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14060042 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10392 NOEL AVE CONTRACTOR:SGK HOME SOLUTIONS, PERMIT NO: 14060042 INC OWNER'S NAME: JACELEN EDMISTON 3801 CHARTER PARK CT STE B DATE ISSUED:06/09/2014 OWNER'S PHONE: 9199230296 SAN JOSE,CA 95136 PHONE NO:(408)264-6964 ❑ LICENSED CONTRACTOWS DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] ` REMOVE&REPLACE 10 WINDOWS& 1 SLIDING GLASS License Class ` Lic.# a0 DOOR.3 BEDROOM WINDOWS WILL BE LOWERED TO /Contractor MEET Date EGRESS&ALL WILL BE TEMPERED WHERE REQUIRED I hereby of arm that I am license under the provisions of Cha er BY (commencing with Section 7000) f 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:$10000 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:32647049 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPI IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT D RMIT 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 L 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 / Date: granting of this permit. Additionally,the applicant understands and will co y -� with all non-point source regulat, ns per the Cupertino Municipal Code, ection 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 upertinoMunicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sect' S 5 5533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized ager Dat 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 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. Signature Date V CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION IN 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(cDcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# OWNERNAME=Pare e c P (D E-MAIL` _t STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME , _ _ PH MAIL STREET ADDRESS © �( CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUH.DER ❑ OwNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME J/ CENSE NUMB de LI COMPANY NAME (C E-MAIL / FAX (� STREET ADDRESS5TA�'�(/1 r�/ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP n PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE I #STORIES USE TYPE OCC. $Q.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA I DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: HDETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY OYES BEING ADDED? ONO ADDITION? []N O--__— PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES T AL ON: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am a property own or authorized agent to act on the property owner's behalf. I ave read this application and the information I have provided i o ct. h e read the Description of Work and verify it is accurate. I agree to co ply wi all applicable local ordinances and state laws relating to buil ' c' authorize representatives of Cupertino to enter the above-identified pr erty fo pectin urposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQ D PLAN C14ECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OYER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. EXPRESS' ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS To—nn if any Hazardous Materials are being used as part of this project. LARGE ❑ FIIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to [ ;nraaoR ❑ SANITARY SEWER DISTRICT of Building Permit application. ❑:ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10392 NOEL AVE DATE: 06/09/2014 REVIEWED BY: MELISSA APN: 326 47 049 BP#: *VALUATION: 1$10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: p PERMIT TYPE: WORK REMOVE & REPLACE 10 WINDOWS & 1 SLIDING GLASS DOOR. 3 BEDROOM WINDOWS WILL SCOPE BE LOWERED TO MEET EGRESS &ALL WILL BE TEMPERED WHERE REQUIRED BY CODE I'_r,rit Fee: T'trmd�. Ptimit Pee: tie^_Pel r .. 1;hcIrcYr, i rs}"r Clther�Mu ib Irtsrr. E3 tJf;ta�r l t�;c. Ita.t/ Phvity, hrsga. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These _f -fees are based on the relimina inormation available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl. PC Fee: Q Reg. ® OTQ.0 hrs $0.00 $557.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. C) OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (,'Ctrr.jli`actioii Kav: Work Without Permit? ® Yes No $0.00 E) Advanced Planning_Fee. $0.00 Select a Non-Residential G Building or Structure 0 Strom Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg Stds Commission.Fee: IBCBSC $1.00 �y MLt $2.00 $557.00 TOTAL FEE: $559.00 Revised: 04/01/2014 NAME: / `i PROPERTY ADDRESS: Y'J� Z; U,� m�� Iy3po, ) COMMUNITY1, _C?nnnF�lT PHO E-EI:HOME PHONE:MOBILE C y -f not ert- 3UtLDING _ l qtJUIyDEAP NEW ROOF MAT RIAL ORDERED: COLOR OF NEW ROOF: 7h, nn}of rf!l-sJ9 �►� . 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