09010044 - PUB10691
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Permit Information
Location Information
Permit Number "
09010044
Address " 1175 CRESTLINE DR
Status `
C - Closed
City/State/Zip CUPERTINO �CA _95014
Master Number
U
Notes
1'
APN 36229042.00
Project
-- ----
-
Unit ------
Apply Date'
01/12/2009
Operator
patg
0,iiner Entity Information
Permit Issue Date
01 /29/2009
Operator
patg __ _
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Owner Name " HOFER JOHN M AND ADRIANNE E
Certificate Issued
07/14/2009
-
Operator
;PALM
-
Use Default
Certificate Type
-
--�
Address (Home -1175 CRESTLINE DR v
Certificate Number
City/StatefZip LGUPE ITR NO CA 95014.5034
Permit ` Property
Zoning
Applicant II
Contractor " �i
Defined Fields
Permit Details
Permit Type "
1R3SFD1REM Q
SINGLE FAMILY DWELLING REMODEL
Usage Class '
11/III B,
II/III B, IV-HT,V-B NEW
Applied Value `
--� 0
SQUARE FT.
�— 0
Calculated Value
I OCR
US C-404 Type
434
ALT: RESIDENTIAL
Permit Form'
IAUTOPERM -PERMIT
Ownership
1 Private *�
Project Size
EXPRESS - EXPRESS
'ermit issued 0112912009
Inter the purpose or any special conditions For this permit
Purpose/Special Conditions
REMODEL=176 SQ KITCHEN (M,E,P) MINOR-STRUCTURAL-N
SANITARY CONDITIONS-
FILMED- 20111
[DAdd Default T
v
*.000K
Back
1 r, Contractors
Fees
Plan Reviews
�LInspections
l� Print Permit J
Adjustments
lr Holds
l['] Copy Permit
l� Close Permit
Overrides
�=� Supplementaifields
IlNotes
Ifit Attachments
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CITY OF CUPERTINO
_
I ~ x,
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT NO.
1175 CRESTLINE DR
STEVE
OWNER'S NAME:
PERMIT L95UE DATE
PHO :
A CONTROL NO.
(408) 255-1461
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Divisi n 3 of the Business and Professions Code. and my license is
in full force and effect. ;�
REMODEL : 17 6 SQ KITCHEN (M, E , P )
License CI Lic.rf s
Dae Cantrador C
MINOR —STRUCTURAL —NO SANITARY CONDITIONS.
ARCHITECT-S DEC O ✓ �y
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
i hereby affirm that 1 am exempt from the Contractors License Law for the
following mason. (Section 70315, Business and Professions Code: Any city or county
whirls requires a permit w conurticl, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
Contractors License law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the
(commencing with Section 7000) of Division 3 of the Business and ProlZons Code) or
8 0 0 0 0
that he is exempt therefrom and the basis for the alleged exemption Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of
not more than five hundred dollar (S500).
3 6 2 2 9 0 4 2.00
i, as owner of the property, or my employees with wages as their sale compensation,
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec. 70". Business
and Professions Code: The Contractors Life sc Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, is owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts far such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
1 am exempt under Sec. , B & P C for this reason
Owner Date
_
WORKER'S COMPENSATION DECLARATION
i hereby affirm under penalty of perjury arc of the following declarations:
❑ i have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the IAbor Code, for the performance of the
work for which this permit is issued
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the IAbor Code, for the performance of the work for which this permit is issued
My War Compensa insurance carrier and Policy number am: /') -7
Cam ._ / V/%D Policy Nol Z 7& /17,
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Cris section need not be completed If the permit Is for one hundred doflars ($100)
or Icss)
I certify that in the parfonnance of the work for which this permit is Lssacd 1 shall not
employ any person in any manncr so as to become subject to the Workers' Compensation
Laws of California. Datc
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be detmad revoked
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit Is issued (Sec. 3097. Civ. C)
'
Lenders Name
,
Lenders Address
I certify that 1 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 mlimscmatims of this city to enter upon the
above -mentioned property for inspection purposes.
(We) agree loepve, indemnify and keep harmless the City of Cupertino against
liabilides, judgm csts and eapense;.which may in any way accrue against said City
inconsequence the g g of thi mil.
IDSCOMPLY WITH ALL NO -POINT
APPLICAF4F�1�7�
Issued by: Date
SOUR
_
Re -roofs
Type of Roof
tgnature fApplicanLIContraclor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant care or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)? /
Yes
All roofs shall be inspected prior to any roofing material being installed.
❑ 0,F6
If a roof is installed without first obtaining an inspection, I agree to remove
WIIi the applicant or future building occupant use equipment or devices which
craft hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
[3 Yes j
1 have mad the harardous materials requirements under Chapter G95 of the Califor-
niaHealth & Safety Code., Secti 25505. 25533 cM5534_ I understand that ifthe building
does not cis Tently have a it is m itsihili W notify tiro pant a the
mquirornent ich a to • sdoI. Ticatc of Occu ry• � �
Signature of Applicant Date
All roof coverings to be Class','ga' or better
'oraatharizc
Owner agent e
_
��
CITY OF
CUPERTINO
CITY OF CUPERTINO
ADDITION/REMODEL
PERMIT APPLICATION FORM 9 1 Ooy
APN # � Z 9 vy � , �v
Date:
Building A ddresl: /
Mailing Address (if different from building address):
Owner's Name-
aye
Phone #
ti-e
Contra tor:
Phone #: 6 - G Kr-- 6 /31
�2) t G�
Fax #:
Contractor License #:
Cupertino Business License #:
Contact: /
Phone � 3
Fax #: 110F
Building Permit Info:e rQ_WLv
Bldg. [D' Elect. Plumb. 0 Mech. Hillside ❑
Job Description:
Addition -What is being added?(Be Specific):
What is being remodeled (not including addition)? Ak I/Z� a �Gc
�C 14, , 467rl,�l /Y1 ndX c S7�Uc�
Remodel Includes Re -Roof: Yes ❑ No 0� If yes list number of squares
Remodel Includes Structural: Yes a No ❑
Do you have the pre -application planning approval? Yes ❑ No [r
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
C�
Remodel: Kitchen Bath Other
Type of Construction (Usage Class):
Occupancy Type:
e
'Q _
1-A, 1-B IUIII/V-A ❑ II/III B, IV -HT, V-B
Valuation: E3(D
Please check this box if the project is a
second -story addition ❑
Project Size: Express Standard ❑ Large ❑ Major ❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable,
Green Building Points Achieved:
include in plan set & the sheet index.
***For Office Use Only***
Over -the -Counter ❑
Revised 01/07/09