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140601150 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22460 STARLING CT CONTRACTOR: S & B CONSTRUCTION PERMIT NO: 14060115 OWNER'S NAME: JONATHAN G BORNSTEIN &PHYLLIS BROCK 1294 CALDWELL CT DATE ISSUED: 06/17/2014 OWNER'S PHONE: 4084062671 SUNNYVALE, CA 94087 PHONE NO: (408) 529 -1818 Vr LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL Q Q License Class Lic. # _ l �" � _ (�/ REMODEL (E) HALL BATH (SEE PLANS) 56 SF. Grp. �,%� Contractor 5 p �O y�y'Date - I Lf 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 Sq. Ft Floor Area: Valuation: $9000 performance of the work for which this permit is issued. 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: 32613025 00 Occupancy Type: 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 DAY + PSBMIT 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 + D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ` ssued by- Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulati ns er the Cupertino Municipal Code, Section 9 18. ,I Signature Z14W Z Date 6 / 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. ❑ 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 Mun' opal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 5, 25 3 , and 25534. Section 3700 of the Labor Code, for the performance of the work for which this r ff (f Owner or authorized agent: Date6 1 � / 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 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 \1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION `iO 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 , (408) 777 -3228 • FAX (408) 777 -3333 • building(a cupertino.org I-1 .___ n IT I- I`7 Drv1CM11T /nP]7PPRPr1 (1RTGTWAL PERMIT 4 L-J NEW CONSTRUCTION AL 1 L1V111vIN i 11 u — -- PROJECT ADDRESS /) VC ,Z) r_ �O ��� ��, N (' APN # J OWNER TAME ?O� ,t / ii /) a� L°�A / / v / V„'w fA� PHONE �U y�V� E- MAIL STREET ADDRESS CITY, STATE, Zicml-&1,;; /,o T60 i � FAX /V�' CONTACT NAME � �--� PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUrLDER ❑ OWNER AGENT P( coNTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT El ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME S' c ©�i5 I I`U C( Dw LICENSE NUMBER / LICENSE TYPE iZ BUS. LIC # COMPANY NAME eC� / L E I I2& MID atA41 ` • t OM Q /Q� F�'732-, /Q /� STREET ADDRESS 12 � y' `/ ! CITY, STATE, ZIP �i �� /,/�/j /� i/�I qy�� `j V /1 ',•/ r" Y� Cam' Z` PHONE (y C% I g c' ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #Q COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK l� of -.,-h 2r� ew--) C L two EXISTING USE PROPOSED USE CONSTRTYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NErAREA BATHROOM /. REMODEL AREA �/_ S KITCHEN REMODEL AREA OTHER REMODEL AREA J t0 FOR 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 IS THE BLDG AN 11 YES B- ; T VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? El NO By my signature below, I certify to each of the following: I am the property owner or authori agent ct o r owner's behalf. I have read this application and the information I have provided is correct. I ha ,read the Description of Work an erify it rate. I agree to comply with all applicable local ordinances and state laws relating to uil ' construction. I t ize presentatives of Cupertino to enter the above -id ntifed o erty for inspection purposes. 72 / Signature of Applicant/Agent: Date: SUPPLEMENTAL INFOX14ATION REQUIRED _ - :�OYER,T,41 COi1NTER1 '' �BUU nITG PLAN IiEVIEw New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building k ' � # £ D permit for new building. ❑ hEAPRESS �i'2 �0I.C' aXFY"s '� '3 � PLANTIL\G PLANREVLEW "v, -'8•i� � 3 4 Commercial Bld s: Provide a completed Hazardous Materials Disclosure[] i. i1 S' £ t sTAND�ARD � A h # PUBLIC -WORKS _ _„ _ D form if any Hazardous Materials are being used as part ofthis project. y '{✓: �Tialuf �L d,5 D�r�i°'kV - � La PIREDEPT Meeting Planning to _ Copy of Planning Approval Letter or with prior ❑ iMIATO S�7\ITARXSEWEWDISTRICT submittal of Building Permit application.�ti �]'�ENViiioxMENTrinLTi r. c -,. BldgaApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22460 STARLING CT DATE: 06/17/2014 REVIEWED BY: MELISSA APN: 32613 025 BP #: *VALUATION: 1$9,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Li PENTAMATION PERMIT TYPE: 1 R3SFDRE i WORK REMODEL E HALL BATH SEE PLANS 56 SF. SCOPE Permit Fee: 6 ,7777r' A'fec llf iron Check /'hti;?b. P.U19 Ale- P/di% ('hea Ah?_'h. Fee Plumb. Per-mil /'C8: k""'. Pcrmh'r''c ;C CJtlx °t ,itc :h, Irts��. Other Piumil frup. Li (i 1'let- Insp. F' e P /7Ci1H7, NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept or addn't info. FEE ITEMS (Fee Resolution 11 -053 Eff. 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 F__56__j s.f. Remodel, Bath (< =300 sf) $626.00 1REMRESBAT Suppl. PC Fee: Reg. ® OT 0.0 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 Colzsfru'ction -1d}Yittlt iT "cf171'c?'c? ': E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential E) Building or Structure 0 i Travel r' ocuorr"wwhorl Fees: Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative Item Bldp, Stds Commission .Fee: IBCBSC $1.00 $1.90 $626.00'­-'1­ TOTAL FEE: $627.90 Revised: 04/01/2014 CUPERTINO Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408- 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 22 (OO S'-re)L -t�� a C-r PERMIT # PlOiWIS OWNER'S NAME: .7&11)11 SorL pSr Ei N PHONE # 109-10G, GENERAL CONTRACTOR: `j t B GODS i lUC_ -T% BUSINESS LICENSE # ADDRESS: 129 C i-ow E/) q=j gyre ✓*I E CITY /ZIPCODE: 5 ov ✓ lt 6 *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(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTO HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ig ature Date Please check applicable subcontractors and complete the following information:` V 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 Owner / Contractor Signature Date 60 2j14S7A#V -V?460 C (!4UpC—j27,-tN0 Ckq5e)lLf 7A LfOGI Z(0'4-1 'A AA" Nor CON4 " ILWITY DEVE-1-0711M ' 7n!-r DEPARTMENT CUPERTINO APPRC*C "ED Is -Mcq Spef�;f';Catlonss MUST be k0pt at the TUSticil- It Is unlawful t .0 MIN a Y— Oil San-no, or to d7ime V' IllV ilo!-I""EPP"OvLllfrol-ntlie Building 0 racial. if A p snd specification LL N( T PE[W No. I% E- LY Tt) Pj 6W L or Sate Law. f 1 11 PTA f2wel CUPERTINO 9uildinc Dr-martment REVIEWED FOR CODE COMPLIANCE Reviewed By: Gj o' - 17-, " m1i h. U� tiCE U VED JUN 12 2014 -Cl J wtl Y - ----------- CUPERTINO 90ding rn. ent FREVIE'vvFf) FOR CODE CC)VIPLIANCc- Reviewed By, lift tE . t7 d Z- CUP lloi.,, nq NCB .ie i.o 31 CUPERTINO Address Y 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 aC)cupertino.org 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. 1 have read and agree to c p Jth h_a ter)s and conditions of this statement Owner (or O er Agent's) Name: + �j �2 J " �' +"7f/� Signature ........Y.... ...K ..................................................... ............................... Date: 4......... J.•4 Contra for Name: s ce V s i LvC71164 m 3!c � /.:r 1f . .... Li# Sign ture .. c ... Date Smoke and CO form. doc revised 03118114