16010026CITY OF CUPERTINOBUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 16010026
6057 SHADYGROVE DR CUPERTINO CA 95014 (375 40 005)
HOMEOWNER/BUILD
ER
OWNER'S NAME:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. #
Contractor HOMEOWNER/BUILDER Date
—BLDG —ELECT —PLUMB
MECH RESIDENTIAL COMMERCIAL'
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.
JOB DESCRIPTION:
COMPLETE INTERIOR REMODEL (1433 SQ FT)
CLUDING
I hereby affirm under penalty of perjury one of the following two declarations:
DOORS, WINDOWS, AND SKYLIGHTS; REMODEL
GARAGE (507 SQ
1. I have and will maintain a certificate of consent to self -insure for Worker's
FT); RE -ROOF WITH FOAM ROOFING (2400 SQ FT);
REMOVE AND
Compensation, as provided for by Section 3700 of the Labor Code, for the
REPLACE SIDING (959 SQ FT); UPGRADE ELECTRICAL
PANEL (200
performance of the work for which this permit is issued.
AMP),
z. 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.
Sq. Ft Floor Area:
Valuation: $400000.00
APPLICANT CERTIFICATION
1 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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
375 40 005
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.
PERMIT EXPIRES IF WORK ISN
T STARTED
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE
OR
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7/8/2016
Issued. by: Abby A ey nde
Date: 07/08/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the `
RE -ROOFS:
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
All roofs shall inspected r to any roofing material be'
g installed. If e roof is
obtaining
installed without first obtaining an inspection, I agree to remo
t
a all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
„2 I, as owner of the property, am exclusively contracting with licensed
i contractors to construct the project (Sce.7044, Business & Professions Code).
Signature
2016 icant:
Date:?/8/ 6
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A"
OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
,performance of the work for which this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
_, ;/ I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements unde
Chapter of the
@C Section 3700 of the Labor Code, for the performance of the work for which this
California Health &Safety Code,. Sections 25505,25533,
and 25534.34. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code
Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or
handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devices
which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality
Management District I
exemption, I become subject to the Worker's Compensation provisions of the
will maintain compliance with the Cupertino Municipal Code,
Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety
25534.
be deemed revoked.
;
Qwner or authorized agent,
APPLICANT CERTIFICATION C
Date: 7/8/2016
certify that I have read this application and state that the above information is
CONSTRUCTION LENDING GEN,:Y
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lendi g agency
for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ
.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARC'HITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Signature Date 7/8/2016
Licensed
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR. PERMIT NO:16010026
6057 SHADYGROVE DR CUPERTINO CA 95014(375 40 005) THE SANDMAN
TERMITE COMPANY
SAN JOSE,CA 95125
OWNER'S NAME:
PHONE NO:(408)265-7400
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO.
License Class fa Lic.#425229
Contractor THE SANDMAN TERMITE COMPANY Date 07/31/2018 —BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH—RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION
COMPLETE INTERIOR REMODEL(1433 SQ FT)INCLUDING
I hereby affirm under penalty of perjury one of the following two declarations: DOORS,WINDOWS,AND SKYLIGHTS,REMODEL GARAGE(507 SQ
a I have and will maintain a certificate of consent to self-insure for Worker's FT);RE-ROOF WITH FOAM ROOFING(2400 SQ FT);REMOVE AND
Compensation,as provided for by Section 3700 of the Labor Code,for the REPLACE SIDING(959 SQ FT);UPGRADE ELECTRICAL PANEL(200
/performance oftheworkforwhichthis permitis issued. #)1vit
. I haveandwillmaintainWorker'sCompensationInsuranas provided for by REV -ADDITION TO FRONT OF BUILDING(244 SF);REPLACE
Section 3700 of the Labor Code,for the performance of the work for which this BOILER FOR HOT WATER AND(E)RADIANT HEATING SYSTEM.-
permit is issued. ISSUED 9/27/2017
APPLIC• T CERTIFICATION REV#2-SHOW GAS LINE AND WATER LINES ON PLANS PER
I certify that I have read this application and state that the above INSPECTOR'S REQUEST-ISSUED 9/27/2017
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 Sq.Ft Floor Area: Valuation:$400000.00
City of Cupertino against liabilities,judgments,costs,and expenses which
may accrue ag- said City in consequence of the granting of this permit.
