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15060042 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10374 SAN FERNANDO AVE CONTRACTOR:JACK AND MARILYN PERMIT NO: 15060042 GOODMAN OWNER'S NAME: JACK AND MARILYN GOODMAN 10374 SAN FERNANDO AVE DATE ISSUED:06/05/2015 OWNER'S PHONE: 4087181360 CUPERTINO,CA 95014-2833 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REMODEL(E)HALL BATH TO INCLUDE CHANGING TUB License Class Lic.# TO SHOWER(60 S.F.) Contractor 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 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:$5000 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 APN Number:35712043.00 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 WI 180 DAYS OF P T 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 DAY LAST C D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgme , costs,and expenses which may accrue against said City in consequence_oMe Issued b Date: S agranting of this permit. Additionally,the applicant understands and w p y with all non-point source regulations 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 Of 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) 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 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 �OL Dater! °� Owner or authorized agent permit is issued. U VP 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. .r Date Signatur CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(4008)777-3333-bullding(LDCUpertino.ong � S--0 / o o� ❑NEW CONSTRUCTION ❑ ADDITION I� ALTER.ATION/TI ❑ REVISION/DEFERRED ORIGMAL PPERMIT 4 PROJECT ADDRESS APN R I. 10376{ Say% Fty'nang�o Ue OWNER NAME PHONE E-MAIL halyA, ,SUc<< &acAwt -,4 4 b - i t - r3 M K 400C1,74 Q WIM-7-Goin 15 STREET ADDRESS CITY, STATE,ZIP FAX a 1 Ste+ Gc k. V10 CONTACT NAME ' PHONE E-MAIL iJ , ao�l,nna�n 4o&--1 l M a d G STREET ADDRESS CITY,STATE,ZIP FAX T, OWNER ❑ OWNER-BUIIAER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONIRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � � ry-� LICENSENUMBER LICENSETYPE BUS.LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHI TECT/ENGLNEER NAME LICENSE NUMBER BUS.LIC m COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK1 e O o v -4 +UYi ev- L Ar{ e EXISTING USE PROPOSED USE CONSTK TYPE r STORIES USE TYPE OCC. SQ.FT, VALUATION(S) EXISTG NEW FLOOR, DEMO TOTAL AREA AREA AREA NET AREA -- BATHROOM. KITCHEN, OTHER. REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: Lj DETACH []ATTACH DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEINGADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF I IS THE BLDG AN YES TOTAL VALUATION: PLANNING APPL r ❑NO PL.0.NNING APPROVAL LETTER EICHLER HOME° 0 V By my signature below,I certify to each of the following: I am the property owner ora ` razed aee5�eiit ct on property ovm 's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and v ' accurate. I agree to c ply with all applicable local ordinances and state laws relating to building construct i I authorize representatives of Cuperti to the above-,aroperty for inspection purposes. Signature of Applicant/Agent: Date: (o— 1 S SUPPLEMENTAL INFORMATION REQUIRED *._._ T CHECK T1PJ3v k NOREEN ,. :3t0UTIi�GSLIP�ti New SFD or Multifamily ciNvellings: Apply for demolition permit for - -� OV�RTHE-COUNTER '�� AREVIEPiT,. existing building(s). Demolition permit is required prior to issuance of buildings K - permit for new building. ��xrREss �LAN�rnGATrREvrEw a _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure -© STANDARD t PUBLicwoRTt s form if any Hazardous Materials are being used as part of this project. Y�r LAR('sE ..................... dry { fl EIREDEYT f m Copy of Planning Approval Letter or Meeting with Planning prior to rrIaaoii T 3.sA�.TrAzzv sE�ERnTs�Rlc 5 sub_mittal of Building Permit application. BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10374 SAN FERNANDO AVE DATE: 06/05/2015 REVIEWED BY: MELISSA APN: 35712 043 BP#: 1 *VALUATION: 1$5,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 R3SFDREM WORK REMODEL E HALL BATH TO INCLUDE CHANGING TUB TO SHOWER 60 S.F. SCOPE Uech, Plan Chock Plumb. Plan('hcekFlee.flan Check il-ler.h.Perinil Fire: Plumb.Permil Fee: F'lec. Permit Tree: (Jltte r h4ech. hasp. Other Plumb Insp. Li Other Elec.Inch. ilecla.Ins1t. lee: Plumb, lisp. Fee: E"lec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 60 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: Reg. Q OT 0.0 hrs $0.00 `$E 44' jj 1Q,h]REMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'O W7r1,WliOn CIX: Adininistr•ative Fee: 0 Work Without Permit? 0 Yes E) No $0.00 E) Advanced Planning Fee. $0.00 Select a Non-Residential E) Building or Structure 0 1%'Uvel Doewnentolion Fees" ,, { r Strong Motion.Fee: IBSEISMICRvjN _54 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC SUBTOTALS, 5 $645.00 TOTAL FEE: $64,9.65_ Revis—A05-t 5 Se OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT.•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building Cakupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specifie6at / .... S'ITEADDRESS APN� y� / � �O Z BP#(SL�j{J(U 0-3794, 15, an ►� � OWNEI;:NAMEO_.WNER ADDRESS. Gaodmn.A., n.?o14 ✓, ai ` ,Er roando a :dt DESCRIPTION OF WORK-' �. - r , . A-gs +a dyl 111104 ` 1 J1 J We are providing you with an Owrier-BuilderAcknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit_until you have read, initialed your understanding of each provision,signed,and. returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- der"building permit that erroneously implies that the property owner is providing his or her own labor and material pelrsonally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by a,n,unlicensed person and his or her employees while working on my property. My homeowner's insurance may not p,r vide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my n urance coverage for injuries to workers on my property. G 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. w„ &3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may p.totect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. G 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. ` .G 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the teal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be co. sidered an"employer"under state and federal law. 6. 