B-2017-0463CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0463
19841 LA MAR DR CUPERTINO, CA 95014-3310 (369 10 03 1)
STEVE B DUFFY
CONSTRUCTION
TRUCKEE, CA 96161
OWNER'S NAME: RANNEY DAVID F AND SUZANNE M TRUSTEE
DATE ISSUED: 03/22/2017
OWNER'S PHONE: 408-828-4557
PHONE NO: (530) 575-8066
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lic. #751382
Contractor STEVE B DUFFY CONSTRUCTION Date 07/31/2018
X BLDG X 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:
KITCHEN REMODEL (190 SF); 1ST FLOOR REPLACE (1) WINDOW
I hereby affirm under penalty of perjury one of the following two declarations:
LIKE FOR LIKE TO MEET EGRESS
1. I have and will maintain a certificate of consent to self -insure for Worker's
REV #1 - UPGRADE PANEL (200 AMPS) - SAME LOCATION - ISSUED
Compensation, as provided for by Section 3700 of the Labor Code, for the
5-10-2017
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
Sq. Ft Floor Area:
Valuation: $0.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
369 10 031
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 05/10/2017
Issued by: Kim Dunbar
OWNER DECLARATION
Date: 03/22/2017
-BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
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)
z. 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: 05/10/2017
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 Municipal Code, Chapter 9.12 and the
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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
QWorker's Compensation laws of California. If, after making this certificate of
��!!
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Secti ns 25505, 2553, nd 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 05/10/2017
I certify that I have read this application and state that the above information is
N NDNGA NCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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 9.1
1 understand my plans shall be used as public records.
Licensed
Signature Date 05/10/2017
Professional
CUPERTINO
CONSTRUCTION PERMIT APPLI10N #
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.or4
❑ NEW CONSTRUCTION ❑ ADDITION
❑ ALTERATION / TI [_1 REVISION / DEFERRE)� ORIGINAL PE PERMIT
PROJECT ADDRESS
i�
APN #
3 Gq ^ (0-061 O —0 2 1 ` lJJ
OWNER NAME
'
PHONE _
4c) L6 `6 4t> S �
E-MAIL
tJ e. 4 vV1 ki
-
'
STREET ADDRESSCITY,
STATE, ZIP
FAX
v�
E eY ;u � �S'� i c}
CONTACT NAME
PHONS
J`S11 ,�
E IL I
vt
O
C
510 �{VI GLi ✓�)
STREET ADDRESS !
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CITY, SS.ATE,`7IP
FAX
J
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 4 -CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR
LI SE NUMBER
LICENS TYPE
BUS. LIC #
COMPANY NAME
E -MAB.
FAX
LY
STREET ADDRESS 1 ,/ YJ
' I
CITY, �A 7,I� / /
(C'
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL r. -r ., .
FAX
STREET ADDRESS
/
CITY, STATE, zIP
PHONE
DESCRIPTION OF WORK (L)CCL V1
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? 4EZNO
ADDITION? (g NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES<
TOTAL VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
Em
By my signature below, I certify to each of the following: I am the property owner or authorized agent to t on property owner's behalf. I have read this
application and the information I have provided is correct. 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 build' cons ction. I prize epresentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT ORMATI N kEQUIRED
PLANCHECKTYPE
ROUTING SLIP,
',ovER-THE-COUNTER
❑ BV"ING AN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for❑
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS'
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
El 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
B1dgApp_2011.doc revised 06/21111
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0463
19841 LA MAR DR_ CUPERTINO, CA 95014-3310 (369 10 03 1) STEVE B DUFFY
CONSTRUCTION
TRUCKEE, CA 96161
OWNER'S NAME: RANNEY DAVID F AND SUZANNE M TRUSTEE
OWNER'S PHONE: 408-838-4557
LICENCED CONTRACTOR'S DECLARATION
ATION
License Class ¢ Lic. #751382
Contractor STEVE B DUFFY CONSTRUCTION Date 07/31/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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
X performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
f Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (ve) 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 03-22-2017
OWNER -B DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
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)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
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
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.
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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
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 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, 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 03-22-2017
ISSUED: 03/2212017
PHONE NO: (530) 575-8066
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
KITCHEN REMODEL (190 SF); 1ST FLOOR REPLACE (1) WINDOW
LIKE FOR LIKE TO MEET EGRESS
Sq. Ft Floor Area: I Valuation: $0.00
APN Number: Occupancy Type:
369 10 031
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Kim Dunbar
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.
Signature ofApplicant:
Date: 03-22-2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code,. . 25505, 25533, and 25534.
,/ J
Owner or authorized agent:'
Date: 03-22-2017
N TR_N LEX136P'�G'AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO � (408) 777-3228 •FAX (408) 777-3333 • building(a�cupertino.ora ��-)A i
C—LIP❑ NEW CONSTRUCTION ❑ADDITION n ALTERATT(7N / TT n RFvr�ml�I i nFFPP PT) nurr.IMeI TWDAMT 41
PROJECT ADDRESS 19841 LaMar Drive
APN# 369-10-031
OWNERNAME
Sue & Dave Ranne
Fag?;, 522 45 EMAIL srannev2@,yahoo.com
STREET ADDRESS 19841 La Mar Drive
CITY, STATE, ZIP
Cu ertino CA 95014
FAX
T
CONTACT NAME Daryl V. Harris
PHONE 530 268-3055
1 '.mA`rhasspc@,sbcglobal net
STREET ADDRESS 2286/ Sunset Ridge Drive
CITY, STATE, ZIPAuburn,CA 95602
FAx530 268-2027
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT N ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE
LICEN E TYPE
BUS. LIC #
COMPA G ,
N
-
EdUr4"Q'5iA00 COV4
FAX
STREET ADDRESS/k I �y ,
-t
STA
C��CZIP
PHONE.7S
' 00(046P930
ARCHITECT/ENGINEER NAMED a 1 V. Harris
LICENSE NUMBERL�\
BUS. LIC #5
COMPANYNAME RH Associates A
E-MAILrchitects E-rhassoc sbc lobal.net
FAX (530)268-2027
STREET ADDRESS 22867 Sunset Rid e Drive
g
CITY, STATE' ZIP
AuburnCA 95602
PHONE
(530)268-3055
DESCRIPTION OF wo' A kitchen remodel of an existing single story w/ attached garage. We will also
- , be replacing/relocating (2) kitchen windows, remove the walk -in -closet window,
and re-traming bedroom -4 -,.-'-window to meet egress.
EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG 1 775
`�'
NEW FLOOR
AREA 0
DEMO TOTAL
AREA 23 NETAREA2 135
'
BATHROOM
KITCHEN
OTHER
REMODEL AREA®
RFMODEL AREAr '1 it'7
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA ODETACH
183
183
360 ATTACH
#DWELLINGUNITS:
ISASECOND UNIT []YES
SECOND STORY ❑YES
I
BEINGADDED? RNO
ADDITION? [ANO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
VED
TOTAL VALUATION:
PLANNING APPL # 1RNO PLANNING APPROVAL LETTER
EICHLER HOME? MNO
C G%
r
By my signature below, I certify to each of the following: I am the property owner or authorizeft agent to act on the property owner's behalf I have read this
application and the information I have prow' ed is correct. I have r the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bui n constructi ..I an werepresentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Ag - ` D
SUPPL NT O TION Tt�UIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multi pings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
171STANDARD
11 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.
❑ ENVntONMENTALHEALTH