12080134 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 21860TERRACEDR CONTRACTOR:BAY AREA CUSTOM P ERMITNO: 12080134
BUILDERS INC
OWNER'SNAME: HAGHIGHIFARZADANDVERONIQUE'rRUS'r 1002SDRANZA\ BLVDSITAI DATE ISSUED:081130012
OWNER'S PHONE: 4082069944 SANJOSE.CA 95129 PHONE NO:(408)446-1200
❑ LICENSED CONTRACFOrR�'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class_ Lie.k 2[36 r r r
T DIECiI RESIDENTIAL COMMERCIAL
Contractor � Date �A— \ 5—k
—1
M� ffi
2
herearm that 1 am licensed under thr precisions of Chapter 9
JOB DESCRIPTION: KITCHEN REMODEL(160SQFT)-NO
(commencing with Section 7000)of Division 3 of the Business S Professions PLUMBING;DEDICATED
Code and that niv license is in full force and effect. LINES FOR EACH APPLIANCES
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenificale of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of die 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 die work for which this
permit is issued. Sq. Ft Floor Arca: Valuation:$15000
A PPLICAN'TCERTI FICAT'ION
I certify that 1 have read this application mid state that the above information is AIhN Number.35625001.00 OccupancyType:
ype:
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize 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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicmn understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all not-point sour rcgtikuicvh�thc Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. .`f/ G
1
Signature Date D,Z-- �3 2 Issued by: ✓�� y&l�y Date: 4
❑ OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Lao for one of RF:ROOFS:
the following too reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business fi Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business R Professions Code).
hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BE ITER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of die Labor Code,for the
perf'oruance of the work for which this permit is issued I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Ileallh S Safely Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for theerformance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health S
P Surety Cade.Section 25532(x)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued I shall contaminants as defined by the Bay Area Air Quality Management District 1 will
not employ any person in any'manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,1 Health S Safety Code,Sections 2.5.505,25533.and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must Ossxuthorr'i� d hri' `
forthwith comply with such provisions or this permit shall be deemed revoked
A I'll LICA\NI'CERT]FICATION CONSTRUCTION LENDING AGISNCY
I certify that I have read this applicationand state than the above information is
correct.I agree to comply with all city and county ordinances mid state laws relating I hereby affmn that there is a consmmetion lending agency for the performance of mark's
to building construction,and hereby authorize representatives of this city to enter Ivor which this permit is issued(Sec.3097,Cie C.)
upon die above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnik.and keep harniless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulmions per the Cupertino Municipal Code,Sectio ARCHITT'(71"S DISCLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Doc
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21860 Terrace Drive DATE: 08/13/2012 REVIEWED BY: Sean
APN; 13P#; 'V.U,UATION: $15,000
*PERMITTYPE: Building Permit PLAN ClIECK TYPE: Alteration / Repair
PRIMARY PENTAMAL'1'ION 1R3SFDREM
USE: SFD or Duplex PERbll1'Tl'PE: i
NVORK Kitchen Remodel 160 s ft
SCOPE
tblech. Ilion Check Plumb. Plan Check Fie,- Plan Check
Mech. Permit
're
Plumb. Permit Fee: rbc. Pern it Fee:
Other A1ech.lncp. Other Plumb Incp. Other Elec.lnvp.
Medi.Insp.Few: Plumb. hap. ree: Elec.Insp.Fee:
NOTE: This ectitnate does not include fees(lite to other Deparunentx(i.e. Planning, Public II'orke, Fire,Sanitary Serer District,School
District,etc.). These feev are ha.ved on the Prelintinan information available and are onh,an estimate. Contact the Dept for audit'I info.
FEE ITEMS (ree Resohuion 11-053 E0: 7/1/112 FEE QTY/FEE MISC ITEMS
s.f. Remodel, Kitchen (<=300 soPlan Check Fee: $0.00 160
Supp!. PC Fee: Q Reg. Q OT 0.0 firs $0.00 $600.00 IRFMRESKIT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. ]asp. Fee0 Reg. Q OT 0,0 firs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conswuction Tux:
Administrative Fee: O
Work Without Permit? 0 Yes Q No $0.00 E)
II Advanced Planning Fee: $0.00 Select a Non-Residential G
Travel Documentation Fees: Building or Structure Q
Strong Motion Fee: IBSEISMICR $1.50 Select an Administrative ]tem
131d,, Std s Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $2.50 $600.00 TOTAL FEE: $602.50
Revised: 0710112012
RECEIVED
SCOPE OF WORK: Kitchen remodel. AUG 13 2012
R
Project shall comply with the 2010 California Building (Base code 2009 IBC), 2010v.Residenbal_(2009
IRC), Plumbing (2009 UPC), Mechanical (2009 UMC), Electrical (2008 NEC), Fire (2009 IFC)and Energy
Codes (2008 Building Energy Efficiency Standards)
Energy code mandatory lighting measures:
1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy
luminaires. (150(k)(7))
2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of the
wattage of permanently installed lighting in kitchens may be in lights that are not high efficacy.
