B-2017-1570 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1570
22345 CARTA BLANCA ST CUPERTINO,CA 95014-1008(326 13 057) REMODO KITCHENS
&BATHS
CONCORD,CA 94520
•
OWNER'S NAME: CUTLER GREGORY M AND MAI,H DATE ISSUED:09/13/2017
OWNER'S PHONE:408-425-1236 PHONE NO:(408)914-8666
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#955200 •
Contractor REMODO KITCHENS&BATHS Date 05/31/2018 • 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:
• KITCHEN REMODEL-(127 SF)
I hereby affirm under penalty of perjury one of the following two declarations:
i. 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.
y1 I have and will maintain Worker's Compensation Insurance,as provided for by
II, Section 3700 of the Labor Code,for the performance of the work for which this
• permit is issued, Sq.Ft Floor Area: Valuation:$16000.00
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 building construction,and hereby authorize 326 13 057
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.
Signet ' / Date 09-13-2017 Issued by:Kim Dunbar
4:41411111P
Date:09/13/2017
I hereby a that�xempt 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
i. I,as owner of thepproperty,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compenstion,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business'&Professions Code)
2. I,as owner ofj the property,am exclusively contracting with licensed Signature of Applicant:
contractors to;construct the project;(Sec.7044,Business&Professions Code). Date:09-13-2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. 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
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 anymanner 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 becoine 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 agen
APPLICANT CERTIFICATION Date:09-13-2017 kr
I certify that I have read this application and state that the above information is - ' %L_._iffl►L ►D . • E
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that ther. onstruction lending agency for the performance
relating to building contruction,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 09-13-2017
Professional
CONSTRUCTION PERMIT APPLICATION
J� •' COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION'
t1 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
y7.ss.
s (408) 777-3228 • building@cupertino.org PEMIT#B-21 1,-- - 1b
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ['ADDITION ',Iril^��A—LTERATION ❑T.I. ❑MEP
^❑RE-ROOF .❑�SIWIMMIING POOL/SPA '
PROJECT Z ADDRESS S Ca-t-�Cl-- I-�ea44 G0.- J t APN# 3 c --./:)) V GI-
OWNER NAME PHONE(� E-MAIL
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ELZONTRACTOR NAME 0 OWNER-BUILDERCOMPANY NAME LICENSE NUMBER LICENSE TYPE
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STREET ADDRESS CITY,STATE, ZIP
E-MAILjt
esilx- ep ., /o, enl,,,, PHONE
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OWNER ❑OWNER AGENT CIS CONTRACTOR AGENT❑ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NAME /�� �/Q E-MAIL /
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STREET ADDRESS A�y �,� � CITY,STATE,ZIP � PHONE
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•
IkSINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY ❑INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN, REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF )2,7_ SF SF .❑DETACHED
EXISING ❑YESEICHLER 0 YES ', SECOND STORY ADDITION ❑❑YES
' FIRE SPRINKLERS 0 NO ❑ NO •
DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER ,
UNITS# UNIT ADDITON: ID ivo 1 S F
POOLS' ❑FIBERGLASS ❑VINYL-LINED ❑OUNII'E ❑PREFABRICATED
POOL-SF SPA-SF II SPA ATTACHED❑YES 0 NO I TOTAL-SF
RECE D B : TOT2IL VALUATION:
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department.of Environmental Heath approval 16p0-0
RE-ROOF'EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES El WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE ElNO IF NO PLYWOOD 1:11" El3/8" PLYWOOD TYPE: PITCH:
p yEs I #OF LAYERS THICKNESS El 5/8" OTHER El OSB III CDX OTHER :12
ROOF ACLASS
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy . SF #of SQUARES
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 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 building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection purposes. I acknowledge and authorize all information contained on this application form`
to be made available for public record.
Signature of Applicant/Agent: Date: 69- 13-2011-4-
-
SUPPLEMENTAL INFORMATION R ej. ED
*New SFD/Second Dwelling Units!:,, amily e lings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide'a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doe revised 08/01/17
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1570
22345 CARTA BLANCA ST CUPERTINO, CA 95014-1008 (326 l3 057)
REMODO KITCHENS
& BATHS
CONCORD, CA 94520
OWNER'S NAME: CUTLER GREGORY M AND MAI H
DATE ISSUED: 09/13/2017
OWNER'S PHONE:
PHONE NO: (408) 914-8666
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO.
