14050152CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21114 GREENLEAF DR
CONTRACTOR:
PERMIT NO: 14050152
�FTFR t�rTNr D
OWNER'S NAME: TAKANO TAIKO
I�Y pC, �'lCsI7
DATE ISSUED: 05/27/2014
OWNER'S PHONE: 8183351431
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
55 SQ FT BATHROOM REMODEL TO INCLUDE M,E,P'S
c9
License Class_ Lie. # 3 ���
Contractor ' PMR_ apl Date, �7 L7
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: $8000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32628098.00
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
WIT N 180 YS 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
180 DA FROM LAST CALLED INSPECTION.
indemnify and keep harmless the Ci o Cupertino against liabilities, judgments,
which may acc a said City in consequence of the
costs, and expenses gainst
Issued by: Date
granting of this permit. Additiona the applicant understands and will comply
with all non -point source regulati s per the Cupertino Municipal Code, Section
918.
RE- ROOFS:
Signature Date
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- 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
r l jt . �� � Date: Z9 - It?
Owner or authorized agent: ��
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
�s�T.Y ;lam.
a
GENERAL PERMIT APPLICATION
c7- mmm E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building cDcuDet ino.org
I;/,T,n.ro,,rn_ n-Krmr+uArnr'e7 r;;4T.;frT MAT
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I— I\rMTTSCELLANEOUS
MISC
PROJECT ADDRESS L I APN #
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OR'NERNAME --I- ^ <n� I pHs, I V �57 .
( E -MAII
STREET ADDRESS 217 I /J(/l}� �n r
CrfY, STATE, W. ��
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CONTACT NAhG /� � /_ /J� PHONES f�� , I �,i E-MAIL
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STREET ADDRESS ,
CITY, STATE, ZZIIP
FAX
❑ O-A -R ❑ OWIW-- M- BUILDER ❑ OWER AGENT ❑ CONTRACTOR ❑ CON MACTOR AGENTf ❑ ARC-r cT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CON'TRACT'OR NAME (/k N LICENSE NUMBER (")
I LICENSE TYPE
BUS. LIC n
COMPANTY h 4ME
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/ZIP
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STEET ADDRESS
I CITY, STATEV
I PHO? E
ARCHITECT/ENGATEER NAME LICENSE NUMBER
I BUS. LIC n
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO
I PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
I IS THE BLDG AN ❑ YES
EICHLER HONIE? ❑ NO
DESCRIPTION OF WORK (10) / G /. %A/ �I )VO J C
TOTAL VALUATION: (�O O
RFC$IITEDB3 Y
By my signature below, I certify to each of the follov irl� the property ovmer or authorized agent to act on the p ovmer's behalf. ve read this
application and the information I have provided is corre have read the Description of Work and verify it is accurate. I agree pplicable local
ordinances and state laws relating to building constru authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: 2- 7? - y
SUPPL T II�7FORMATION REQTJ=D
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MEPA1iscApp_2011.doc revised 06121111
CITY OF CUPERTINO
QUIP T't C9rT1V4 A Tl1R _ RTTTT ."IN(i' 11IVICInN
LAIADDRESS:
2114 greenleaf dr
DATE: 05/27/2014
REVIEWED BY: Mendez
APN:
BP #:
"VALUATION:
1$8,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
0:0 1
PENTAMATION
1 R3SFDREM
PERMIT TYPE:
WORK 155
sci ft bathroom remodel to include m e 's
SCOPE
$0.00
Menu Cbec k
Ltecat. r'� °rntit Fee:
? ix'r' i lec h, 7;7.�P
;i lx�cit. I; �sF1. 1'c e
f trtwb. I'lon C'kx:c.-ti
Phw7b Permit Fec:
0111tr� Plum,) Ins'>.
Phtrrrb, hzsp. Pace:
I
t 'ec. 1'r z t h,'cl;
El
NOTE: This estimate does not include fees due to other Departments (i.e. manning, ruaac wortcs, rlre, ,3unuury ,3ewer utatrtcy 01-nuut
r_ :t,.t.t. _4 , ai, ,.., l n.t—i tho Dant fnr nddn't inin_
IltJ tt taw., C91. Z. i ttc =.- asi c Darn a,w o.. ..w ..,......... ».
