B-2018-0060CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0060
1185 YORKSHIRE CT CUPERTINO, CA 950144967 (362 11 006)
DIRECT HOME
REMODELING
1721 ROGERS AVE
SAN JOSE, CA 95112
OWNER'S NAME: PHILLIPS BRIAN G AND SYLVIA M TRUSTEE
DATE ISSUED: 01/09/2018
OWNER'S PHONE: 408-257-2345
PHONE NO: (885) 388-6695
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. #
Contractor DIRECT HOME REMODELING Date
X BLDG —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:
REPLACE WINDOWS (16) SLIDING DOORS (4) - LIKE FOR LIKE TO
1 hereby affirm under penalty of perjury one of the following two declarations:
MEET EGRESS
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: $14000.00
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
362
36211 006
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 01/09/2018
Issued by: Kim Dunbar
OWN I DER DECLARATION
Date: 01 /09/2018
.R-B
1 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. 1, 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: 01/09/2018
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
L 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, 1
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, l must forthwith comply with such provisions or this permit shall
_
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 01/09/2018
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 01/09/2018
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
1 11 •" i "IL • ' 1
(408) 777-3228 • building@cupertino.org
CUPERTINO I REVS DEF#
❑ NEW CONSTRUCTION ❑ ADDITION E9 ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS I IAPN
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STREET ADDRESS
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CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER LICENSE
TYPE
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STREET ADDRESS
CITY, STATE, ZIP
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❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT 07coNTRAcroR AGENT [I ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
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STREET DDRESS
CM, STATE, ZIP PHON
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DESCRIPTD
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(INGLE-FAMILY/DUPLEX
❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXISTING SF
NEW FLOOR SFJ
PORCH
SF I DECK SF
I DEMO SF
I STORIES t JTOTALNETSF
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
1
EXISING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION
FIRE SPRINKLERS 11 NO
❑ NO
ONO
DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS t UNIT ADDHON: ❑ NO S F
I
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED YES ❑ NO I TOTAL - SF
RECEIVED
TOTAL VALUATION:
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department o(Environmental Heath approval
1 141
RE -ROOF
EXISTING ROOF TYPE: F] BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD S GLES ❑TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD ❑'h„ ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOF CLASS
❑ YES
# OF LAYERS
THICKNESS ❑ 5/8" OTHER
[-]OSB ❑ CDX OTHER
• 12
A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ 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 aclmowledge and authorize all information contained on this application form
to be made available for public record. �—
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Units/Multifamily Dwellings: 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.doc revised 08/01/17