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12100054CITY 01, CUPE.RTINO BUILDING PERMIT BDD,DINGADUmtss: 21613 LA PLAYA CT COINTRACfOR:T_BV_ T1D_ E peRwTNO: 12100054 Dk�Fi It GT(iCrL- D� OW.Nrit'S S,WIE: LUBBEN RICHARD T AND GALE L DA'rh: ISSfxi): 10/09/2013 OWNER'S PHONE: 1'1I ONE NO: ❑ LICESSED CONTRACT( R'S DECLAILV1'ION r r r . l Ill II LD INC P11 11 f UNFO: BLDG F.LF.Cr PLUMB Lit. q ,6 License Class./\\ r r r / q Contractor �!P_J C(. 6 C*kFDare � / MF.CII RF.SIDr?VITAL COMMERCIAL _ I beech}' arffarn that 1 :un licensed under rhe primsions of Chapter 9 .101{ DESCIt11''HON: KI'rCII1i,NRI?MODIi1.120SQIT-M.13A-1'lia0SQ1'I' (cum nencing with Section 7000) of Ilirision 3 of the Ilminess \ Professions Code and that any license is in full force ;,all eKret. I hereby affirm trader pen:dn' of perjury one of the following lien declarations: I hays and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 or the labor Code, for the Sq. 14 Floor Area: Valuation: S40000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for h%' Section 3700 of the Labor Code, for the perror lance of the work for which this permit is issued. APS Number: 35623009.00 Occupancy Type: APPLICANT Cli RTIFICATION I certify that l have read this. application and sine that the above information is PERIIIIT EXPIRES IF WORK IS NO.1'SI'ARTI?D correct. Iagrec to complywith all city and county ordinances and state lams relating �yl•I'IIII\`I DAYS OFI'LRMIT ISSUANCI?OIl to building construction, and hereby authori're representatives of this city'to enter upon the above mentioned propertyRn inspection Purposes. (We) agree to save DAY OMLASTCALLED INSPECTION. indemnify and keep harmless the City ofCupertino against fiabditics.judgmcros.costs, and expenses which mayaccrue against said City in consequence ol'Ihc(sgrating ofthis permit, Additionally, the applicant understands and will comply' Issued1SO by: Date: . with all nun-point a rel• r '010IIOms pl'f the• 'npeflllto (Municipal Code, Sect all 9.18. •''� Signature Date / RF: ROOFS: All roods shall be inspected prior to any roofing material being installed. If a roof is C� installed without first obtaining an inspection, I agree to remove all new materials tot inspection, ❑ ONiN'1'R_ . .DER DECLARATION Signature of Applicant Datc: I hcrrby affirm that I :un csrmpl from the Contractor's I,icrnsc Law for mar of the following two n•sunso ALL ROOF CONTRINGS TO BF CLASS "A" lilt ISI'' 171'12 I. as owner of the property, or my employees with wages ass their sole compensation, will do the work, mid the structure is not intended or offered for sale (Sec.7044, Business C Professions Code) I, as owner of the property, am exclusively conitacting with licensed contractors to HAZARDOUS MATERIALS ERIALS DISCLOSIIRF construct the project (Sec.7044, Business & Prodessions Code). I Inne read the hazardous materials requirements under Chapter 6.95 of the California IIcallh R Safety Code. Sections 25505. 25533, and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain coal plies lice with the Cupertino Municipal Code. Chapter 9.12 and the declarations: hs Ilealth & Safely Code. Secdon'_5532(a) should 1 store or handle hazardous have laid will maintain s Certificate of Consent to self-insure fon Worker's material. Additionally. should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air emt:uninmrs ;is defined by the Bay Area Air Quality Managenu•nl Dislricl I performance of the work for %%)rich this permit is issued will maintain Compliance with the Cupertino Municipal Code. Chapter 9.12 :old I have and will maintain Worker's Cmup nSation 111SmaI1Ce, as provided for by Section 3700 of'the Labor Code, for the perforn,mme ol'uhe work for which this the Uc:dth l SafetyCode. Secti r- 355 r!!'