15030020 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20658 KIRWIN IN CONTRACTOR:BROTHERS HOME PERMIT NO:15030020
IMPROVEMENT
OWNER'S NAME: HOCUTT EUGENE C AND PATRICIA L 2510 DOUGLAS BLVD DATE ISSUED:03/04/2015
OWNER'S PHONE: 4086464039 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
2 p REMOVE AND REPLACE(11)WINDOWS AND(3)PATIO
License Class (y/� l�ic.#I 7 9�CI DOORS TO MEET EGRESS IN BEDROOMS
Contractor //QQ [,'0 I N W� &Ze Date V —
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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$15100
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:35923008.00 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 F AST 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
918.
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. 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 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,Secti 5505,25/ ,and 25534. 4
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: !S
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 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
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTth10 (408)777-3228• FAX(408)777-3333•buildinq(@cuperfino.org 1
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECr ADDRESS /J / _ ( APN# 06X.00,
OWNERNAME PHONE� 0 E-MAIL Uv
STREET ADDRESS / CITY,STATE,ZIP / I FAX
(�Ai G41
CONTACT NAME / PHONE ZA/► / E-MAIL
STREET ADDRESS CITY,STATE,ZIP �,�J a�/ FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR A-eONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER �/j oo LICENSE TYPWF q/ BUS.LIC#
COMPANY NAME E-MAIL o (' FAX
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STREET ADDRESS A� CITY,STATE,ZIP PHONE60
07Z, A
171
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#(J`J 5
COMPANY NAME E-MAIL FAX
STREET ADDRESS , 1P CITY,STATE,ZIP Q PHONE
DESCRIPTION OF WORK I `�( •-_67- V A OW �'5 Ag"g-
4 P-WA eorL-'s l l�
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 AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES
BELNGADDED? []NO ADDITION? ❑NO
PRE-APPLICATION [:]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED�BITx 0§, yq. „-� -zk TOTAL VALUATION:
PLAMNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO - - „
tea` �M
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 I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating wilding cot Ictto . I authorize representatives of Cupertino to enter the above-i enti red property for inspection purposes.
SignatureofApplicant/ Date: /
SUPPLER A ORM N.REQUIRED "` L�a4
- P.`L%1.1 HECILT:YPE ROUTIAGSL3P v
New SFD or Multi Wellings: Apply for demolition permit for
OVER IHIiCOUNTER ME kL--JH:BUILDI NG P1` REVIEFN
existing building(s). Demolition permit is required prior to issuance of building _ � t
permit for new building. _ a.PREss - zPLAN>\iNGYLAN<xEVIE—Commercial Bldgs: Provide a completed Hazardous Materials Disclosures D Rt; EUBLI Yvt�Rr<s'
form if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. o '� tYSEv RT�
- _.�.� ,��EA'VIRON114ENTAL'HEEAZT -?� '
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20658 kirwin In DATE: 03/0212015 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$15,100
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE:
WORK remove and replace 11 windows and 3patio doors to meet egress in bedrooms
SCOPE
�r
fin�
l9ech. I'larr C'heck Plrsrrtb. Plarr(�l�eek Elcc.Plan Check
L1eeh. PermitF'ee l'lumh, Prrmzt 7%cu;: Flec.�. Perinil Fir'.
Onc�r ;1/cch. Insp. Ocher Plumb Insp. Ocher Llec.lnshr.
wech. Insp. Fie: Plumb.Insp. Fie: Lslec.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(La 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 De t or addn7 info.
FEE ITEMS(Fee Resolution 11-053 E . 7ff 11/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 L_L4_j # Window/Sliding Glass Door
Suppl.PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $574.00 1WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. ® OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(;otzsfruclion Tarr:
Administrative Fee: Select allon-Residential �
Building or Structure
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fee_ $0.00 Select a Non-Residential
Building or Structure 0
Tr44,,el Documentalion t%eeS: _T= A
Strong Motion Fee: IBSEISMICR $1.96 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
F
$2.96 $574.00 r
T AL FEE $576.96
Revised: 02/14/2015
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2015
REVIEWED FOR CODE COMPLIANCE
Reviewed By:
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