License Class GENERAL BUILDING CONTRACTOR Lic. #955200
Contractor REMODO KITCHENS & BATHS Date 05/31/2018
X BLDG X ELECT —PLUMB
MECH X RESIDENTIAL COMMERCIAL
1 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 - (127 SF)
I hereby affirm under penalty of perjury one of the following hvo declarations:
REV# I - ADD SUB-PANEL (60 AMPS) (LAUNDRY ROOM) ISSUED I-
1. I have and will maintain a certificate of consent to self-insmro for Worker's
22-2018
Compensation, as provided for by Section 3700 of the Labor Code, for the
I— performance of the work for which this permit is issued,
2, f 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 At eft:
Valuation: $16000.00
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
AIN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
326 13 057
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 WORI{ 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
Issued by: Kim Durbinr
Date: 09/13/2017
O R-BUILDERCLXf ATION
1 hereby affirm that 1 am exempt from the Contractor's License Low fur one of the
RE-ROOFS
following two reasons:
All roofs shall be inspected prior to any rooting material being installed. if a roof is
t. I, as owner critic property, or my employees with wages as their sole
installed without fist obtaining an inspection, 1 agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sce.7044, Business & Professions Code)
z. has owner of the property, am exclusively contracting with licensed
Signature of Applicant -
contractors to construct the project (Sce.7044,.Business & Professions Code).
Date: ------ -
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CL?AOREI ER
I 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. 1 have and will maintain Worker's Compensation Insurance, as provided of by
I have rend 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
a. 1 certify that in die performance of the work far which this permit is issued, 1
Health & Safety Code, Section 25532(a) should 1 store or handle hazardous
shall not employ any person in any manner so as to became subject to tine
material. Additionally, should I use equipment or devices which emit hazardous
tilt 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 said
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, 1 must forthwith comply with such provisions or this permit shalt
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date:
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 agalnst 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 DECLARXHON
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
SignatureDate
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION Nome
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 EDIs _
(408) 777-3228 • building@cupertino.org PEMITXB- _ ISS
CUPERTINO REV DEF DEF k_
F-1 NEW CONSTRUCTION I (ADDITION n AT TR.RATInN n T i',I.7I'ARFP IRF.Rnni; I7.SWTMMING Pnni./SPA
PROJECTADDRESS
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OWNER NAME PHONEE
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CONTRACTORNAME ❑OWNER -BUILDER COMPANYNAME
LICENSE NUMBER
LICENSE TYPE
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❑ARCHITECT WWNER El OWNER AGENT ❑ CONTRACTOR AGENT ❑ ENGINEER ❑DEVELOPER El TENANT
CONTACT NAME
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STREET ADDRESS
CTIY, STATE, ZIP
PHONE
DESCRIPTON
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❑SINGLE-FAMILY/DUPLEX ❑MULTI -FAMILY ❑INDUSTRIAL ❑COMMERCIAL
USE
TYPE
OCC
'SQ.FT.
VALUATION ($)
EXISPINGUSE
EXISTINGSF
NEWFLOORSF
PORCHSF
DECK IF
DEMOSF
STORIESk
TOTAL NET SF
REMODEL
REMODEL KHCHEN
REMODELOTHR
GARAGE ATTACHED
BATHROOM IF
IF
SF
IF ❑ DETACHED
EXISING ❑ YES
EICHLER ❑ YES SECOND
STORY .ADDITION
NO
[:]FIRESPRINKLERS NO
ONO
DWELLING
SECONDDWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNITS
UNITADDITUN: El NO SF
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL -SF SPA-SFSPAATTACHED ❑YES ❑ NO TOTAL -SF
Cornme nu! o � MuRi-Po rilv.Bwildines with Public Smm''r r Poois 'en r' es Drnn 4 nrf of Enr''m ver Fnl H ntl ...... - 7
RECEl Y: /
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TOTAL VALUATION:
RE -ROOT EXISTING POOP TYPE: [:1 BUILT-UP ROOF EJ ASPHALT SHINGLES❑WOOD SHAKES❑WOOD EHINGLES❑TILE 'OTHER (SPECIFY)
REMOVE/REPLACE❑NO
FEND
PLYWOOD [:]'A;' ❑3/B"
PLYWOOD TYPE:
PTTCH:
ROOF CLASS
[-]YES
POFLAYERS
THICKNESS❑5/S" OTHER_
❑OSB ❑CDX OTHER
—.12
A
PROPOSED ROOF TYPE:❑BTIILT-UP ROOF DASPHALT SHINGLES El WOOD SHAKES []WOOD SHINGLES ❑OTHER
*Provide a signed copy of the Cupertino's Tear -Off Policy SF :d SQUARES
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 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 building construction. I authorize representatives of Cupertino to
enter the above -identified property for inspection purposes. I acknowledge and authorize all information contained on this application form
to be made available for pub '
Signature of Applicant/Agen : - Date: e9`"- 2
SUPPLEMENTAL INFOR N REQUIRED
*News SFD/Second Dw e Units/Multifam' flings;-A.Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a co ed Hazardous Materials Disclosure farm if any Hazardous Materials are being used as part of this project.
`Copy of Planning Approval Letter or Meeting With Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08101117