B-2018-0524 Rev #1 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2018-0524
1167 CRESTLINE DR CUPERTINO,CA 95014-5034(362 29 038) FUTURE VISION
REMODELING INC
VAN NUYS,CA 91406
OWNER'S NAME:ICUO SITYH S AND MANN C TRUSTEE DATE ISSUED:04/18/2018
OWNER'S PHONE: PRONE NO:(800)485-4919
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#991840
Contractor FUTURE VISION REMODELING INC Date 04/30/2020 X BLDG—ELECT—PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REMODEL(2)BATHROOMS-(102 SF);REMODEL OTHER-(440 SF);
I hereby affirm under penalty of perjury one ofthe following two declarations: INSTALL(N)FURNACE IN ATTIC.
t. 1 have and will maintain a certificate of consent to self-ineare for Worker's REV#l-NEW WINDOWS(3)LIKE FOR LIKE TO MEET EGRESS-
Compensation,as provided for by Section 3700 ofthe Labor Code,for the ISSUED 7-9-2018
performance of the work for which this permit is issued.
/ 2. 1 have and will maintain Worker's Compensation Insurance,as in for by
(�— Section 3700 ofthe Labor Code,for the performance ofthe work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$50000.00
APPLICANT CERTIFICATION
I certify that I have read this appllcation 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 36229 038
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 07-9-2018 Issued by:Jasmine Archbold
Date:04/18/2018
OWNER-BUILDER DECLARATION
I hereby affirm that I um 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.Its 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
ompensation,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 Io construct the project(Sce.7044,Business&Professions Code). Date:OZ-2-2.418
I-hereby flinn-mrdr,penal"f-perjury-onevHhe-folluwhtg-three-declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BETTER
u I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 ofthe Labor Code,for the
performance ofthe 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 petformmnce 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
a. I certify that in the performance of the work for which this permit is Issued,I Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
shall not employ n an manner so as to become subject to it" material.Additionally,should I use equipment or devices which emit hazardous
p y any person i y m J air contaminants as defined by the Bay Area Air Quality Management District 1
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 ofthe the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:07-9-2018 `�
I certify that I have read this application and state that the above information is CONSTRUCTION URNDiN(: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 mentionedproperty 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 07-9-2018 professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• buildiiig@cupertino.org PEMIT tB-`a o�y� dSd-'I
CUPERTINO REV s 1 DEP p_
❑NEW CONSTRUCTION [:1 ADDITION ❑ALTERATION_❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECTADDRESS APN1
�1 GYe�LI7 LfI�J � �
OWNERNAME T�qh le` PHONE 43 C� E-MAIL
STREET ADDRESS I CITY,STATE,ZIP
4
❑CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUM ER LICENSE TYPE
STREET ADDR 5eCITY,STATE,ZIP
ys -_
E-MAIL PHONE BUS.LIC
❑ARCHITECT ❑OWNER❑OWNER AGENT ❑CONTRACTOR AGENT(]ENGINEER❑DEVELOPER❑TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIITON f� rr Gre-/
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL [:]COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SP PORCH SF DECK SF DEMO SF STORIES n TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ATTACHED
BATHROOM.SF SF BP SF ❑DETACHED
_10.0 P1" YE,
EICHLER El �ECOND�TORYAU6ITIO� O
FIRE SPRINKLERS❑NO ❑ NO ❑NO
DWELLING ISECONDDWELLING []YES E3ATTACHEDE3DETACHED OTHER
UNITS 0 UNIT ADDITON: []NO S F
T07-11F❑FIBERGLASS ❑VINYL-LWED ❑GUNITE E]PREFABRICATED
POOL-SF SPA-SF SPA ATTACHED❑YES ❑NO TOTAL-SF
RECEIV�ED�B TAL VALUATION:
Cav meeinl or Multi-Familu Buildings with Publie Sroiriunine Pools raguires Deun fnerlajEvr ental Hcat]nr ovnl
900 1zj 0VV
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UPROOF❑ASPHALT SHINGLES❑WOOD SHAKE S❑WOOD SHINGLES TILE OTHER(SPECIFY)
REMOVE/REPLACE NO IF NO PLYWOOD ❑ ❑3/S" PLYWOOD TYPE:
PITCH: ROOF CLASS
YES n OF LAYERS_ THICKNESS❑5/S" OTHER ❑OSB ❑CDX OTHER -•12 A
PROPOSED ROOF TYPE: BUILT-UP ROOF DASPHALT SHINGLES El WOOL)SHAKES❑WOOD SHINGLES El OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF- not 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 laves 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 3017.docrevised08/01/17