14050028 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10276 VIRGINIA SWAN PL CONTRACTOR:BROTHERS HOME PERMIT NO: 14050028
IMPROVEMENT
OWNER'S NAME: MIYAMOTO JUDITH A TRUSTEE 2510 DOUGLAS BLVD DATE ISSUED:05/05/2014
OWNER'S PHONE: 4085170571 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 0
REMOVE AND REPLACE 15 WINDOWS, 1 PATIO DOOR TO
License Cla �� Lic.# Q MEET EGRESS IN BEDROOMS
ContractoA/—o 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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10488
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:31646003 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 WITHIN80 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 DA F OM LAST CALLED 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 Issued b Date:
granting of this permit. Additionally,the applicant understands and will comply y'
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
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
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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 05,25533,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 CONSTRU ON 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
918.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION O�
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 O�
CUPERT{[rt0 (408)777-3228- FAX(408)777-3333-building(5--)cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS 0 V(o \) "10' v1 -�✓ APN# '`n 41&
(205-66
'fit 5-6v
OWNER NAME ,/ ,/TaPHHO•NE t10 5( 0 5� E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT NAME l PHONE 65 Z4r E-MAIL
STREET ADDRESS ) L CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR IICONTRACTORAGENT ❑ ARCHITECTJ /11 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER4/Ja LICENSE TYPE //17 BUS.LIC#
COMPANY NAME MAIL ``�� i FAX
STREET ADDRESS �j / CITY,STATE,ZIP / PHONE -1 'AAn
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# rj ((
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORKbr�e live C 6 / A- /Pon v y
/
b" lw&:� `3 M
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
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 ARE I GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT [:]YES SECOND STORY []YES
BEINGADDED? []NO -ADDITION? [:]NO
PRE-APPLICATIPLANNING APPL# ❑NO IF YES,PROVIDE COPY PLANNING APPROVAL LETTER EICHLER HOME?F IS THE BLDG AN Q ptECEiVED;B qd_ _ TOTAL VALUATION:
$k, S W.06
By my signature below;I certify to each of the following: I am the property owner or authorized agent to act e pr perry owner's behalf. I have read this
application and the information I hav ided is corre ve read the Description of Work and veri ' Is ie. I agree to comply with all applicable local
ordinances and state laws relating in construct authorize representatives of Cupertino to enter the above-id e t le pro erty for inspection purposes.
Signature of Applicant/Agent: Date: S/
SUPPLEME AL INFO QUIRED PcYP> ocsLir� _ ,.
New SFD or Multifami gs: Apply for demolition permit for '
OVER. OtJNTER - BUII DING PI A_ ^REYIEVi j
existing building(s). Demolition permit is required prior to issuance of building ,
permit for new building. PLAlYRE�IEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure T 'DARD vBJwb�ucs �
form if any Hazardous Materials are being used as part of this project.
�,-
_Copy of Planning Approval Letter or Meeting with Planning prior to m rrAxY sE W90AMM-APMM
submittal of Building Permit application. h t �
�. �. �_�- YL�JEIQVIRO]VRlEnTAL"HEALTFI�f�+YM.<-
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
21 1 —
ADDRESS: 10276 virginia swan pi DATE: 05/05/2014 REVIEWED BY: mendez
APN: BP#: *VALUATION: J$10,488
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE: i
WORK remove and replace 15 windows 1 patio door to meet egress in bedrooms
SCOPE
r
feel 7't',xri t l ex'k R 1'hwlb. T hwl t'%.e(—A
ti1>cla. t' i;
rwiz Fee: 1'h m .l�'c. rrr Y Fete:
FTT
liilx rWcc h.lar,.» Othe['Plumb lrisp.
1'ie:r tr«P' ",A): 1'haiiib. Tiasp. Fee
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. 0 OT0.0 hrs $0.00 $557.00 1WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
( oizsrnwfion 71rv:
Work Without Permit? 0 Yes No $0.00 E)
Advanced Planning Fee. $0.00 Select a Non-Residential
Building or Structure 0
f'r-�:�s�l I)o�ar,r�srr�P�x1i�>rr l�`et�s.' �
Strong Motion Fee: 1BSEISMICR $1.05 Select an Administrative Item
Bldg_ Stds Commission.Fee: 1BCBSC $1.00
TOTAL 559.05
d_ ® ALS r.: $2.05 $557.00 FEE: $
Revised: 04/01/2014
PLOT PLAA5
CHECKED BY
5/5 4-
-KANNING DEPT.
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