Additionally,thi=..licant understands and will comply with all non-point APN Number Occupancy Type:
source regula per the Cupertino Municipal Code,Section 9.18. 375 40 005
ignature Date 9/27/2017
PERMIT EXPIRES IF WORK IS NOT STARTED
OWNER-BUILDER DECLARATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I hereby affirm that I am exempt front the Contractor's License Law for one of the 180 DAYS FROM LAST CALLED INSPECTION.
following two reasons:
1. I,as owner of the property,or my employees with wages as their sole Issued by Abby Ayende
compensation,will do the work,and the structure is not intended or offered for Date:07/08/2016
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm under penalty of perjury one of the following three declarations: installed without first obtaining an inspection,I agree to remove all new materials for
1. I have and will maintain a Certificate of Consent to self-insure for Worker's inspection.
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Signature of Applicant:
2, I have and will maintain Worker's Compensation Insurance,as provided for by Date:9/27/2017
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
3. 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 HAZARDOUS MATERIALS DISCLOSURE
exemption,I become subject to the Worker's Compensation provisions of the I have ui
Labor Code,I must forthwith comply with such provisions or this permit shall Californiareadthe Heanc &SafhazardousetyCode,materials Sectionsreq25505rements,under Chapter 6.95 of the
25533,and 25534. I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
be deemed revoked. Health&Safety Code,Section 25532(a)should I store or handle hazardous
APPLICANT CERTIFICATION material.Additionally,should I use eQ',r ipment or devices which emit hazardous
I certify that I have read this application and state that the above information is air contaminants as defined by the Oa,: ea Air Quality Management District I
correct.I agree to comply with all city and county ordinances and state laws will maintain compliance with thea u o tino Municipal Code,Chapter 9.12 and
relating to building construction,and hereby authorize representatives of this city the Health&Safety Code, e tions 25505,25533,and 25534.
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, (Owner or authorized agent:
judgments,costs,and expenses which may accrue against said City in Date:9/27/2017
consequence of the granting of this permit. Additionally,the applicant understands CONSTRUCTION LENDING AGENCY
and will comply with all non-point source regulations per the Cupertino Municipal I hereby affirm that there is a construction lending agency for the performance
Code,Section 9.18. of work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
Signature Date 9/27/2017 Lender's Address
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 6067 SHADYGROVE DR
DATE: 0110512016
REVIEWED BY: IV
EL - ISSA
375 40 005
BP#:
*VALUATION; E
u
66,660
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration /
Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION
PERMIT TYPE:
IR3SFDREM
WORK
REMODEL/RECONFIGURE (E) 1,433 S.F. SFD. RE -ROOF 24 SQ'S FOAM). REPLAC
E/CREATE 13
SCOPE
WINDOWS & 7 DOORS. REMOVE (E) FIRE PL. ADD 2 (N) & REPLACE 2 (E) SKYLIGHTS
FEE ITEMS (Fee Resolution 11-053 Aff 711173)
I'Rw Check
A. F
hee:
Plan (.,heck
Buildinj4 or Structure
Rdvised: 10/01/2015
Ofherf,furlb A's'-'-
Oihe�-
L—i
Vech,
Elee. fnvFee,
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer
District, School
District, etc.). Thesefiees are based on the preliminar
information available and are only an estimate. Contact the D
'I info.
FEE ITEMS (Fee Resolution 11-053 Aff 711173)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00LL,433S.f.
j
Remodel, Other
Suppl. PC Fee: (E) Reg, 0 OT�hrs
$0.00
$4,888.001
JREMRES2
PME Plan Check:
$0.00
F- -2-4- —#
Window Sliding Glass
Door
Permit Fee:
$0.00
$717.00 1
IWINREP
Replacement
Suppl. Insp. Feer Reg. 0 OT�hrs
$0.00
2,400 SX.
1
Re -roof
PME Unit Fee:
$0.00
$408. 001 IREROOFRES
PME Permit Fee:
$0.00
7"
-01181ruellon 6�x: j
7_
A&ninWralive 1-7ee:
0
Work Without Permit? 0 Yes (F) No
$0.00
G)
Advanced Planning Fee:
$0,001
Select a Non -Reside
tial E)
Buildinj4 or Structure
Rdvised: 10/01/2015