13020083 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10240 RANDY LN CONTRACTOR-T8&-3J),BE PERMIT NO: 13020083
=ERMINED
OWNER'S NAME: BURSTEIN LOUBA I DATE ISSUED:02/142013
OWNER'S PHONE: 4083430232. PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTIO RESHIENTIAL U COMMERCIAL
License Class_ Lic.# q] q116 REMODEL BATHROOM 66 SQ F1'
IContractor Q_J'T Date
I hereby affirm that I am licensed u er 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
I hereby affirm under penalty of perjury one of the following two declarations:
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 theworkfor which this permit is issued. Sq.Ft Floor Area: Valuation:$7000
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 APN Number:31623094.00 Occupancy
1YPe:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and scale that-the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county.ordinances and state laws relating WITHIN 180 DAY OF PERMIT ISSUANCE OR
to building construction,and hereby,authorize representatives of this city to enter
upon:the above mentioned property for inspection purposes. (We)agree to save 1801 O AST CALLED INSPECTION.
indemnify and keep harmless the Cityof Cupertino against liabilities,judgments, -
costs,and expenses which may accrue against said City in consequence of the '//3
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: '�[�
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Dstc.,O. 1 L(— All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDERDECLARATION
Signature of Applicane Date:
I hereby affirm that I em exempt from the Contractor's License Law for one of
the following two reasons: - ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner oft he property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 ofthe Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 505, 6533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become.subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) _
- Lender's Name
APPLICANT-CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and countyordinances 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,sand expenses which may accrue against said City in consequence of the I understand my 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:
Signature - - Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (j v
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinG(G.cupertino.orG
❑NF
W CONSTRUCTION ❑ ADDITION [-] ALTERATION/TI ❑ REVISION/DEFERRED ORIGIN ERMIT ti
PROJECT ADDRESSO
APN q
o o n �b
OWNERNAME �( J1 PHONE I�a p^�4 S— Oa�
C�AT�-tE-MAIL
�o�,t10 �an(/� I c T4 CA 1%D(I( FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
O OwHEs. O OWNER-BUBDER ❑ OOwwNEt AGENT ❑ CONTRACTOR ❑CONrEACroRAGENr ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CO NA �f2c1,aI LICENSE NUMBER LICE? TYPE BUS.LIC#
L'
rIPA ?i EE-MAIL FAX
74rAD716SI
, Sf CHY,SiATE,ZIP PHONE
ARCHITECTIENGIN RNAME LICENSENUMBER BUS.LIC#
COMPANY NAME —FE-;AIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCmP1710N OF WORK d:66V64/
M T �'1pDNM
EXISTING USE PROPOSED USE CONSfRTYPE I *STORMS
USE TYPE OCC. SQ.FT. VALUATION(E)
EXISTG NEW FLOOR DEMOTOTAL
AREA AREA AREA 6ARBA
BATHROOMII KITCHEN OTHER
REMODELAREA UU REMODELAREA REMODELAREA
PORCHAREA I DECK AREA TOTAL DECIOTORCHAREA GARAGE AREADETACH
ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY []YES
BEING ADDED? [3NO ADDITION? []NO /
PRE-APPLICATION DYES EYES,PROVIDECOPYOF IS THE BLDG AN ❑YES RECEIV Y: TOTAL VALUATION:
PLANNING"I'L# []NO PLANNINGAPPROVALLEITER EICHLERHOME? []NO �G —110W
By my signature below,I certify to each of the following: I am the property owner or authorizeag to act on the property owner's behalf. I have read this
application and the information I haME
MCL I have read the Description of Work and erify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating ttion. I authorize representatives of Cupertino to enter the above-ide,{ntified property for inspection purposes.
Signature of Applicant/Agenn 6t ley Date: �-r ^�3
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ElEXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBucwORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10240 RANDY LN DATE: 02/14/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: $7,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM
USE: PERMIT TYPE:
woRK REMODEL BATHROOM 66 SQ FT
SCOPE
n 5
,Meeh. Plan Check Plumb.Plan Check F.ler. Plan Check
Mech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee:
Other Mech. Insp. 01her Plumb Insp. Other Elec.Insp.
Heck Insp. fee- Plumb. hap.Fee: Elec.Insp.Fec.
NOTE:This estimate does not include fees due to other Departments(L e.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn°I info.
FEE ITEMS (Fee Resolution 11-053 E$' LI 121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F607 s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: Q Reg. 0 OT 0.0 his $0.00 $600.00 1REIMESEAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tai-:
Administrative Fee: 0
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
Travel Documentation Fees: A
Strong Motion Fee: IBSE1SA17CR $0.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
I�f l I 3 t>l II�I' ( % e,4inx . w�
, I SIi{i'llr :. ' $1.70 $600.00 `;}4' TQFTAI��)FEE,eaT,
$601.70
Revised: 01/01/2013
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
jou s! during construction. It is unlawful to make any
r.n des or alterations on same,or to deviate
thr..6'lom,without approval from the Building Official.
Tho damping of this plan and specifications SHALL NOT
br;r,Ehj to permit or to be an approval of the violation
of any provisi ns of ny City Ordinance or State Law.
J� BY. d r Y
DATE e
PERMIT NO. O
SCOPE OF WORK:
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. Ail 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 210.11(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/. 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 receptacles shall be listed
tamper-resistant receptacles. (CEC 406.11)
Building Department
City Of Cupertino
10300 Torre Avenue
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: /0 PERMIT#
OWNER'S NAME: LOV6, PHONE#
GENERAL CONTRACTOR:'UIlr,o ',L BUSINESS LICENSE#
ADDRESS: �11 CITY/ZIPCODE: S
*Our municipal code requfrei.alfb6sinesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBC T CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: a—
signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
owner Contractor Signature