FEE ITEMS (I ee Resolution 11 -053 E f 711113)
... ... ...�___._
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
55 s.f.
$626.00
Remodel, Bath (< =300 sf)
1REMRESBAT
Suppl. PC Fee: (j) Reg. 0 OT
0:0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. 0 OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Con tri.i dion 7'UX.,
F
,ldi inistraiil'r' 1'c'':
E)
Work Without Permit? ® Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
I
G
0
A
7r��el 1.)o uirtU wotion Fees:
Strony, Motion. Fee: IBSEISMICR
$0.80
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
�J
$1.80
$626.00
_TOTAL FEE:
$627.80
Revised: U4 /U1 /ZU14
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C D ITY DEVELOPMENT DEPARTMENT
11RIDING DIV'ISIGN - CUPERTINO
Thic, set 067,19ns and specifications MUST be ko ' pt at the
construction. It is unLiwful 'LO M!-l;,e. any
or alio, aticris sa.
oi .1 �
nne, or to devialte
Wi-L";rj0t,,'L appy fr'3 ,-n the Bujlcj,g Official.
pl,8'n o,-ld S,n,. ,-.,ificoJons St-W-L NOT
10 rL 0i 'n;-, pr oval of the, vii i on
(y o itY of anly Or aTO Law.
EV,
AN AF i�
Sq
CIL
CUPERTINO
Building Department
7,
REVIEVF-D FOR CODE COMPLIANCE
Reviewed BY:
I
ADDITIONAL CODE RE Q UIRMENTS
Enemy 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
403.2)
5. Shower heads shall have a water flow not to exceed 2.0 gallons per minute @ 80 psi. (CPC 408.2)
6. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 1.8
gallons per minute @ 60 psi. (CPC 403.6)
7. Shower stalls shall have a clear interior fmish 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 408.6)
8. Shower compartments and walls above bathtubs with installed shower heads shall be fmished 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 409.4 & 408.3)
10. A 30 -inch clear width for water closet compartment and 24 inch clearance in front of water closet.
(CPC 402.5)
- -- Electrical Plan Notes:
11. The installation of smoke alarms in all of the following areas shall be provided: (CRC 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: (CRC 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(A))
17. In all areas specified in 210.52, all non - locking type 125 -volt, 15- and 20- ampere receptacles shall be
listed tamper- resistant receptacles. (CEC 406.12)
ResKitBathPolicy_2014.doe revised 01115114
CUPERTINO
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertiao, CA 95014-3255
Teleptione:408777 -32 8
Fax; 408- 777 -3333
R / SUBCONTRACTOR LIST
j JOB ADDRIES& 21114 GreenleafI �r PERMIT ; 1405 -0152 _
OWNER'S NAME: Kimura Taiko I PHONE 9 888 -955 -0535
GfENFFiAi CONTRACTOR: BUILT T PERFECTION , BUSINESS LICENSE 4 35392
ADDRESS: 15021 VENTURA BLVD # 6 _ CITY/ZIPCODE: SHERMAN OAKS, CA 91403.
*Our municipal code requires all bus i sses w orizing In the ci to leave a City of Cupertino business license.
NO BUILDING FINAL OR T'IaYA IOCCUIaANC-V INSP TION(S) WILL BE SCHEDULED UNTIL THE,
DENIM CONTRACTOR AND L, SUBC+r NTRACT6. S HAWS OBTAINED A CI']C�' F CUII ERTINO
BUSINESS MCENSE. %' ( t1r l �l /Ll
I am not using any subcontractors: r -
Si re Date
Please check applicable subcontra ox's and comote e following information:
0°
SUBCO`iT%kcTOlE;:.
BUSOESS NANTE, �-
BUSIl'��TESS LICENSE #
Cabinel -i & Millwork.
Cement Finishing
Electrical
,Excavation
Fencing
Flooxing / Carpeting
Linoleum / Wood
j
_
Glass / Glazing
Heating
�-
Insulation
,Landscaping
I _....._.,..._
Lathing
1
Masoxv:y
Painting ! Wallpaper
j
Paving
Plastering
Phimi9ing
Roofing
Septic Taals
Sleet Metal
Sheet Rock
Tile
_
I
Owner I Conwacioir nature
I
Date