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14050132CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10566 E ESTATES DR CONTRACTOR: MARK R LONG PERMIT NO: 14050132 CONSTRUCTION, INC. OWNER'S NAME: STEVENS JERRY W AND SHARON I T 15976 LINDA AVE DATE ISSUED: 06/20/2014 OWNER'S PHONE: 4082523028 LOS GATOS, CA 95032 PHONE NO: (408) 348 -4038 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] / REPLACE 4 (E) WINDOWS. LOWER SILL ON 3 BDRM License Class �n L,ic( # Q � 5B G3 WINDOWS ON 2ND FLR TO MEET EGRESS (NO 1 ►4 Contractor W L t-G71� ICJ D "10 STRUCTURAL) 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 p rformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $7400 tpo<nd 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: 36925025.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTS correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAI' €I3� R�IIT ISSUANCE O 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 D OM LAST C ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses wh ay accrue against said City in consequence of the granting of this perm . A i Ily, the applicant understands and will compl Date: with all non -p int s urce r g latio per the Cupertino Municipal Code, Section 9.18. ^ RE- ROOFS: Signature Date V All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 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 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) 1, 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. 1 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 1 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 Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance wit th Cu Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S ti s 2 5, 2 33, 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. : 1 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 1 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 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 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 CUPERTINO v CONSTRUCTION PERMIT APPLICATION '11� U COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 e0 (408) 777 -3228 • FAX (408) 777 -3333 • buildinq(a cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS / O f %n / �/ �"��_ ✓ /� /J I� APN # �„ O� j5 OWNERNAME� PH /jL,z' L„/ E -MAIL STREET ADDRESS � 5 &V � V ! CITY, T[ � D FAX , CONTACT NAME �• ` C`I! PHONE ^3./267 ✓A G� /'E/�! E -M IL l�mM��� STREET ADDRESS / .� ^ CITY, STATE FA ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT 11 CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME�j E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHO E ARCHITEC /ENGINEER NAME LICENSE NUMBER - ,� BUS. LIC # COMPANY ; E -MAIL ' • FAX r... / V STREET AD R /7l G CITY, STA , ZIP ry;�t� JYI +/ P C .J `. DESCRIPTION OF WOR. Y \� C FOIL C EXISTING USE PROPOSE USE COYR. S � TYPF, # $yQRIES `G /- USE TYPE OCC SQ.FT VALUATION ($) EXISTG NEW FLOOR�.� DEMO TOTAL AREA AREA 5�F/�J AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH ❑ ATTACH # DWELLING UNITS IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE- APPLICATION ❑ YES IF YES, PROVIDE C O IS THE BLDC AN ❑ YES Y; AL VA UAT ON: PLANNING APPL # I] NO PLANNING APPR A _TTER/ EICHLER HOME? ❑ NO 000 By my signature below, T certify to eac e follo ing. I am the property owner or auth n o act on th operty owner' alf. I Ave read this application and the information I hav o ded i orrect I have read the Description of Work and verify it is curate. o comply with all applicable local ordinances and state laws relating t ild ng c struction. I authorize representatives of Cupertino to enter the a dentifie erty for inspection purposes. /ove )pro Date: / Signature of Applicant/Agent: 7 SUPPLEME TA NFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifa ily d ellings: Apply for demolition permit for existing building(s). De olition 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 form if any Hazardous Materials are being used as part ofthis project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10566 E ESTATES DR FEE DATE: 05/22/2014 REVIEWED BY: MELISSA APN: 369 25 025 BP #: ��j �-� `VALUATION: 1$7,400 PERMIT TYPE: Building Permit Window / Sliding Glass Door 1WINREP Replacement PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: hrs PENTAMATION 1GENRES PERMIT TYPE: WORK REPLACE 4 E WINDOWS. LOWER SILL ON 3 BDRM WINDOWS ON 2ND FLR TO MEET EGRESS SCOPE (NO STRUCTURAL) 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution-II-053 E ff 7%L %13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 L 4 1 # $418.00 Window / Sliding Glass Door 1WINREP Replacement Suppl. PC Fee: (j) Reg. ® OT FO .Q hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:) Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 1 G Work Without Permit? © Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure E) i Strong, Motion Fee: 1BSEISMICR $0.74 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.74 $418.00 TOTAL FEE: $419.74 Revised: 04/0112014