1 understand if I am considered an"employer" under state and federal law, I must register with the state and et)eral government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject �e to serious financial risk. . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family rdential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by In�ce. nsed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work isperformed under contract with a licensed general building Contractor. 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for g'r% 'financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction t. def:,cts in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 k 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal fe enue Service, the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State Lid" rise Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed co.-tractors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that ache party legally and financially responsible for proposed construction activity at the site address listed above. ".A 11. 1 agree that as the art legally and financial) responsible for this proposed construction activity,I will abide 9 � party 9 Y Y P by all applicable laws and requirements that govern Owner-Builders as well as employers. kf12. notify agree to I a9 the issuer of this form immediately of any additions, deletions, or changes to.any of the (livin . mation'~I�have-provided-on'this form. Licensed contractors,are regulated,bylaws:designed to.protect.the-public. If . you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you maysustain as a.result of a complaint...Your only remedy against unlicensed Contractors:may,be in civil.court. It is:also-important for.you-to understand that if an unlicensed Contractor or employee of that individual or firm is injured.while working on your property,you may be held liable for damages. If you-obtain a'perrriit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) ' hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned.to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si nature. _ Property Owner's.Signature: Date:,__...�. --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owne►'s driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10 cv143.00 in - ` O 000 Vanity Counter electrical rn Shower/Tub � ' o < m co a M a.a. co 0 0 M n C n ® p� c; v X r_ W Z m CD 0 rt �3 �p � cDn�s Guest Bathroom 4J Goodman Residence COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO Q APPROVED ® This set of plans and specifications MUST be kept at the 101 job site during construction. It is unlawful to make any changes or alterations on same, or to deviate 118Ctherefrom, without approval from the Building Official. ® The Stamping of this plan and specifications SHALL NOT be held to permit or to b--e an val of the violation of any prov' ' n or State Law, 5 PERMIT# / J 4� Z SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE / COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION •CUPERTINO, CA 95014-3255 10300 TORRE AVENUE CUPERTINO (408)777-3228• FAX(408)777-3333• building(a,cupertino.orcl Permit No. b l d � �- •� Address 6 r __ � z F_1� �� 0� #of Alarms Smoke: ,, Carbon Monoxide: ' �- PERMIT CANNOT BE FIN�L'FjD AND COMPLEEDu kJN�TIIi THIS41 CERTIFICATE ' . � �" � -.��-� ��€ e4�"" ,- � �-� � �,y'i J `3-.h=ro �rt�� • �il � 'i'� 4��'����`,F�i����-0�.I�f��.r i"ny��.q� °y 7' �h .$" 'S r.�,, �'k , 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 X X bedroom(s) 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 com 1 with the terms and conditions of this statement Owner or O r Agen' Nam f - Si nature.... :...........................................Date: Contractor Name: Signature...................................................................Lic.#......................................Date: ................... Smoke and CO form.doc revised 03/18/14 S I L J WATER-CONSERVING PLUMBING FIXTURES 1 OWNER CERTIFICATE OF COMPLIANCE coLly COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUI'ERT[N't7 (408)777-3228• FAX(408)777-3333• building(cDcupertino.org Owner Namea /-//&)l APennit No. ! e Address _.X PE�tNIIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE ,' ]ELAS B1EEN + AND IZETiTRNED TO THE BUILDING DI�ISIUN 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 ffortn. Oester, S.ignature:_ - ' ;Date 777%o �"�-- Go to Que"Ll." ston 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property 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. Date � Oto Go nei' ; JLNo uestfon 3. 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. s _ Owner': mate o o o GtQuestion 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. `s �'Owier'S� natu]eF Dat �use e��Y_es` My real property is luiltand availa e for or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. My property is a single-family 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=6,be replaced with water-conserving plumbing fixtures throughout the building. On or before January 1, 2017, a1:l non-compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of wlether`property undergoes alterations or improvements). ❑ Myproperty 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. SB40 7 2015.doc revised 02/04/15