B-2016-2911 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2911
7618 SHADOWHILL LN CUPERTINO,CA 95014-5062(362 24 026) COMPLETE
CONSTRUCTION
EXPERTS INC
SAN JOSE,CA 95129
OWNER'S NAME: DAUGHERTY WILLIAM T ET AL DATE ISSUED:11/23/2016
OWNER'S PHONE:408-930-1310 PHONE NO:(408)650-2432
LICENSED CONTR ACTOR'S jacLARATKa
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.#1009320
Contractor COMPLETE CONSTRUCTION EXPERTS INC Date 12/31/2017 X BLDG Y ELECT _PLUMB
MECH X 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:
1ST FLR,OFFICE/BEDROOM/BATH ADDITION(429 S.F.);REMODEL
I hereby affirm under penalty of perjury one of the following two declarations: DINING RM&BEDROOM 2(230 SQ FT);ELECTRICAL PANEL
1. I have and will maintain a certificate of consent to self-insure for Worker's UPGRADE(200 AMP).
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
' 2. 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:429 Valuation:$80000.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state laws relating to.uilding construction,and hereby authorize 362 24 026 R-3(Custom)
representatives of this ci ; o enter upon the above mentioned property for
inspection purposes (VV: 'r:-to save indemnify and keep harmless the '
City of Cupertino a:4 inst i.Id
-s,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue agai �,�`lic•'r- i!consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the•fplica d-rstands and will comply with all non-point
source regulatio` per • _ }�i7i -u .',ipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
ai
Signa ure 4®��r®/ Date 11.23.16 Issued by:SEAN HATCH
Date: 11/23/2016
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: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove 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 Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11.23.16
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1, 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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Mu.i'cipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)sli d I st re or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipme,t or d "
+ ces which emit hazardous
air contaminants as defined by the Ba/Are Air Q 1, 'ty Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C 1'erti,o Aun/ipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code/•ecti i I. 1• nd 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ®�gr/�-��• a
be deemed revoked. Owner or authorized a ®/tea/./f
APPLICANT CERTIFICATION Date:11.23.16
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending 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 C.)
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 ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 11.23.16 Professional
,
/ CONSTRUCTION PERMIT APPLICATION
,t0,1
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
/wyt.r9„:„ 10300 TORRE AVENUE•CUPERTINO,CA 950144255 B .
CUPERTINO (408)777-3228• FAX(408)777-3333•bulldinqAcupertIno.orcl
0 NEW CONSTRUCTION 2 ADDITION ❑ALTERATION/TI ,El, REVISION/DEFERRED ORIGINAL PERMIT#I
PROJECT ADDRESS APN1f
7618 SIIADOWHILL LANE 382-24-026
OWNER NAME
BILL AND TOFFANY DAUGHERTY PHONE 408-930-1310 E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
7610 SHADOWHILL LANE CUPERTINO,CA.95014
CONTACT NAME
JEANNIE AIASSA rxorrs 408-230-2989 JAIASSA@YAHOO.COM
STREET ADDRESSCITY,STATE,ZIP FAX
2151 OAKLAND RD SPC 151 SAN JOSE,CA 95131
ID.OWNER 0 OWNSR03UILDER ❑ OWNER AGENT 0 CONTRACTOR 0 CONTRACTOI AGENT 123 ARCHITECT ❑ENGINEER El DEVELOPER 0 TENANT
CONTRACTOR NAMB LICENSE NUMBER LICENSE TYPE BUS.LIC it
NATHAN WEIZMANN 1009320 GENERAL
COMPANY NAME E-MAIL FAX
WISE BUILDERS NATHAN.WISEBUILDERS@GMAIL.COM
STREET ADDRESS CITY,STATE,ZIP PHONE
5205 PROSPECT RD PING 256 SAN JOSE,CA.95129 415-610-6155
ARCHITECT/IENGINEERNAME DAVID HAUNG..... LICENSENUMbIIk BUS.LICE
COMPANY NAME E-MArL DAVID@D2SENGINEERING.COM PAx
D2S ENGINEERING
STREET ADDRESS CITY,STATE,ZIP PHONE
1707 GUADALUPE AVE SAN JOSE,CA,95125 415-269-2880
DESCRIPTION Or WORK - -
ADDITION TO REAR OF HOUSE.EXISTING 3 BEDROOM 1 BATH.PROPOSED 3 BEDROOM 2,BATH AND OFFICE
EXISTING USE PROPOSED USE CONSTR.TYPE • $STORIES
RESIDENTIAL RESIDENTIAL VB 1 USE TYPE OCC. $Q.PT. VALUATION($)
BXISI'G NEW FLOOR DEMO TOTAL -
A�1190 AREA429 AREA NETAREA
BATHROOM KITCHEN - OTHER -REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECIQPORCtI ARIA GARAGE AREA: 0 DETACH -
17 ATTACH
V DWELLINO UNITS: IS ASECOND UNIT ❑YES SECOND STORY DYES
1 BEING ADDED? M NO ADDITION? ONO
PEE-APPLICATION OYES IF YES,PROVIDE COPY Or IS TIB;BLDG AN ❑YES 'w = ^r -TOTAL VALUATION: - -
PLANNING APP,9 ❑NO PLANNING APPROVAL LETTER EICHLER HOME? m NO c -
- - 80,000.00
By my signature below,I certify to each of the following: I am the property owner or authorized ag if to act on the property owner's bel alf.:Tltavee kead this
application and the information I have provided i Direct. 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 to buil - g c traction, I authorize representatives of Cupertino to enter the above-identified property,for inspection purposes.
Signature of Applicant/Agent: Date:10-13-16
SUPPLEMENTAL 1NEOItMATION REQUIREDrI. 4.et;'ilrxx"r. : .., atODTIiYGga
_New SFD or Multifamily dwellings: Apply for demolition permit for
existingbllildin s, Demolition do0 OYERTHe6;50N3'I R BU[LDIN_GPLAN REVIEW
gO permit is required prior to Issuance of building
permit for new building. Q iafiitass El•priA.119 3 S�Lnt95iE4n3�v :
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDABIi ''m" PUBLIC WORKS;
form if any Hazardous Materials are being used as part of this project, d i nRCE l7 IJREDEP'"
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. 14IAJOR :+Nrr-ARv sRwt;R x.::•.Ric r
TY.RNvmOiiiif alit taidit . .-
Bldpipp_2O11,doc revised 06/21/11