?33.: 25534. permit is issued. Ihrner or authorized agent: I certify than in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Wet ker's Compensation Imus lir California. Ir, after nuking this certificate of e<nnption, I CON'S RIICI'ION LIiNDING AGENCY become subject to the Worker's Compensation provisions odlhc Labor Code. I must I hereby affirm that there is it construction lending agency for the purl imnanec of Imthwith comply with such provisions or this permit shall be deenied revoked. work's for which this permit is issued (Sec. 3097. Civ C.) Lender's Name AIT LICA ST CERTIFICATION Lender's Address I certifv that I have read this application and state that the above information is , 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 indenmify and keep harmless the City of Cupertinno against liabilities, juth ants. ,x ileill'1'ICCI"S DECLARATION K,VIION costs, and expenses which may accrue against said City in consequence of the I understand any plans shall be used as public records. granting of this permit. Additionally. the applicant understands and will comply. with all non-point source regulations per the Cupertino Municipal Code. Section Licensed Professional 9.18. Sign:nure Date CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of,Cupertino 10300 Torre Avenue JOBADDRESS: Z/ J41 4 PER -MIT # /Z/LAS OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE.# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(5) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTRS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS,LICENSE: /U Q 1 am not using any subcontractor.. l l fi z S"_ re bate Please check applicable subcontractors and following information: Owner / Contractor Signature Date SUBCONTRACTOR BL44NY9S NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping j Lathing Masonry Painting/ Wallpaper Paving. Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ' Owner / Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION. JAFADDRESS: 21613 La Playa Ct DATE: 10/09/2012 REVIENVED BY: Sean c tech. Permit Fee: APN: BP#: 'VALUATION: $40,000 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Elce. Insp. Fee: PENTAMATION 1R3SFDREM PERMIT Tl'PE: WORT: Kitchen remodel 120 sq ft); master bathroom remodel 40 sq ft). SCOPE $0.00 NOTE: This estimate cines not include jeer due to other Departments (i.e. Planting, Public Warks, Fire, Sanitary Sewer District, School Distrirt. etc ). These lees are hased on the nreliminary infarnntion available and are onh, an estinnte. Contact the Dent foraddn'l info. FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11) Mech. Plan Check Plumb. Plan Check Flee. Plat Check c tech. Permit Fee: Plumb. Permit Fee: rlec•. Permit Fee: Other Much. Insp. Other Plumh Insp. Other Elee. Insp.El Hoch. Insp. Fee: Plumb. hist). Fee: Elce. Insp. Fee: NOTE: This estimate cines not include jeer due to other Departments (i.e. Planting, Public Warks, Fire, Sanitary Sewer District, School Distrirt. etc ). These lees are hased on the nreliminary infarnntion available and are onh, an estinnte. Contact the Dent foraddn'l info. FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 120 s.f. $600.00 Remodel, Kitchen (<=300 sf) IREA-IRESKIr Suppl. PC Fee: Q Reg. Q OT 0.0 -its- $0.00 PME Plan Check: $0.00 40 s. f. $600.00 Remodel, Bath (<=300 sf) 1REAIRESBAT Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con.1wuction Tar: Administrative Fee: O G Work Without Permit? O Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure (D 0 A Travel Documentation Fees: Strong, Motion Fee: 1BSFISMICR $4.00 Select an Administrative Item 131ch; Stds Commission Per. IBCBSC $2.00 SUBTOTALS: $6.00 $1,200.00 TOTAL, FEE: 1 $1,206.00 Revised: 10/01/2012 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinD(@cupertino.oro ❑ NEW CONSTRUCTION ❑ ADDITION &ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT Y-. PROJECT ADDRESS /PI Q ^ I tc`c C/ `� l� CyE-MAIL`/ Co 3S(v �J�,9 OWNER NAME + r- PHONE Hlo� _ 373V� R STEET ADDRESS 1(�� "5W CITY, STATE ZIP J FAX CONTACT NAM /-1/I� PHONE E-MAIL I 1 STREET ADDRESS NV!V / /\�l a^I �y 1 L p CITY, STATE ZIP V lNTRACTOR /❑, /t 1❑ �ow"NTA ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR AOE'Nt ARCHITECT ENGIN TER ❑ DEVELOPERV TENANT CONTRACTOR NAME e(,� _/Ja07 n -- - LICENSE h R ,y /� LICENSE E o BUS. LIC k COMPANY NAME /� ` I��c.c^,.-`LC��,/`�7-{"'' ^ E-MAIL FAX 'CO�I(( f� - I l�C-� IJ�I� STREET ADDRESS /f(/G �J/% �/I`n �L`n CITY, STATE, Z ( (� \ O \ /� PHONNEO I b C C, `J �V - ARCHITECTIENGINEER NADIE LICENSENUMBER BUS. LIC: COMPANYNAME E-MAIL - FAX STREETADDRESS CITY. STATE, ZIP PHONE ' ' I (� DESCRIPTION OF WO /� I �//'} (','Gy1,l`-rC1/nC�Xk{7'O SCl. `-( \t-1 \ ` ( Z0 / I ✓ iP C90 i1't^ efttG `7V �� i-rl� iroA Um EXISTINSiUSE t—I PROPOS USE CONSM-TYPE V;3 aST0�IE5 USE TYPE OCC. sQ.E7. VALUATION ($) EMSTG AREA NEW FLOOR - AREA DEMO AREA TOTAL NET AREA Y)�; 3 /O ` BATHROOM 1tFTCHEN OTHER REMODEL AREA y%1 REMODELAREA/�6 REMODEL AREA //{ � //�.