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15100145I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 1081 MILKY WAY OWNER'S NAME: BLALACK JENNIFER M AND RUSSELL CONTRACTORi` .h PERMIT NO: 15100145 DATE ISSUED: 10/19/2015 OWNER'S PHONE: 4089666417 1 , ] PHONE NO: LICENSED CONTRACTOR'S DECLARATION License Class o �,_ Lic. Contractor CC4N �YiiIiA Rp4yoC _ 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. 2. 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 e 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 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. 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: 1. 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. 2. 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. s. 1 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 ❑ VOLUNTARY FOUNDATION REPAIR Sq. Ft Floor Area: I Valuation: $7400 APN Number: 36219001.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAVISLED INSPECTION. a 41- U ,C l 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. Ownerr uth i2 a � Date:10-19-16- 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 CONSTRUCTION PERMIT APPLICATION -ANJ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERT[NO (408) 777-3228 • FAX (408) 777-3333 - building (c)cupertino.Ong F— NEW CONSTRUCTION n ADDITION n ALTERATION / TI n REVISION / DEFERRED ORIGINAL PERMIT n PROTECC ADDRESS I LICENSE TYPE APN # 1 U / OWNS IA , r ` STREET ADDRESS PHONE /� a) / ti �� E-MAIL ARCHITECT/ENGINEER NAVE STREET�D SS CITY, STATE, ZIP 4 E-MAIL FAX CONTACT NAME CITY, STATE, ZIP PHO E-MAIL STREET ADDRESS ,,�� , � � � f,l1 � � CITY, STATE, ZIP -Cr © FAX ❑ OR'NER ❑. OWNER -BUILDER ❑ O"Aq a.R AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAN CONTRACTOR N'AM ILICENTSENL14BER I LICENSE TYPE BUS. LIC COMPANY N ,E Lali&2014f, igefroa i E-MAIL i ? T l FAX STREET ADDRESS CITY, STATE, ZIP Cfj t, PF�QNto ARCHITECT/ENGINEER NAVE LICENSE NUMBER BUS`. LICC 9 COMPANY NAME. E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE OF WORK ^v% n' 1->f LPr c:'W o t-ok 4 a irk a Dn k v V-vN(-i-c, Yi,K-.- r -,v. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES Signature ofApplicant/Agent: Date: (� i 8 SUPPLEMENTAL II\TPOR-MATION REQUIRED _ USE TYPE I OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL permit for new building. EkPREss FDPI:AI�'I1IllGPLATIRE�'IEW_�` nt AREA AREA AREA NET AREA B ATHROOM KITCHEN OTHER Copy of Planning Approval Letter or Meeting with Planning prior to REMODEL AREA REI,IODEL AREA REMODEL AREA s��ITARYSE�FERDISTRICT PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH I # DWELLINGiJNTIS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ ES BEING ADDED? ❑NO ADDITION? ENO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDGRECEIVTZ OTAL VALUATION: PLANNING APPL []NO PLAI\'NING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or t d aged act property owner's behalf. I have read this application and the information I have provided is*C-O. ve read the Description of«pork and ver' Is accurate. I agree to complyWith all applicable local ordinances and state lav s relating to buildinguthorize representatives of Cupertino to enter the above -identified pr perty�f-or inspection purposes. Signature ofApplicant/Agent: Date: (� i 8 SUPPLEMENTAL II\TPOR-MATION REQUIRED y20IiTII�TG;SLIP` I�Tew SFD or Multifamily d-ovellings: Apply for demolition permit fory�� TTCOTJItTER sf c�BITIZDL�'GL4N REVIEW .': g existing building(s). Demolition permit is required prior to issuance of building r� .7 _ i �i 'YI �t��.v3 •yz 3 a� L "�ZS�� �� ���' "��.L2<+£�'�aayr'��=.M1�i7 ���;+F permit for new building. EkPREss FDPI:AI�'I1IllGPLATIRE�'IEW_�` nt Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Jc ,Y C_7 STA>\DARD TT��'//�'VS>4SCp�IC�Jy�'�',.eh�.i`i�e��+.�.. ��- PllDLTI.• 1'T OLIl\il 1-00 form if any Hazardous Materiais are being used as part of this project. 