)
IEPERMITFEE Electrical Permit Fee
E
--------
PERMITFEE Mechanical Permit Fee
M
1M
1PpERMITFEE Plumbing Permit Fee P
Stand Alone Electric Pln Ck(hourlY)
E
1 ELCPLNCK
< � M
1MECPLNCK
Stand Alone Mechanical Pln Ck(hrly)
Stand Alone Plumbing Pln Ck(hrly)
P
1 PLMBLNCK
in Standard Plan Check(when no E/M/P)
B
1 STPLNCK-(3 Hr M
when not over counter) hourly-stand alone
B ALL PERMIT
1BCBSC
Cal Bldg Standards Commission Fee TYPES
� . . B-
1BS
EISMICR Seismic Residential
. j.
1BSEISMICO Seismic Commercial B
VDOC Travel &Documentation
B
1 TRA
B
1BUSLIC Business License
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
1.IPEkTINO
Buildin artm ant
PERMIT #
JOB ADDRESS: j Dbl
PHONE if
OWNER'S N FAX#
GENERAL CONTRACTOR:
I am not using any subcontractors: Signature Date
able subcontractors and complete lete the follow information:
Please check applicable E BUSINESS LICENSE #
SUBCONTRACTOR BUSINESS NAM
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood _
Glass / Glazing ref
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile _
Owner/Contractor atu.re
Date