(150(k)(8))
Plumbing plan notes:
3. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed
2.2 gallons per minute. (CPC 402.1.2)
Electrical Plan Notes:
4. The installation of smoke alarms in all of the following areas shall be provided: (R314.3)
a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of
bedrooms.
b. In each room used for sleeping purposes.
5. The installation of carbon monoxide alarms in the following areas shall be provided: (R315.1)
a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping
area in the immediate vicinity of the bedrooms and on every level including basements in
dwelling units that have fuel-fired appliances or attached garages.
6. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle
outlets in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1))
7. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing
machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units,
built-in heaters or any other fixed appliance with a motor of 1/4 h.p. or larger shall be on a separate
20 amp. branch circuit.
8. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished
basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar
sinks (within 6 feet of the edge of the sink), shall have ground-fault circuit interrupter(GFCI)
protection. (CEC 210.8)
9. In all areas specified in 210.52, all 125-volt, 15-and 20-ampere receptacles shall be listed
tamper-resistant receptacles. (CEC 406.11)
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. It Is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions of any""city Ordinance or State Law.
BY-
DATE
Y-DATE
PERMIT NO.
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 MEMO
CUPERTINO (408) 777-3228• FAX (408) 777-3333• building(Dcupertino.Grg
❑ NEW CONSTRUCTION ❑ ADDITION •ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT
PROJECT ADDRESS AG� APNI
OWNER NAME t r PHO, E-MAIL l/V
e Ko P1 I' (�Ogpq,.
STREETADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREETADDRESS CITY,STATF, ZIP FAX
❑ OWNER O OWNER-BIJUDER O OWNERAGENT ,CONTRACTOR OCONTRACrORAGEXT O ARCHITECT O ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME L'Pit 4 Q O') LICENSE NUMBER LICENSETYPE BUS.LICK
v
COMPANYNAME E-MAIL FAX
�120'xCrn
STRE DRESS CITY,STATE,ZIP C r Pf ONE 7
n DSA z 11r� « � �s c ME 2dti -a 8
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC 8
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF
he I I L�C o
VM �fN
EX6TING SE PROPOS�-D USE CONSTR TYPE k STORIES
�y /�-t� y . /:�. USE TYPE OCC. SQ.F7. VALUATION(S)
EXISTG NEW FLOO✓R! // DEMO V //TOTAL �TGf(�nf `V
AREA AREA AREA NET AREA EM EL \/O%R r-3 6�
BATHROOM MCHEN OTHER
REMODEL AREA REMODEL AREA //_D RE.SIODEL AREA
PORCH AREA DECK AREA TOTAL DECKNORCH AR[A GARAGE AREA: LJ DETACH
ATTACH
N DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY OYES
BEINGADDED? ONO ADDITION? ONO
PRE-APPLICATION OYES IF YES,PROVIDE COPY OF IS Tilt:BLDG AN DYES •RECEIVED BY'., -- TOTAL VALUATION:
PLANNINGAPPLM ONO PLANNING APPROVAL LETTER F-ICHLERHOME? ONO - / 1 6G
..�i _./.V. . \ Gds
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 1 have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply With all applicable local
ordinances and state laws relating to bu*Idin —17– auT ori representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: D� ^ �� --�
SUPPLEMENTAL INFONREQUI RED PLAYCIIECKlYPl, _ - 'ROUTING SLIP .
New SPD or Multifamily dwellings: Apply for demolition permit for ovf:R=ridxcoun rFR nuu.DrNc rLAN Rt:alt:e•.
existing building(s). Demolition permit is required prior to issuance of building -
permit for new building. ;❑"ENFREss Ela'Iau:rSc vI:AN:REttietF.
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 sr,n,nAkW ❑-PUBLICiVORKS
form if any Hazardous Materials are being used as part of this project. R
❑ J:ARct: ❑ FIREDEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to '.,.❑' M,uoR I ❑ &M'ITARYSF,N'ER DISTRIcr
Submittal of Building Permit application. -
❑ ENVIRONMENTAL HEALTH,-
BldgApp_101 Ldoc revised 06121111