14060030CITY OF CUPERTINO BUILDING PERMIT
1 BUILDING ADDRESS: 21810 EATON PL I WINDOWS INC CONTRACTOR: AMERICAN VISION I PERMIT NO: 14060030 I
OWNER'S NAME: GENNADY STUPAKOV AND MAYA 1 400 MATHEW ST DATE ISSUED: 06/06/2014
OWNER'S PHONE: 4085075708 I SANTA CLARA, CA 95050 1 PHONE NO: (408)617 -0901
I� LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # / V�
Contractor ��I t� �tS /b)o ate
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.
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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Se n
918.
Signature �, ' `r Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Signature.
Date
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
REPLACE 3 WINDOWS AND 2 SLIDING GLASS DOORS,
SAME
SIZE & LOCATIONS (WILL BE BE TEMPERED AND MEET
EGRESS WHERE REQUIRED BY CODE)
Sq. Ft Floor Area: I Valuation: $5300
APN Number: 32619114 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM D INSPECTION.
ate:
'_/ RE- ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533 nd 25534.
Owner or authorized agent: Dater
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
n
CONSTRUCTION PERMIT APPLICATION d�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
v�
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 \
(408) 777 -3228 • FAX (408) 777 -3333 • buildingp_cupertino.org
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PROJECT ADDRESS
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OWNER NAME
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E-MAIL
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STREET ADDRESS 21 J ® j� O'^ �/ I l
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C�TY�STATE, IP 1
FAX
CONTACT NAME
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❑ OWNER ❑ OWNER - BUILDER OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER �J�
3
LICENSE TYPE
BUS. LIC #
COMPANY NAME �/y,,/-•.l`l_'{,9 A /' /- i -
Y�/+�`�'L V
E -MAIL
FAX
STREET ADDRESS YQ^,
Cr�YM, SST TE, ZIP (ev ^ T—o
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PHONE rf 1 -6cl 0
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ARCMTECT/ENGINEER NAME
LICENSEjjNUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE
CONSTR. TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA GARAGE AREA DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
BEING ADDED? []NO
SECOND STORY ❑ YES
ADDITION? ❑NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
LETTER
IS THE BLDG AN ❑YES
EICHLER HOME? ❑
-
OTAL VALUATION:
C /5
PLANNING APPL # ❑ NO PLANNING APPROVAL
_
O
By my signature below, I certify to each of the following: I am the property owner or authoriz gent to n the owner's behalf. I have read this
is I have read the Description of Work and verify I I accurate. I agree to comply with all applicable local
application and the information I have provided correct.
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Date:
S ignature of Appl icant/Agent:
SUPPLEMENTAL INFORMATION REQUIRED
Q
� islhAN C HECK TYPE
T �.
ROUTING SLIP
p OVER= THF,�G,QUNTER
❑ DING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
_
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.'
EXPRESS
❑ 'PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
O ;PUBLIC WORKS
_
form if any Hazardous Materials are being used as part ofthis project.
vaxG
El `FIItEDEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
�0 MATgR _
❑SANITARY SEWER DISTRICT -
submittal of Building Permit application.
.
MNVIRONMENTALALTH ,
BldgApp_2011.doc revised 06121111
CITY OF CUPERTINO
AVIV TCTTMArrnP — RTTTT.IIINf DIVIgION
imADDRESS:
21810 EATON PL
DATE: 06/06/2014
REVIEWED BY: MELISSA
APN: 32619114
BP #:
*VALUATION: $5,300
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
p
Suppl. PC Fee: (j) Reg. 0 OT
PENTAMATION 1GENRES
PERMIT TYPE:
USE:
$0.00
PME Plan Check:
WORK
REPLACE 3 WINDOWS AND 2 SLIDING GLASS DOORS SAME SIZE & LOCATIONS WILL BE BE
SCOPE
TEMPERED AND MEET EGRESS WHERE REQUIRED BY CODE)
= <-
I 9crel?. i'Icrn C. reek
b I'f unb. Plan Check l ec, Plan " "heck
bs .%Ir. lli,,•mi 1 Fee: Numb. Pernfif Fee::
C1 % }cr l(cch. In Chhe+ Plumlf Irlov, Other I- i7C(,. Lj
fnv). 1°e7c Tllunb, lisp. Fee: lJcc. Ins',",
NOTE: This estimate does not mctuae fees aue to otner Departments (i.e. itUr1r,,ftgy U "UttL rr u. nay au.--y �, a• .• - y -
_c___ Cnntort thH Dent fnr addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Eff. 7/1/13)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$418.00
Window / Sliding Glass Door
IWINREP Replacement
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. ® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
{.,C }?tSii'uction Kfi":
s flln {I't1,5'1! " {ditL'c> 1<'E> :
0
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
•
I1 °i , >� l)(?C t i12t'7I %17tt!'l 1`k'.0 >S:
Strong Motion Fee:. IBSEISMICR
$0.53
Select an Administrative Item
Bidy, Stds Commission Fee: IBCBSC
$1.00
g J® ll
$1.53
$418.00
TOTAL FEE:
$419.53
Revised: 04/01/2014
CUPERTINO
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 • buildina cupertino.org L
Permit No. / /� NO 0`3 O
Address D 14 h Plat-e-, # of Alarms Smoke: D Carbon Monoxide: /
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 R314 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 acree to comoly with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
S �%Ot/
m X
Si gnat .:.......... ...d' ...................................... ....................Date:dj..�� .� /....
Contractor Name:
Signature.................................... ............................... Lic.# ....... ............................... Date: ...................
Smoke and COform.doc revised 03118114
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CUPERTIr
La Building Departr
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REVIEWED FOR CODE COMPLIAN
Reviewed By,.
-Tb
(,Vj X0
VIVID H 0 re
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Ve
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DING D!"� 1SION - CUPERTINO
r,Y APT"FlIM"'ED
n!nnsand specifications MUST be kept at the
- -S'Pu-tion- It is unlawful to make any
on same, or to deviate
i'hou
-t approval from the Building Official.
and s;, ecif !cations SHALL NOT
val of the violation c
e or State Law.
9