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15070198CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20173 APPLE TREE LN CONTRACTOR: SGK HOME SOLUTIONS, PERMIT NO: 15070198 INC. OWNER'S NAME: SHEPHERD CHRISTOPHER J AND JAN 3801 CHARTER PARK CT STE B DATE ISSUED: 07/28/2015 OWNER'S PHONE: 6507321857 SAN JOSE, CA 95136 PHONE NO: (408) 264-6964 LI ENSED CONTRACTO 'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL !/] REPLACE (E) 2ND FLR BALCONY SLIDING GLASS DOOR License Class & (E) 1ST FLR GARAGE WINDOW (SAME SIZE & LOCATION, Contractor Date WILL MEET EGRESS & BE TEMPERED WHERE I hereby affirm that I am license under the provisions of Chapter 9 REQUIRED BY (commencing with Section 7000) o 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 Sq. Ft Floor Area: Valuation: $2500 ormance of the work for which this permit is issued. ave 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: 31633095.00 OccupancyType: ype: 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 18 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, 18 INSPECTION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will Date: ji with allnon-po' t source gulations per the Cupertino Municipal C e, Sec 'on 9.18. Signatu Date ( S 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. ❑ 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(x) 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, Section 505, 25 , and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: lz��_Date: �LA 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 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-)cupertino.org I I NFW CO NCTRI ICTION FI ADDITION l D I -I ALTERATION / Ti n REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS '73/ (/ JV Q� ( APN # 2 J RRX777 v OWNER NAME PHONE E-MAIL STREET DDDR S �ul l J CITY, STAT / FAX CONTACT NAME _ V ^ P E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR 95QTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME! LICENSE N MBE � LICENSE TY BUS. LIC # L,,/ / �(�/ COMPANY NAME / E-MAIL r IAX STREET ADDRES �1 �— (, f' CITY, S IP / ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK tie - EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. 1 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: ODETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN RE PLANNING APPL # ❑NO PLANNING APPROVAL LETTER EICHLER HOMEI NO By my signature below, I certify to each of the ': I am the property owner ora orized age a property owner's behalf. i have read this oisgt. application and the information 1 have vide1 have read the Description of Work and verify it is accurate. I ap�ee to compl with alla icable local ordinances and state laws relating t ui on. 1 authorize representatives of Cupertino to enter the above-iden ed propelor ' pectlon purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION RTUIRED 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 ER -THE -COUNTER BUILDING PLAN REVIEW 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 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 2011.doc revised 06/21/11 CITY OF CUPERTINO I!►1��YI/�I FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Fewer District, School of,. a Th -co rpec are paced on #tip nrpliminary infnrmation availahle and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolullon 11-053 U. 7/1/13) ADDRESS: 20173 APPLE TREE LN DATE: 07/28/2015 REVIEWED BY: MELISSA fech. 1'ermit Fe, - APN: 316 33 095 BP#: "VALUATION: 1$2,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex p Plumb. Insp. F L _ PENTAMATION 1GENRES USE: $0.00 PERMIT TYPE: WORK REPLACE E 2ND FLR BALCONY SLIDING GLASS DOOR & E 1ST FLR GARAGE WINDOW SCOPE (SAME SIZE & LOCATION, WILL MEET EGRESS & BE TEMPERED WHERE REQUIRED BY CODE) NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Fewer District, School of,. a Th -co rpec are paced on #tip nrpliminary infnrmation availahle and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolullon 11-053 U. 7/1/13) 11ech. Plan Check 1 `laamh, flan Check Elec. I'lcan Check. fech. 1'ermit Fe, - Phimb. Permit Fee: E'lec. Permit 1'ee: �?tiaer�llech. Imp. ph nri, lt r)ther Elec. Insp. Lj i tach. Insp. Fee Plumb. Insp. F L _ t':lec. Insp. Fee NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Fewer District, School of,. a Th -co rpec are paced on #tip nrpliminary infnrmation availahle and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolullon 11-053 U. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $431.00 Window / Sliding Glass Door I WINREP Replacement Suppl. PC Fee: Q Reg. 0 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 'onslruction Tax. =(/minlstrative Fee: E) Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) �'A iwvel Documentation Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $431.00 TOTAL FEE: $432.50 Revised: 07/02/2015 OFFICE COP ".&C& v JU` 2 8 2415 8y ONMA i e 0 =A—o .