13100085Al
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10031 CARMONA CT
CONTRACTOR: 'A 5
PERMIT NO: 13100085
C-o dV 51Yt,,-.)C'(-1 o�
OWNER'S NAME: CANTER, NANCY
DATE ISSUED: 10/11/2013
OWNER'S PHONE: 4088648315
PHONE NO:
JOB DESCRIPTION: RESIDENTIAL COMMERCIALL]
LICENSED CONTRACTOR'S DECLARATION
License Class + GNIIN►' Lic. # 6 — 11: — 7 g.7
REMODEL 2 (E) BATHROOMS (70 S.F. TOTAL)
Contractor [m �S�h �►�y`i'w_ Date_ Q/
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.
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 the work for which this permit is issued..
Sq. Ft Floor Area:
Valuation: $5000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35716114.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state 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 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
18 WALLED INSPECTION.
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 may accrue against said City in consequence of the
Date: /0///
granting of this permit. Additionally, the applicant understands and will comply
y'
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
-
RE- ROOFS:
Signature Date_
A E_- &
All roofs shall be inspected prior to any roofing material being installed. If a roof is
'4
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER- BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am 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 of the 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 of the 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 25505,25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: ate: Q
�-
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and 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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 •FAX (408) 777 -3333 •building an-cupertino.org
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n T,mixi (- nMeTRT TrTTnN n AnnTTTnN M AT.T -RR ATTON / TI n REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
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OWNER NAME� HC o71TQY
PHONE
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-MAIL
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ST ET ADDRESS
CITY, STATE, ZIP
C u P ur i n o Cct.
FAX
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CONTACT NAME ^
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PHONE
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❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 1; i `
LICENSE NUMBE� ^
LICENSE TYPE 8
BUS. LIC #
,
COMPANY NAME A
Con tr c- ;'0
E -MAIL /�
A C6 '.trvLti ol,..0 L✓
FAX
STREET ADDRESS
A, G,.. '
CITY, STATE, ZIP �
PHONE46S 7
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
1Z vvk o dIe wo g f�1(00 uk-' •✓o 40Vd', a-• wt Its
D r E I ed
r. cd.C.
EXISTING USE
PROPOSED USE
CONSTR. TYPE
1 # STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
REMODEL AREA 7o
KITCHEN
REMODEL AREA -
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH ARE I GARAGE AREA: DETACH
❑ ATTACH
9 DWELLING UNITS:
IS A SECOND UNIT []YES
SECONDSTORY ❑YES
BEING ADDED? []NO
ADDITION? []NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
-"
TOTAL VALUATION:
PLAN[�'INGAPPL# ❑NO PLANNING APPROVALLETTER
EICHLER-HOME? ❑NO
-
Wt.4af,ope',ty
��:
_.By
,� ,S000
my signature below, I certify to each of the following: I am the property owner or authorized agent to ac 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 laws relating to bui ing c nstruction. I authorize representatives of Cupertino to enter the above- identiie property for inspection purposes.
7')
Signature of Applicant/Agent: �— Date: l �/ I 0 I
SUPPLEMENTAL INFORMATION REQUIRED
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'M - 0R viuyc siP
°R- =H�co TER
�i] 'BUILD GpynN REVIEw"�,,, �_
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
rt4�
permit for new building.
E"
- L REVIE
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
_
form if any Hazardous Materials are being used as part of this project.I
— Copy of Planning Approval Letter or Meeting with Planning prior to
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�ARI�SEWERDIS
submittal of Building Permit application.
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ENVIRONMENT
BldgApp_201 Ldoe revised 06121111
CITY OF CUPERTINO
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T7'i T'i T'i CTTM A T(1R _ RIT11,11INf 15TV1410N
Mech. Flan Check
;Ltec;h. Pertnit Fee:
Other,Vech. Insp. ' I
He:ch Insp, Tee: L�J
AInTF• Thic pedmato daoc.nat incbtde fees
Plumb. Hari Check Elec. Plan Check
Phtmh. Permit Fee: Elec. Permit Fee:
Chlrer Plumb Insp. Other Elec. Insp.
Plumb. Insp. Fee: Elec. Insp. Fee:
e to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept_for addn'[ info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
ADDRESS: 10031 CARMONA CT
DATE: 10/11/2013
REVIEWED BY: MELISSA
APN: 35716114
BP #:
*VALUATION: 1$5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
p
Suppl. PC Fee: Q Reg. ® OT
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
USE:
$0.00
PME Plan Check:
$0.00
WORK
REMODEL 2 E BATHROOMS 70 S.F. TOTAL
Permit Fee:
SCOPE
Suppl. Insp. Fee-.0 Reg. ® OT
Mech. Flan Check
;Ltec;h. Pertnit Fee:
Other,Vech. Insp. ' I
He:ch Insp, Tee: L�J
AInTF• Thic pedmato daoc.nat incbtde fees
Plumb. Hari Check Elec. Plan Check
Phtmh. Permit Fee: Elec. Permit Fee:
Chlrer Plumb Insp. Other Elec. Insp.
Plumb. Insp. Fee: Elec. Insp. Fee:
e to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept_for addn'[ info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F70 71 s.f.
$626.00
Remodel, Bath (< =300 sf)
1REAMESBAT
Suppl. PC Fee: Q Reg. ® OT
0.0
hr's
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-.0 Reg. ® OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
€'onswuction 1" ax:
Adininistrcative Fee:
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non - Residential
Building or Structure
0
�
Travel Documentation Fees:
Strong Motion. Fee: IBSEISMICR
Bldg Stds Commission Fee: 1BCBSC
$0.50
$1.00
$1.50
Select an Administrative Item
$626.00 $627.50
Revised: 10/01/2013
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SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building a)cuoertino.oro
d7y� -i Permit No.
C-7 # of Alarms Smoke: Carbon Monoxide:
OtifSr�Pi
PURPOSE
This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above- referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to cqMpty with 00 terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature ... 6.......
ontriactor Na e:
/�
lk—.1 5/ 'hLQ
Signature ............... ...... ................... Lic.io I3.. ............................... Date:
Smoke and CO form. doc revised 03118114