B-2018-0106CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2018-0106
10301 S BLANEY AVE CUPERTINO, CA 95014-3120 (369 32 013)
ANTHONY HODDER
CONST
CUPERTINO, CA 95014
OWNER'S NAME: HAGGARD PAUL ET AL
DATE ISSUED: 01/17/2018
OWNER'S PHONE: 415-497-5881
PHONE NO: (408) 499-5990
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 5 Lic. #446573
Contractor ANTHONY HODDER CONST 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 WINDOW (9) SLIDERS (2) (LIKE FOR LIKE)
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
C mpensation, as provided for by Section 3700 of the Labor Code, for the
ormance of the work for which this permit is issued.
I ave and will toWorker's Compensation Inas provided for by
Section 3700 of the Labor C.for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $10000.00
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
369 32 013
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 sale ity in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understan s and will comply w all non -point
source regulations per the Cuperti Municipal Cod Se ion .1
180 DAYS FROM LAST CALLED INSPECTION.
Signature 1
Issued by: Kim Dunbar
OWNER -BUILDER DECLARATION
Date: 01/17/2018
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. 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 (Scc.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: 01-17-2018
1 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. 1 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. 1 certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equ' m nt or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the B Ar Air Quality Management ist ct I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the per no Mu Code, Chapt 9. an
exemption, l become subject to the Worker's Compensation provisions of the
the Health & Safety Cod , Sec ns 550 , 533, and 255
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 01-17-2018
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 Date 01-17-2018
Professional
M
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION B'
r
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building@cupertino.org PEMIT #B - Ql b OlD ALJ
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWMMNC; POOL/SPA
PROJECT ADDRESS 2 , / 9 / T /! V
IN 0 / /� 3 /
OWNER NAME IPHOt
f 5 1 /� 7 —� S�A �
�J
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
❑ CONTRACTOR N WNER-BUILDER COMPANY
NAME
��� �-
LICENSE NUMBER LICENSE
c�s� � sfi3
TYPE
f�
TREETA RE�
CITY, STATE, ZIP �)
E — PHONE d- - �� 7 —S� BUS. LIC A
`f�K (/v% (�V B Y CQ/ Wwl
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT[] ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP PHONE
DESCRIITON —f Z
jDSINGLE-FAMILY/DUPLEX ❑MULTI -FAMILY ❑ INDUSTRIAL []COMMERCIAL
USE
TYPE
OCC
'SQ.FT.
VALUATION (�)
EXISTING USE
EXISTING SF
NEW FLOOR SF
PORCH
SF I DECK SF
I DEMO SF
I STORIES A
TOTAL NET SF
REMODEL
BATHROOM SF
REMODEL KITCHEN I
SF
REMODEL OTHR GARAGE
SF SF
❑ ATTACHED
❑ DETACHED
EXLSING ❑ YES
FIRE SPRINKLERS ❑ NO
EICHLER ❑ YES
❑ NO
SECOND STORY ADDITION NO
DWELLING SECOND DWELLING []-,ES ❑ ATTACHED ❑ DETACHED OTHER
UNITS A UNIT ADDITON: ❑ NO S F
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
RECEIAL
V�iLUATION:
D l
POOL -SF SPA - SF SPA ATTACHED [J YES ❑ NO TOTAL -SF
Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath rtrMro:wl
RE -R 0 OF
EXISTING ROOF TYPE: ❑ BUILT -UT ROOF ❑ ASPHALT SHII�TGLES ❑ WOOD SHAKES ❑
WOOD SHINGLES ❑TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
❑ 1 -ES
I IF NO
A OF LAYERS
PLYWOOD ❑ lh" ❑ 3/8"
THICKNESS ❑ 5/8" OTHER
PLYWOOD TYPE:
❑OSB ❑ CDX OTHER
PITCH:
.12
ROOF CLASS
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 info on 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 or 4hces an state laws rel g uilding construction. I authorize representatives of Cupertino to
enter the above identified property f r ' ��paetfo—r poses. I o 1 d e and authorize all informatio contained on this application form
to be made available for public rec d.
Signature of Applicant/Agent: Date: ( t�
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