5 Copy of Planning Approval Letter or Meeting with Planning prior to flMA7oR submittal of Building Permit application. s��ITARYSE�FERDISTRICT BIdg.4pp_2011.doc revised 06121/11 CITY OF CUPERTINO 117P—M FEE ESTIMATOR —BUILDING DIVISION ADDRESS: 1081 milky way DATE: 10/19/2015 APN: 362 19 001 BP#: REVIEWED BY: melissa *VALUATION: 1$7,400 *PERMIT TYPE: Building Permit Elec. Pl(m C lrech PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p Flec. Permit Fee PENTAMATION 1 GENRE PERMIT TYPE: WORK voluntary foundation repair SCOPE 0.0 hrs 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 Dreliminary information available and are only an estimate. Contact the Devt for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/132 :Mech. flan (Jzeck Plumb. Ulan (."heck Elec. Pl(m C lrech 21,fech. Permit.h'ee: Phunb_permit lyes:', Flec. Permit Fee Other .Meeh. Insp. Other Plumb Ins*. t )ther Elec. Lisa. Suppl. PC Fee: Reg. 0 OT 0.0 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 Dreliminary information available and are only an estimate. Contact the Devt for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.001= # $859.00 Foundation Repair IFOUNDREPA Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ,, .s -action Tai:, 4i/P)lhf istl"t'tfivc 1`,ee' O Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Q o � Travel r.�E)C;'il)l?L'i?/(TtIE)1? �"E'.G's: Strong Motion Fee: IBSEISMICR $0.96 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.96 $859.00 TOTAL FEE: $860.96 Revised: 10/01/2015 01. California Retrofit 510-253-8628 Constiuction Contractors Lick. #956185 Scope of work 1) Seal crack on perimeter foundation using Simpson epoxy in side and over the crack on 3 locations. 2) Install steel flat plate 10"x 10"x 1 /4 thick over the crack on aither side with two epoxy bolts 1/2"W'. As it show on page #2 Pe- r c � C t t3 t .2 �3 gC �� Uy-c4trio Roy'l i e t cc l C o v.6 c Owner address: Russell & Jennifer Blalack 1081 Milky wy Cupertino, CA 95014 Cell (408)966-6417 ;F.. _CUPER i�Uild r�No ��9 DPpartMent r'n JJ dd OC � 1 r � 2015 . VE�, Pof� cr�oE C Kev,eWea By, cWLIgNCE '00410 Y oFcz 4 4'-0* - -- 46' 4' ;.J 5 A k� -VeY FWWIL C,y-A Lo caq oto. S gp+ Ao 10W�on� OXN 5 1,coo OY\ 40p ay\j Iwo oh \"llloo 14 ��ohouj f as I L4, 161 w r)a \3 CUPERTINO Hufldino F)PTartinent OCT 19 2015 REVIEWED F:0R CODE COMPLIANCE Reviewed ---- ----- CUPERTIN 1�J �k`�d � — \ t _ i , o - ' .. .�_ i-, i.{ � �•.+ i ➢z •e 1. I �g. i �« A COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 I 65-i5f/ _r (40 8) 777-3228 • FAX (408) 777-3333 ^ buildingCcDcupertino.org Owner Name Ii�Le s-5 CL [_ k. T N t� i 1 E J2 )-2, L_- ,$ L A- C /L Permit No f `7_ Address 1 tg / 4 -J / L (C �i GiJ /1 �l 't -1 Oef,(2 —1 / y\'D 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn. X No Go to Question 2. 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. Skip the rest of the form and sign bottom of form. 9V No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 12 IN No Go to Question 4. 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. Skip the rest of the form and sign bottom of form. � Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: 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 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. 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, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following nage. ,`�, _ i _. Owner or Owner Agent's Signatu� n� ��_ Date,- kee --,)�- J S Upon completing and signing this C�-hficate; !'cease return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08/26/15 BUI LDL �G PERN�IT Ci0TNTOT BE FENALED AlTD COiYII'LET D TTAT�7 T7 THISCERTIFICATE HAS BEEN STC; , -A!�'D RETITRNED TO -THE BV LDV1NTT sEDB71SIONN 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is no rcgUIECu Lu uo upr,iaucu. SB407 2015.doc revised 08/26/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usa a/Flow Rate i Fixture Type 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 /Flow Rate 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 means 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 no rcgUIECu Lu uo upr,iaucu. SB407 2015.doc revised 08/26/15 SMOKE d CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPUANCE . MIA COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION ECUP hRTIGS 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 o building(d.cupertino.org 1: Ian 0ebY 8:cic PERMIT CANNOT BE FINALED ANI) COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SYCN , AND 131,TURNFD TO THE BIDING DrviSION 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 sh-igle-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 hasihave 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 terms and conditions of this statement '.O.wr F-, (D.wner-Agent�s,)-Name: i,tSSis J L4 -L4 -CK si`n_a__:ture.-��— ate_: -2. ` Ci refractor-Name:jx 4 'J _1; �9"�A I�L G� Signature. .'Lica# Datic:1 .IQ ."i Smoke and CO form.doc remised 03/18/14