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14090138C CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7579 KIRWIN LN CONTRACTOR: AMERICAN HOME PERMIT NO: 14090138 RENEWAL INC OWNER'S NAME: NOMA MICHAEL AND LYNN 310 SHAW RD STE A DATE ISSUED: 09/22/2014 OWNER'S PHONE: 4084460779 S SAN FRANCISCO, CA 94080 PHONE NO: (650)553 -9054 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ INSTALL HARDI SIDING TO FRONT FO SFDWL 550 SQ FT !� License Class Gt-) Lic. 4 ? —1 ©5 q Contractor ,A-m L,?_,, -,i 4vd - 1P4/LJh Date 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 h e and will maintain a certificate of consent to self - insure for Worker's m tion, as provided for by Section 3700 of the Labor Code, for the erfor ce of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $14000 1 a d will maintain Worker's Compensation Insurance, as provided for by APN Number: 35921006 00 Occupancy Type: ti 3700 of the Labor Code, for the performance of the work for which this pe it 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 AYS O ERMIT 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 LAS CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against!said City in consequ e of the Issued by: Date: d granting of this permit. Additionally, the applicant underst and will comply with all non -point source regulations per the Cupertino nicipal Code, Section RE- ROOFS: 9 18. �j 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- ER DECLARATION Signature of Applicant: Date: I hereby affirm that 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) 1, 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 d 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 permit is issued. 21 Owner or authorized agen • Date: 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 CONSTRUC 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 nstruction 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 1 CONSTRUCTION PERMIT APPLICATION 0 ( 3 119 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ,1 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 �f CUPERTINO (4088) 777 -3228 • FAX (408) 777 -3333 • buildiinng a0cupertino.ora NEW CnNSTRTiCTTnN I I ADI)TTInN 1 1 AT.TFR ATInN / TT I I RF.VTSTnN / DF.FFRRF.T) nRICENAi. PERMIT # PROJECT ADDRESS //' �'� ti I A� E APN # 5 Z I (:. V �„ /'Y 1 `�J�i/ t./�� ///''% OWNER NAME ,n /1 0.0 A __,. PHONE • 4•„ • Lf C(�(r7 E-MAIL STREET ADDRESS / �� (J (� CIT T( 4TE, ZIP 17LJL7IA)O e_ 'A % FAX CONTACT NAME EILEEN COOK. PHONE 707-527-7727 E- MA1Leileen @permitservices.com STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. L 0 Natal Gutierrez 740587 B C17 a� COMPANY NAME E-MAIL FAX AMERICAN HOME RENEWAL 650- 553 -9053 STREET ADDRESS CITY, STATE, ZIP PHONE 310 SHAW ROAD STE A SOUTH SAN FRANCISCO CA 94080 650 - 553 -9054 ARCHITECT /ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 1A- I I 1 ( I I`720 A)-7 C>C— �-,A - /'/ �L VI -tom 1 l 1�r t rlul C N7. J� S. j EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES oAv USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR - DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK /PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED T3`Y - TOTAL VALUATION: PLANNINGAPPL# ❑ NO PLANNING INGAPPROVA L LETTER EICHLER HOME? ....:.: : ... . ..._. / " (JVi/ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th operty owner's behalf. I have read this application and the information I have provided incorrect. I have read the Description of Work an rifyiris a u agree to comply with all applicable local ordinances and state laws relating to building c representatives ertino to enter t a ove- identified propert for inspection purposes. Signature of Applicant/Agent:. Date: 2 SUPPQMENTAL INFORMATION RE ROUTING SLIP ou> R= xCOiiNrER ❑' BUILDING PLAN REV>Ew _ New SFD or Multifamily dwellings: Apply f olition pernrit for existing building(s). Demolition permit is required prior to issuance of buildm permit for new building. ❑� Exhimss El PaxxINcPLAN REVIEW _ Commercial Bidgs: Provide a completed Hazardous Materials Disclosure tL sT vpAtw, ❑ PUBLIC WORKS 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 [j IKA�oR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. CQ . ENNIRONNtENTAL, HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO Ti F.F. Ti.QTIMATnR — RITII.nIN(i' DIVISION im, ADDRESS: 7579 kirwin In DATE: 09/22/2014 REVIEWED BY: Mendez APN: BP #: *VALUATION: 1$14,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p Siding 1SIDEOTHER All Other PENTAMATION 1GENRES PERMIT TYPE: WORK install harding siding to front fo sfdwl 550 sq ft SCOPE $0.00 _ g Ah,(J t" rt Check PFruwh. P!on Check Plea. 111"Ir t fwO( ", ._ lli,fwlil Fee.. Plamf ;. Pt nz t Pee, ! c Pc,;,?! 11'e other r'T vmb fns p- oib "'v.1 ic"(. h2q.). llhwtu, T3sp. Fee:Its- -E. 1sup, Pee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, ,vuane worres, rtre, aanuary newer'Utsrrict, acnuot r.:..._:... .. ,. ,rL _ .,. f n.,: tt,o and are nnly an e.timate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 550 s.f. $646.00 Siding 1SIDEOTHER All Other Suppl. PC Fee: Reg.' Q OT -0:0 1us $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.Q) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C! }tiwj,tiL'hOn 7­ uv: rIdP`2inislral S'v T`CT: 0 E) Work Without Permit? 0 Yes No $0.00 Advanced Planning? Fee: $0.00 Select a Non - Residential Building or Structure E) 0 T i°E-o"el /.ff3 - t;itle'YaJLrll£TY/ FE'.G's: Strom Motion Fee: IBSEISMICR $1.82 Select an Administrative Item Bldg: Stds Commission Fee: IBCBSC $1.00 }U'_ x $2.82 $646.00 7 TO`1AL FEE:' $648.82 Revised: 08/20/2014 CUPERTINO Address I rt. 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 acupertino.org _ Permit No./� '% g '% ci KJ A W,(Aj ZAI # of Alarms Smoke: 2/ 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 eadl 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: En 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 here repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by eans of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. electr' a tt�d for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certif that the alarms referent �b vhas / have been p p ty, Y Y alarm( s) 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 aaree to comoly with the terms and conditions of this statement Owner (or Owner Agent's) Name: M1Qj,0 a L. /Vo 141/+ Si nature....,-en ..r. !JLP.. ..... 2-.7.P?r . - :............... ............................... Date: x /...�.1.... Contractor Name: Signature.................................... ............................... Lic.# ....... ............................... Date: ................... Smoke and CO form. doe revised 03118114