� V PORCHAREA D((ECCKAREA TOTALDECX?ORCHAAEA GARAGE AREA/UDDETACH ❑ ATTACH N DWELLING UNITS: ISASECOSDUNIT ❑YES SECONDSTORY ❑YES BELNGADDEDe ANO ADDITION? NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNINGAPPLk ❑NO PLANNING APPROVAL LEITER ISTHEBLOGAN ❑YES EICIILER IIOp1E' ANO RECEIVEDB Y'r jJT ' v TOTAL VALUATION: o"I ,' 1111 /( By my signature below, 1 certify to tach of the following: I am dproperty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have pros&' -A-i a ager. I haver ad esonp 1 n of Work and verify it is accurate. I ag c to c pl}' with all applicable local laws to dirt/ o I i for inspection ordinances and state relating t n¢ cons [ Ic� ze reprcscntatiae of upenir toenter the aboc -_' Ie jpr erty purposes. Signature of ApplicanVAgenC y/ Date: (7L SUPPLEMENTAL I;\IFORNIATION D ' a 2o3r=CI'`f",T" 1: V "' PLL\,CIIEH6:T1'I'E� ''� .�-ROUTI\GSIiIY Pg gn` v`s-` rt OVER=THE COU\TF.R r i[�Y �„�-,,,,r 'c•.. NIDI\G f ,"- New SFD or Multifamily duel lings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building perTnli for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure yI�HE.CPRESs� N+l'�'}. ❑a❑�stw'n'DA`RDf'`1. -K ` ❑D PLA\q\C PL+N RE\TEt\'1 1 UBLIf \l'ORJSa _ form if anv Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to +-©nLAItGF H{�r i}.(MS T�, „�? �'❑ FIRE DEPT �4 _ _ submittal of Building Permit application. MAJOR ❑ sANIrARYSENERDIST�RII 8❑�i ENVIRONMEx'TALhHE BldgApp_ Ol Ldoc revised 06121111 rm �ryr -� Y 'COPY: SCOPE OF WORK: Kitchen and Master Bathroom Remodel. Project shall comply with the 2010 California Building (Base code 2009 IBC), 2010. Residential (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)) 3. Permanently installed luminaires in bathrooms, garages, laundry rooms and utility rooms shall be high efficacy luminaires OR are controlled by an occupant sensor(s) certified to comply with Section 119 that does not turn on automatically or have an always on option. (150(k)(10)) Plumbing plan notes: 4. Water closets shall have an average water consumption of not more than 1.28 gallons per flush. (CPC 402.2) 5. Shower heads shall have a water flow not to exceed 2.5 gallons per minute. (CPC 402.1.1) 6. 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) 7. Shower stalls shall have a clear interior finish area of 7.1 sq. ft. and be able to accommodate a minimum 30 inch circle at the threshold level. These clearances shall be maintained up to a height of 70 inches above shower drain. (CPC 411.7) 8. Shower compartments and walls above bathtubs with installed shower heads shall be finished with a smooth, nonabsorbent surface to a height not less than 72 inches (6 ft). (CRC R307.2) 9. The maximum hot water temperature discharging from the bathtub, shower and whirlpool bathtub filler shall be limited to 120 degrees Fahrenheit. The water heater thermostat shall not be considered a control for meeting this provision. (CPC 414.5 & 418.0) 10. A 30 -inch clear width for water closet compartment and 24 inch clearance in front of water closet. (CPC 407.5) Electrical Plan Notes: 11. 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. 12. 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. 13. 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)) 14. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such circuits shall have no other outlets. (CEC 210.1 l(C)(3)) 15. 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 Y. h.p. or larger shall be on a separate 20 amp. branch circuit. 16. 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) 17. In all areas specified in 210.52, all 125 -volt, 15- and 20- ampere receptacl1s f bg js e'dAZED tamper-resistant receptacles. (CEC 406.11) OCT 0 9 2012 BY. c Will Y10-P,I k v � (\ T A V I O p Vx W � COMMUNITY DEVELOPMENT DEPARTIRE� r O BUILDING DIVISION - CUPERTINp APPROVED 1 is set of plans and specifications MUST be klpt at the j b site during construction. It is unlawful to rt�ake any changes or alterations on same, or to d erefrom, without approval from the Building fficial. e stamping of this plan and specifications SH LL,Wr e held to permit or to be an approval of the v( I f any provisions of any City Ordinance or Sta Lam. BY _ ? ' DA 60 �G,1?,.a — -- PE iMiT NO. SLI i ■ t9- I. N t D Z F