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15070003N BUILDING ADDRESS: 10556 LARRY WAY CITY OF CUPERTINO BUILDING PERMIT I CONTRACTOR: 4- 1 PERMIT NO: 15070003 OWNER'S NAME: ROBERT & CHRISTINE VAN HOY DATE ISSUED: 07/01/2015 OWNER'S PHONE: 4082572397 1 , 1 PHONE NO: ? I LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date 1 hereby affirm that 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: h 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 ttw' granting of this permit. Additionally, the applicant understands and will c with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date_/ ❑ OWNER -Bt J LDER 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) 1, 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: 1 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 ❑ COMMERCIAL ❑ REMODEL & RECONFIGURE (E) 154 S.F. KITCHEN (NO STRUCTURAL CHANGES) Sq. Ft Floor Area: I Valuation: $ 10000 APN Number: 31602026.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERAUT ISSUANCE OR DAYS FR LED INSPEC IO . d h • /� 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, and 25534. lam/ Owner or authorized agent: �X,L�� Date:—71 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Na �s-safr • CONSTRUCTION PERMIT APPLICATION COMMIUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(Ocupertino.org { CC•O -'C /� )3 ❑ NEW CONSTRUCTION ❑ ADDITION L1 ALTER-ATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 4 PROIE171 ADDRESS �u L p'P APNe7 r ( -© O 0556 OWNER NAME Lob PHONE 40 E-MAIL 1.0 STREET ADDRESS vl CITY, STATE, ZIP CU `/ n /(� I FAX CONTACT NAME PHONE E-MAIL! STREET ADDRESS I CITY, STATE, ZIP FAX 2a 1:C/ ❑ OWNER ❑ OWNTR-BuIDER ❑ OWNcRAGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGLNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER ( LICENSE TYPE BUS. LIC k � O O�� COMPANY NAME E-MAIL FAX STREET ADDRESS 1 ( r l (� f l CITY, STATE, ZIP ` PHONE l � �(C G( V 1 ARCHITECT/ENGIN'EER NAME LICENSE NUMBER BUS. LIC �" COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK �� . TdU(JG 1 �J� 1 I (I d w V1I c;i, Q� 64 P') I log !. IDS � P, c l 4o CuL, H l' I QEF' F f gnuh r 40(0C a Am .� 1 t' F-4 EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEN40 TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA S REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH A TACH DWELLINGUNITS: IS A SECOND unrr [3 YES SECONDSTORY []YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN= TOTAL, VALUATION: PLANNTNGAPPL: ❑NO PLANNING APPRON'AL LETTER EICHLER HOME. NO By my signature below, I certify to each of the following: I am the property ownerauthorized age ct on the property owner's I have read this application and the information I have provided is correct. I have read the Description of'W verify it is accurate. I aeree to comply withrd--applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. -71 Signature of Applicant/Agent: Date: / / s SUPPLEMENTAL WFORMATION REQUIRED ' 4. PLA!\ CHECK TIDE _ n ' v ROUTLN G SLIP New SFD or Multifamily dwellings: Apply for demolition permit for " F existing building(s). Demolition permit is required prior to issuance of building O�ERTHECOLII�TER BUIIDII�GPL4NREVIEFV permit for new building. P �g• OE ExPFEss r � ❑i PLANALNGPLAIv RE Commercial Bldgs: Provide a completed Hazardous Materials Disclosure�srAr�aRD � _>' Pusitco64 �.'_ _ = -�❑ form if any Hazardous Materials are being used as part of this project. ❑�FIREDEPT — Copy of Planning Approval Letter or Meeting with Planning prior to ;� .LARGE --�� Wiz. �"� �: submittal of Building Permit application. IKAaoRMW t sA1`?T,ItY S `ERnISTRrcT' e o7�MENT- GFIEiti��`IFI B ldgApp_201 1. do c revised 06/21/11 CITY OF CUPERTINO ffim FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10556 LARRY WAY DATE: 07/01/2015 REVIEWED BY: MELISSA fr'o'7 - APN: 316 02 026 BP#: b `VALUATION: 1$10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair —7 PRIMARY SFD or Du Duplex USE: p Elec. Insp. Fee: PENTAMATION 1 R3SFDREM PERMIT TYPE: / WORK REMODEL & RECONFIGURE E 154 S.F. KITCHEN NO STRUCTURAL CHANGES SCOPE $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt_ etc )_ These fees are based on the vreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E„�f.' 711/131 <:h. 1''lan Chec7_1 kPhutth. Plan Check lec:. Plan (7 fr'o'7 Fe' � Otircr Aic"h. lnsp F-1 ,,)owr Plumb ImpLi Other Glec. Insp. Li I ','ch. Insp. Fee: /'hrmb, hast). hey° Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School nictrirt_ etc )_ These fees are based on the vreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E„�f.' 711/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction 1 ix. Achninistrative Fee: 1 O E) Work Without Permit? ® Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Truvel Uac•uinenlation Fees: Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.30 $645.00 TOTAL FEE: $647.30 Revised: 05/07/2015 9L i) JC7 1 1 I I l 1 I w I i CUPERTINO Address L �S�o SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 _yl F 1 L fS q wr (408)777 3228 • FAX (408) 777-3333 • building(a)-cupertino.org Permit No. llmnl rr (, kNN()T BF FIN AT ('I) :ANTI) COA'TPT.F,TPT)'T" vTT ', TTTTSVC RTTFW''ATF. l)NllRT 1 (� l lTl Tat II 1)(Nt, T)l� KION2. PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section 8314, 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 agree to comply with the terns and conditions of this statement Owner (or Owner Agent's) Name: .................. . Vla�A�^ �'/ Ly',//Si nature...... .../........6LA .................................... Date: [. ...!...'.I.... Contractor Name: Signature........ ............................................................ Licl...................................... Date:................... Smoke and CO form.doc revised 03118114 CVPERTINO Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 7773228; fAX (408) 777-3333 • building (o)_cupert! no,org _A F1 L po� � h� 5. Please refer to the attached California Civil Code Sections 1101.1— 1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the fonn. Owner' Signature: I No Go to Question 2. Date: 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the properly or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. Owner' Signature: No Go to Question 3. Date: 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: �No Go to Question 4. Date: 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. <,Yes Owner' Signature: Date: My real property is built and available for use or occupancy on or before Januaiy 1, 1994. Civil Code Sections 110 1. 1 through 110 1. 8 apply. Refer to the attached. j My property is a single fancily residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB4072015.doc revised 02/04115 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbingtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and Califo a Gre n Building Standards Code, and manufacturer's installation requirements, and that the water -copse p umb' ixes o ply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: Date: Upon completing and signing this Certificate, please return it to the ))uilding Division in order to final your pen -nit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower -than the figure shown, it is not required to be upgraded. SB4072015.doc revised 02/04115 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 !Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @.60. psi; and must gallons per minute @ default to maximum 60 psi, and must , 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other the above are May be used to achieve unavailable, aerators or reduction: other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower -than the figure shown, it is not required to be upgraded. SB4072015.doc revised 02/04115 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTO ^ BUSINESS LICENSE #I GG,Ze, ADDRESS: ,.CITY/ZIPCODE:.4 '`-01-0f *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date Owner / Contractor Signature Date 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