13110014I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20173 APPLE TREE LN
OWNER'S NAME: SHEPHERD CHRISTOPHER J AND JAN
OWNER'S PHONE: 4083201211
❑ CENSED CONTRACTOR'S DECLARATION
License Class �—/ Lic. #
Contractor Date 3
I hereby affirm that I am lice sed under the provisions of Cha er 9
(commencing with Section 70 0) 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
pe5f2nnance of the work for which this permit is issued.
M onand will maintain Worker's Compensation Insurance, as provided for by
3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point s rce regulations per the Cupertino Municipal C e, S tion
9.18.
Signature Dat
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
I certify that in the performance of the work for which this permit is issued, l 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
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.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature Date
CONTRACTOR: SGK HOME SOLUTIONS, PERMIT NO: 13110014
INC.
3801 CHARTER PARK CT STE B DATE ISSUED: 11/04/2013
SAN JOSE, CA 95136 PHONE NO: (408) 264 -6964
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
REMOVE AND REPLACE 10 WINDOWS TO MEET EGRESS
IN
BEDROOMS, AND 2 PATIO DOORS
Sq. Ft Floor Area: I Valuation: $10880
APN Number: 31633095.00 1 Occupancy Type:
PERMIT EXPHIES IF WORK IS NOT STARTED
WITH ��jj180 DAYS OF PERMIT ISSUANCE OR
180 DA&A FWOM LAST CALLED INSPECTION.
Issued by Date: // _� /3
RE- ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9. 2 an
the Health & Safety Code, Sect'o 5 , 25533, and 25534. / �/
Owner or authorized agent: Date( '7
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(- cupertino.org
0\1 U
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
APN It
l
OWNER NAME ,
PHONEO/� 2� /J /
Q ~J t (
E-MAIL
STREET ADDRESS �7
CITY, STATE, ZIP
FAX
CONTACT NAME /� t� �
G (r,
PHONE it //
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E -MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNV AGENT NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBE
LI SE TYPE,
BUS. LIC #
..+
COMPANY NAME
E -MAIL
JAI
FAX
STREET ADDRESS //
CITY, STATE, Z/ �
r�
PH N
Qf�r (rJ
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
U
�
EXISTING USE
PROPOSED USE CONSTR.
TYPE
0 STORYN
1
USE
TYPE
OC
SQ.FT.
ALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
I AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DI CKIPORCH AREA
GARAGE AREA: DETACH
I
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY [] YES
BEING ADDED? []NO
ADDITION? []NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
RECE4ffn�.B�
V14,
TQ ION:
�.._-
/
,�7y
t
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information [ hav vided is orrect. I have read the Description of Work and verify it is accurate. I a ee to mply with all applicable local
ordinances and state laws relating t I g stnlction. I authorize representatives of Cupertino to enter the above -ide died o for inspection purposes.
Signature of Applicant/Agent: Date: JO
SUPPLEMENTAL INFO TION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
_
existing building(s). Demolition permit is required prior to issuance of building
01;;THF COUNTER
G PLAN REVIEW
permit for new building.
❑ ExPREss
G PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
11 STANDARD
El PUBLIC WORKS
form if any Hazardous Materials are being used as part of this 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_20 11. doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ImlADDRESS:
blCoh t'!ari Cs(
DATE: 11/04/2013
REVIEWED BY: Mendez
APN:
BP #:
`VALUATION: 1$10,880
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
('. %lrrr,, hl %, /). / ccc
PENTAMATION
PERMIT TYPE: 1 GENRES
WORK
remove and replace 10 windows to meet egress in bedrooms and 2 patio doors
SCOPE
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc_ 1_ Those feoc are haeed nn the nreliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 11 -053 Eff 711/13)
blCoh t'!ari Cs(
1'Inn,h IYir, ('li :ct,
t'(ctoz C'ncc• {
Plan Check Fee:
( Pcr,t
.1. IYl5
C III E t" ill nj' l7i t %.
Cili c'i' 1. /� i. -_ �f1.Cl>. EJ
a1<�c1�_ 1t.,1�. 1 ""
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/:;ec.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District_ etc_ 1_ Those feoc are haeed nn the nreliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 11 -053 Eff 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
12 #
$557.00
Window / Sliding Glass Door
1WINREP Replacement
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-.0 Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Ct��tstt rrctrr�rr J'a :
�1cltrirti.ctrariL� FCC.,
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
0
�
I'ruiel l�ocn�rr��r�tutic�rt l��reti.
Strong; Motion Fee: IBSEISMICR
$1.09
Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.09
$557.00
TOTAL FEE:
$559.09
Revised: 10/01/2013
Address
ja i/ 001'5'
PURPOSE
This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required,
GENERAL INFORMATION
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.115 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations.
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of 'a d well n ur it including basements
X
X
Within each sleeping rflom
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling; units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6,2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above- referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I hnvc mail mnrl anrmo fnrmmnhs with -tfua u n9Sr mnNitinnc of Nato ct�fcmonf
Owner (or Owner A genrs) Marne
..... Date: Si nature _... ..:...... .....,........
Contractor jN(ame: ( % 1
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Sign . ...;v- .. . -.. Uc g ..... 1.. .. Date: ...................
Smoke and COform.doc revised 03118114
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Name: 6� ?S SC7:�rcj r
Address: v
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Email:
Phone:
1/2 inch = 1 Foot
Off: 408-264-6964 www.sgkhomesolutions.com Fax: 408-264-6126