B-2017-1094CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1094
11614 OAK SPRING CT CUPERTINO, CA 95014-5140 (366 52 067)
GOLDEN GATE HOME
IMPROVEMENT INC
SAN RAFAEL, CA
94901
OWNER'S NAME: SHARMA MANMOHAN K AND NISHA
DATE ISSUED: 07/10/2017
OWNER'S PHONE: 650-492-9263
PHONE NO: (415) 459-1600
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class $ Lic. #840757
Contractor GOLDEN GATE HOME IMPROVEMENT INC Date 06/30/2018
X BLDG —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:
REPLACE (2100 SF) OF LAP SIDING IN KIND
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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
Sq. Ft Floor Area:
Valuation: $39000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
366 52 067
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 ap licant understa s and will comply with all non -point
source regulatio per the Cupo Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 7/10/2017
Issued by: Jasmine Archbold
Ir
Date: 07/10/2017
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
t. 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: 7/10/2017
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. 1 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
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 Cu rtinoMunicipal ode, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Cade, ections 25505, 3, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agenyAz�_�_�
APPLICANT CERTIFICATION
Date: 7/10/2017
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 7/10/2017
Professional
V-YPERTINO I
NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinga)cupertino.orA
❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS % / ^
✓
APN #
v�
OWNER NAME %�/'1 (1 ,y C I, C�^� �
PH(OON6P) y)- - T -.13
E -MAIL
STREET ADDRESS
(J
CITY,S TE, ZIP O�
FAX
L
`
CONTACT NAME�
•.y `Z � /,?,/)
�l 1 h
I —i-
P `� (6
7 J
�'✓
STREET ADDRESS
CIT STATE, Z
"A
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT YCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANf
CONTRACTOR NAME /' J I
LICENSE NUR
o
LICENSE TYPE
BUS. LIC #
L4 0 Li
COMPANY NAME 0 ^ /�✓S l E-MAIL
f`J �►?l, �G�,�rl�s lei tJ conte
�S S - l cam
STREET ADDRESS rci^ �O CITY, ST E17�
/ !� J
PHONE
� [/ b
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OFWORK
jA
Re
EXISTING USE � f^
1✓/
PROPOSID U$E� � CONSJ'R�TYPE
j`/�
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATIONEXIS($)
(./(
V( 1v
AREATG
NEW FLOOR
DEMO
TOTAL
T AREAS�
W-3
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
DETACH
IGARAGEAREA:
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? WO
ADDITION? M)NO
PRI! -APPLICATION E] YES IF YES, PROVIDE COPY OF
IS THE BLDG AN E] YES
RECEIVED BY:
TOTAL VALUATION:
PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have pr ded is co . I ha'ead the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' ing co ction. uthorize representativ pe mo to enter the above�tified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEM139TAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN 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
11 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
1:1 SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doe revised 06121111
7.12. 16 cat C
Seven Springs Owners Association
Application for Approval of Architectural Change/Addition
CATEGORY C
Category C - Modifications that are exterior modifications with no changes to the original building strucnfre or floor plan. All rooting,
siding, window material change, exterior paint color change, addition of a roof attic fan, or garage door, fall into this category.
Date: 6 _l � Ll_2 , (: Request for Approval of Proposed Change
PLEASE PRINT THE FOLLOWING INFORMATION
Name: 6flMC4 Address: .1�6.LL
IIome Phone: ()$. 25S -6=_ � �W�o"rk Phone: �� �� • ( Z x 2 S
email: 02net C _tel Qcxlt 4ti.l�,• n
Description of Proposed Change:
1) Paint Color Change: Please choose from "approved list" New Exterior Siding Color & Garage door(s) - same color,
Specified body color Moilke i__1 r- Trim color: W/UCZa,�F,rf t door color:
2) Roofing Material Change (please c eck one choice) ' s -S C' _ ` " ce
a. Lightweight Concrete Tile from MonierLifetile - style "Cedarlite 5780", color "Muirwood"
b. GAF Laminated Fiberglass Asphalt - style "Grand Canyon", color "Mission Brown'
c. GAF Laminated Fiberglass Asphalt - style "Grand Canyon', color " "Stonewood"
d. Decra Stone Coated Stec] Rood System- style "Decry Shake", color "Shadow•ood"�
e. Class "A" Fire Retardant Roofing System using pressured treated cedar wood shingles with fire retardant fiberglass cap sheet
underlay. Need to have a City of Cupertino Permit accompanying this application for all wood shingle roofs.
3) Siding Material Change (Please check one choice)
Siding Material: Hardiplank Cedarmill (wood grain finish) t/or IIardiplank Smooth Finish
Which sides are you changing material? (front --back—left _--right
4) Window Material and Design change: (Please check this box): Vinyl Windows - color White _
*Must include manufacture also Include cut sheet for type and style of windows. Retrofit __ New Constr.
5) Adding a Roof Attic Fan , Tubular or Skylight , Satellite Dish
Air Conditioner (location of Condenser),
Please attach information regarding the proposed change Application must include dimension, color of the proposed fan and its
location on the roof. Please include detailed drawings, specifications, and product brochures if available.
Tubular skylight kv to 14" diameter, one roof atticfan up to 26" in width & height – paint to match roof
6) Garage doors:
a. Recessed wood panel, not raised in center same style for windows ("PLAIN" – non decorative)
Style 84 (8 panels across, 64 (6 panels across), 44 (4 panels across). Style , with windows or Style _ no windows
b. Insulated wood, insulated metal wl wood facing or "Carriage House" style 303C windows _ 303 no window,
7) Solar System: Adding solar panels to the roof of home.
(Requires drawing indicating placement of panels and photo for type of panel to be installed)
8) Any additional exterior modification: (please specify)
Homeowner's Signature: _
The request is in compliance with Seven Springs HOA Architectural Guidelines: http://seven-sptings.org/fileslarchitectual-guidelines.pdf
Architectural Control Committee/Bcard: Approved_ Pending
Denied _ Pending J
Architectural Control Committee Board: Signature: ,, '� Date: