15090083CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22350 CUPERTINO RD
CONTRACTOR: SGK HOME SOLUTIONS,
PERMIT NO: 15090083
INC.
OWNER'S NAME: MICHAEL MOORE
3801 CHARTER PARK CT STE B
DATE ISSUED: 09/14/2015
OW 'S PHONE: 6502839434
SAN JOSE, CA 95136
PHONE NO: (408) 264-6964
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE 8 (E) WINDOWS (1 IN BATH IN LONGER,
/r
NON-STRUCTURAL) & 1 SLIDING GLASS DOOR
License Class t I Lie. #
Contractor Date S
I hereby affirm that I am licend under the provisions of Chapter 9
(commencing with Section 700 of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
Sq. Ft Floor Area:
Valuation: $9000
I hereby affirm under penalty of perjury one of the following two declarations:
t. I have and will maintain a certificate of consent to self -insure for Worker's
APNNumber 7-�50 89LI, C O
Occupancy Type:
pensation, as provided for by Section 3700 of the Labor Code, for the
rmance of the work for which this permit is issued.
e and will maintain Worker's Compensation Insurance, as provided for by
4ct
on 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
WITHIN 180 D F PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is
1 FRO ST CALLED IN SPE TION.
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 e
upon the above mentioned property for inspection purposes. (We) agr a
Iss y: Date: /
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may Iperue against said City in consequence of the
granting of this a Ad ' ' nally, the applicant understands and w c mply with
all non -points c 1 ns per the Cupertino Municipal C It-n�.
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature Date
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
1. 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
HAZARDOUS MATERIALS DISCLOSURE
sale (Sec.7044, Business & Professions Code)
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I, as owner of the property, am exclusively contracting with licensed contractors to
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
construct the project (Sec.7044, Business & Professions Code).
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations:
Additionally, should I use equipment or devices which emit hazardous air
i. I have and will maintain a Certificate of Consent to self -insure for Worker's
contaminants as defined by the Bay Area Air Quality Management District I will
Compensation, as provided for by Section 3700 of the Labor Code, for the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Owner or authorized
*Vl�;Date:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
a. I certify that in the performance of the work for which this permit is issued, I shall
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code, I
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked.
Lender's Address
APPLICANT CERTIFICATION
ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is
I understand my plans shall be used as public records.
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
Licensed Professional
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ! �Q
(408) 777-3228 • FAX/(408) 777-3333 • building
0cupertino.org Q $ 3
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LJ NEW CONSTRUCTION LJ ADDI I IUN AL 1 CKA I1VIV 1 11 L_J
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❑ OWNER [IOWNER-uSUB-D(DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NASff5 SE NUMBE �DV
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BUS. LIC #
COMPANY NAME
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DESCRIPTION OF WORK
le
EXISTING USE
PROPOSED USE
CONSTR TYPE I
# STORIES USE
TYPE OCC.
SQ.Fr.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
REMODEL AREA
KITCHEN
REMODELAREA
OTHER
REMODEL AREA
PORCH AREA DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA' DETACH
# DWELLING UNITS:
IS A SECOND UNIT YES
BEING ADDED? ❑ NO
SECOND STORY YES
ADDITION? ❑ NO
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
Is THE BLD YES RECEIVED BY:
TOTAL VAI.UAT[ON:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
ETCH ME? []NO
Q A O
By my signature below, I certify to each of the follo 'ng: I am the property owner o onzed a tt Ie property owner's behalf. I have read this
it is I agree to omply all applicable local
application and the information 1 ha p v ed s rrect. I have read the Descri on of W n accurate.
i
ordinances and state laws relating t i struction. i authorize representatives of Cupertino to enter the above-ide r pe s purposes.
Signature of ApplicanUAgent: Date:
SUPPLEMENTAL INFO TIONQUIRED PLAN CHECK TYPE ROUTING SLIP
SFD or Multifamily dwellings: Apply for de lition permit for ❑ OVER-TEL&COUNTER ❑ BUILDING PLAN REVIEW
—New
existing building(s). Demolition permit is required prior to issuance of building
ElExPREss ❑ PLANNING PLAN REVIEW
permit for new building.
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 11M"OR El SANITARY SEWER DISTRICT
_
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
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 onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-033 E.. 7/1/13)
ADDRESS: 22350 CUPERTINO RD
DATE: 09/14/2015
REVIEWED BY: MELISSA
,lech. Permit bee:
APN: 326 50 084
BP#:
*VALUATION: 1$9,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENRE
PERMIT TYPE:
WORK
REPLACE 8 E WINDOWS 1 IN BATH IN LONGER NON-STRUCTURAL & 1 SLIDING GLASS
SCOPE
DOOR
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 onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-033 E.. 7/1/13)
sch. Plan Check
Plumb. Plan CheckF-T
E'lee. Plan Check F7
,lech. Permit bee:
Plumb. Permit Fee:
[1,11c, Permit Pee.:
41ier .Vfech..lnsp.E1__L_
lrher Plumb .insp,
)t7rt. t 7c>c . i, >
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: 0 Reg. 0 OT
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 onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-033 E.. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$574.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
1-4A
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
O
f, 1 /fit _�,t�� rz ��
alVi
Strong Motion Fee:
IBSEISMICR
$1.17
Select an Administrative Item
1
Bldg Stds Commission Fee: 1BCBSC
$1.001
SUBTOTALS:
1 $2.17
$574.00
TOTAL FEE:
1 $576.17
Revised: 07/02/2015
M1 -
COMBUIL NG UIVI ON G GUPERIINO
/4p P F,'a...i 'a"t, —
7 D
This set of plans and specifications MUST be kept at the
job sito during construction. It is unlawful to make any
changes or alterations odingtate
t��icial.
therefrom, without approval from the Bu
The stampina of this plan and specifications SHAL.I- NOT
be held to permit or to be ' L c:-,raval of tha vloi<}.ti n
of any pr dinance or Stage Law.
PERMIT NO.
Lender
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Master
Bedroom
Master
Bath
OFFICE COPY
Building Sketch
State
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41
Famity
Room
Foyer
Bedroom
`A Entry
`I Bedroom 12.0
Bath
fV
34.0'
Code
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PLA S CHECKED BY
OATS -�
PLANNING DEPT
CUPERTINO
0
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Kitchen Nook
11.01 CCPERTIN p
Living W/die9 DeAartent
Room Bedroom ' ' SEP 14 2015
EwEL) Fof CODE
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Laundry Bath RE '
Bedroom Bedroom
2 Car
Garage
20.8'
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