B-2017-0499CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0499
10460 SERRA ST CUPERTINO, CA 95014-6581 (342 59 012)
REMODELWEST
CONSTRUCTION INC
SARATOGA, CA 95070
OWNER'S NAME: STEVENS TIMOTHY J TRUSTEE & ET AL
DATE ISSUED: 04/14/2017
OWNER'S PHONE: 415-215-0230
PHONE NO: (408) 2574900
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lic. #680463
Contractor REMODELWEST CONSTRUCTION INC Date 11/30/2017
X BLDG _ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X 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:
REMODEL KITCHEN (274 SF); REMODEL (3) SECOND FLOOR
I hereby affirm under penalty of perjury one of the following two declarations:
BATHROOMS (230 SF); OTHER REMODEL (LIV RM, FAM RM,
m. 1 have and will maintain a certificate of consent to self -insure for Worker's
DINING, LAUNDRY, CLOSET) (812 SF); REPLACE WINDOWS (34) &
Compensation, as provided for by Section 3700 of the Labor Code, for the
(2) SLIDING DOORS LIKE FOR LIKE TO MEET EGRESS.
'performance of the work for which this permit is issued.
jI have and will maintain Worker's Compensation Insurance, as provided for by
'
c (J� Section 3700 of the Labor Code, for the performance of the work for which this
permiris issued.
Sq. Ft Floor Area:
Valuation: $328456.00
APPLICANT CERTIFICATION
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
342 59 012
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.
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 4/14/2017
Issued by: Abby Aygnde
OWNER-BUIL DER DECL•A_RATION
Date: 04/14/2017
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
m. 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 ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 4/14/2017
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A'! OR BETTER
m. 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
s. 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
air contaminants as defined by the Bay Area Air Quality Management District I
Worker'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, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 4/14/2017
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.
1 understand my plans shall be used as public records.
Licensed
Signature Date 4/14/2017
g
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
1.0300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - fAX (408) 777-3333
El NEW CONSTRL)ift[bN El ADDITION
9ALTERATION /T1 0 RFVISION/DL-'I-'L-RRLD ORIGINAL PERMIT H
PROJEC ' r ADDRESS _7A1'N9 342-59-012
10460.Serra Street Cupertino, Ga. o95014
ThAN)Ttevens and Leigh E Stevens
PHONE
E-MAIL
Umstevens25@yahoo.com
STREET ADDRESS
10460 Serra -Street-
CITY, STATE. 7..I
Cup ino, GA 95014
FAX
""Z'il MN'M'
Debbie in rik
PHONE
408-2574900
F- Ana";
ST�%Rfflg'
ffi r, , Sunnyvale Rd
CITY, STATE, ZIP
Saratoga,.CA 9.50070
RAX
1
ri OwNEp n OWNER-BUILDLR 13 OWNER AGENT 1CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT ENGINEER 11 DEVELOPER ❑ TENANT
001&AMC T
Ja RR NAME
Feld.
E
6gUMB R
LICENSE TYPE
BI 04t
4543511210
COMPANY NAME
,RemodelWest Construction Inc.
F. -MAIL
breid@remodelwest.com
FAX
STREE'I I ADDRESS
12333 Saratoga Sunnyvale Road
C rI Y; STATE ZIP
Saratoga, Ca. 95070
NNE -257-4900
ARCJIITECT,'rNGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-NIAIL
FAX
STREET ADDRESS
CrI`Y. STATE. ZIP
PHONE
DESCRInJO"FWORK__
I)Remodel Kitchen 2) Remodel Master Bathroom 3)Remodel Laundry Room 4) Replacement Windows 5)New Interior Doors 6) New fireplace inserts
EXISTING USE
R3 -SFR
PROPOSED USE CONSTR
R3, -SFR
TYPE
VB
4 STORIES
2
USE
TYPE
OCC.
SQ.Fr.
VALUATION (S)
FMSTGNEWFLOOR
AREA 3838
AREA
DEMO
I AREA
TOTAL
NET AREA 3B38
BATHROOM
KITCHEN
OTHER
REMODEL AREA-
Sf
RENIQff�A
SI
I I
I
RF*_14OD9_fr St
170
PORCH AREA.
DECK AREA TOTAL DEWTORCH ARE
: GARAGE AREA: ACH
1
786 sf TTACH
.. .. ..........
DIVELEN-buNITS:
ISA SECOND UNIT
SECOND STORY
1
BEING ADDED? O
ADDITION?
PRE -APPLICATION ]V:IS F YES, PROVIDE COPY OF
ISTHEBLDGAN 171
RE ED PY: TOTAL VALUATION'
PLANNING APPLI 4 .0 PLANNING APPROVAL LETTER
EICHLERHOME? 'o
� *`%
42et ed
By my signature below, I certify to each of the following- I am the property owner or authorized agent to act on the proper ht-_,�-If. I 116ve read this
application and the, information I have provided is correct. I have read time Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-idehtified property for inspection purposes.
Signature ofApplicant/A nt: Date: 312811 7
SUPPLEMLINTAL INFORMATION REQUIRED
PLAN CH ECK'fYPE
ROUTING SLIP
F1 OVER -THE- . COWNITER
0 BUILDING PLAN-REVIFNV
New SrD or Multifamily dvvellings:Apply for demolition permit for
e-_,istingbuildlng(s), Demolition permit is required prior to issuance of building
permit for new building.
I—XPRESS,
PLANNING PLAN REVIEW
Commemial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Material I s are being used as part of this project.
171 STANDARD
13 LARGE
171 PuBlievvoiil
11 F'IRf DEPT
Copy of Planning App roval Letter or Meeting with Planning prior to.
submittal of Building Permit application,
n MAJOR
171 1 SANITARYSLI-WR DISTRICT
13 ENVIROINNIENTAL)IF-AL'1711
131dgz1pp_2011.doc revised 00,21111