B-2018-0042CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0042
1190 CRESTLINE DR CUPERTINO, CA 95014-5035 (362 24 037)
S & S TILE INC
SAN JOSE, CA 95120
OWNER'S NAME: RILLING KENNETH F AND CAMPBELL STACEY TRUST
DATE ISSUED: 01/05/2018
OWNER'S PHONE: 408-688-1653
PHONE NO: (408) 293-6004
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class S Lic. #546084
Contractor S & S TILE INC Date 11/30/2018
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:
REMOVE AND REPLACE (2) SINKS, (1) SHOWER, (1) TUB.
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
performance of the work for which this permit is issued.
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
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
362 24 037
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
Additional , e applicant understands a will comply with all non-point
source u tions per the Cu ertino M nicip I Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 1.5.18
Issued by: Abby&undc
Date: 01/05/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
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)
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: 1.5_18
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
z. 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 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 witht ertino Municipal Code, hapt r 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety d , ctions 25505, 533, an 255
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 1.5.18
1 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 Dated 5.11
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building@cupertino.orQ PEMIT #B - d G - &moi K
CUPERTINO I REV # DEF #
❑ NEW CONSTRUCTION ❑ ADDITION fxI ALTERATION ❑ T.I. 19MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
1
APN #
1190 Crestline Drive
362-24-037
OWNER NAME PHONE
E-MAIL
Ken and StaceV Campbell 408-688-1653
mirs3@sbeglobal.net
STREET ADDRESS
CITY, STATE, ZIP
I
1190 Crestline Drive
Cupertino, CA
❑>< CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY
NAME
LICENSE NUMBER LICENSE
TYPE
Steven H. Stuck S
& S Tile, Inc.
546064 B/C36/C54
STREET ADDRESS _—JCITY,
STATE, ZIP
7167 Echo Ridge Drive
San Jose, CA 95120
E-MAIL
PHONE
BUS. LIC #
sandstileinc@sbcglobal.net
408-293-6004
34092
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT[] ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
Steven Stuck
sandstileinc@sbcglobal.net
STREET ADDRESS
CITY, STATE, ZIP PHONE
7167 Echo Ridge Drive
San lose, CA 95120 408-592-8504
DESCRIPTON
Chanize out the tile and plumbinz fixtures in the master and hall bathrooms.
a
❑x SINGLE-FAMILY/DUPLEX ❑ MULTT-FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
I EXISTING SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SE
REMODEL
REMODEL KITCHEN
REMODEL OTHR
GARAGE ❑ ATTACHED
BATHROOM SF
SF
SF
SF ❑ DETACHED
LLNG YES
EICHLER YES
SECOND STORY ADDITION YES
ONO
FIRE SPRINKLERS ❑ NO
❑❑ NO
DWELLING []YES ❑ ATTACHED❑ DETACHED OTHER
ISECONDE)WELLING
UNITS # UNITADDITON: ❑ NO SF
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF SPA ATTACHED 0 YES ❑ NO TOTAL - SF
RECEIVED BY:
TQ14L VALUATTON:
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath amproval
d<__CD
RE -ROOF
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES[] WOOD SHAKES ❑
WOOD SHINGLES ❑ TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IF NO
PLYWOOD ❑'h" ❑ 3/8" PLYWOOD
TYPE:
PITCH:
ROOF C_:NSS
❑ YES
I # 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 theformation I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable 1 a rdinances and ptalte laws relating to building construction. I authorize representatives of Cupertino to
enter the above -identified pro r for mspectio p ose a owledge and authorize all information contained on this application form
to be made available for public d.
`
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 08/01117