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15120083Fii CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20488 STEVENS CREEK BLVD UNIT 1607 CONTRACTOR: RICHARD R JONSON & PERMIT NO: 15120083 RACHELSANTOS OWNER'S NAME: RICHARD R JONSON & RACHEL SANTOS 20488 STEVENS CREEK BLVD UNIT 1607 DATE ISSUED: 12/08/2015 OWNER'S PHONE: 6502798549 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] REPLACE (E) WATER HEATER, SAME LOCATION License Class Lic. # 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: $3344 1 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: 36953167.00 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 18 . S -OF -P RMIT 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 18 MD -S-FR - LLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, City in the costs, and expenses which may accrue against said consequence of I /� ' Date: granting of this permit. Additionally, the applicant understands and will comply Y -/- with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 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 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) „ 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. Date oCAJ�iJ� /a Owner or authorized agent per. it is issued. 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. �'IVl� l a J Signatu � 1� �~� /J GENERAL PERMIT APPLICATIONMEP COMMUNITY DEVELOPYiiENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 9501A 3255 (408) 777-3228 • FAX (4-08) 777-3333 • build inG(c)CUDerinO.Orq ❑PL 3ING ❑ Vj—=kl\7C.kL ❑ ELECTRICAL ❑ Aa-ISCELLA—NMOUS PRO= ADDP.Ess OW1iRNA�Js �U �1V D�Ii� t`✓ �lJ /J v"" " I v Pi?Ol� WS"U / 1 a 71 E.IJaIL rre4 1 �6 m(N A�. `tel v Vc�'_"µ ST=T ADDRESS OCqe m , I CITY, STATE, ZIP ' �i� x f I FAX ,r CONTACT N.4 R ✓E VL+f1 L` v PHO;\ /`/Vr E-1viAIL STREET ADDRESS �a,M ® r 1 ry CITY, STATE, ZIP r ?�9► lyc.� ;�rOv+R'-a- ❑ ORn r -R AGET ❑ CONTRACTOR ❑ C01.7'P.A.CTOR AG NT ❑ ARCH= -ECT ❑ ENGiT=ER ❑ DE'ELOPE ❑ TEK,4h7 CO?QTRACTORNA]L eA PjTLLICE?.SMel.EATU]"/BER/� 5; i) I LICENSEi1-PE I_ I I�S.LIC1 C01JP.i�YN.i� 1� f N /, CT E-MAIL FAX STREETADDRESS(yyh 1 i 0'i 09 qS // "ITY, STATE, Z P PHONE A:R CETECT IENGNEER N.4A<E LICENSE NL A113ER I BUS. LIC COIJ.PANYKlkiJc= E -M -Am I FAX STREET.4DDRESS CITY, STATE, Zi? I PHONE USE OF ❑ SFD or DUPLEX ❑ MUL TI-iA-24LY PROJECT N WZDLP�TD ❑ YFS PROMECT LN ❑ YES IS THE BLDG AN ❑ � �S BUZTDLIG: ❑CO],9,=-r-.CL4L URBANR.'i=RFACHARrA ❑ NO FLOOD ZONE ❑ No EICILER$01✓'c? ❑ No I DESCMPTION OF WORK �t S OF Vv hTeVe)f 4 -iZ X0700 AVOWD TO amo-et l 49LAIZOAf\1/ 5D4 6N TOTAL VALUATION: ( 4q By my signature below, I Cei:ify to each of the following: I am the property owner or au`uorized anent to act on the property Owner s behalf. I have read this application and the information I have provided is correct. I have read the Description of'Work and verify it is accurate. I agree to comply with all applicable local ordinances and s`te lzv,'s relit ng fo bu ldinQ constrBuct/ios. I au horize rlpre =ntatives of Cupe Lino to enter he above-ide ned o��y for ction purposes. Si amre ofApplican /Agent: Vw VJ = Date: SU-PPLEMENTAI. D\ F 0RvfATI014 REQUIRED -r -y; ORFSCE.LSEONLI s ��`OVE1rTS3E Cwkii O,i�'R�'ER X"z 0.2 ; ZTRnE3 'S 4 3 � .t . C r .. 3� 1v1'EP7�isc-,iDp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION APPLIANCE EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater J 1PRWHEATR 1 # $29 TOTALS: $29.00 Ale, h. Ilan Plumb. Plan Check 1 0.0 1 hrs $0.00 Plo,-1 Check Plumb. Permit Fee: IPPERMIT Te(�. Other Plumb Insp. 0.0 hrs $48.00 0"'her AIech, 11 e: NOTE.- This estimate does not include fees due to other Departments (i.e. Planning, Public worxs, itre,,Yanitarysewer vtsrrict,,Nciiooi n—'.. i Irl, nc.n inn n h—dnm ilia nralimi""ri) i"fnrmatinn 17vailahloand aro nnhy an ovfimatp- 1-nntart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) ADDRESS: 20488 STEVENS CREEK #1607 DATE: 12108/2015 REVIEWED BY: MELISSA Plan Check 1e`ee: APN: 369 53167 1 BP#: *VALUATION: 1$3,344 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION PRWHEATR F -PERMIT TYPE: A WORK REPLACE (E) WATER HEATER, SAME LOCATION SCOPE L -- SUPPI, APPLIANCE EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater J 1PRWHEATR 1 # $29 TOTALS: $29.00 Ale, h. Ilan Plumb. Plan Check 1 0.0 1 hrs $0.00 Plo,-1 Check Plumb. Permit Fee: IPPERMIT Te(�. Other Plumb Insp. 0.0 hrs $48.00 0"'her AIech, 11 e: NOTE.- This estimate does not include fees due to other Departments (i.e. Planning, Public worxs, itre,,Yanitarysewer vtsrrict,,Nciiooi n—'.. i Irl, nc.n inn n h—dnm ilia nralimi""ri) i"fnrmatinn 17vailahloand aro nnhy an ovfimatp- 1-nntart the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check 1e`ee: Suppl. PC.Fe, e PME Plan Check: $0.00 SUPPI, PME Unit Fee: $29.00 PNM Permit Fee: $48.00 ("Onsiructhni 71�x- Administrative Fee: JADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 4 $171.50 $0.00 TOTAL FEE: $171.50 Revised: 10/01/2015 i� CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(c1cupertino.orq — 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 specifiedat: SITE ADDRESS 11:1v1 L_*10,77.APIC, . A—I 1:Z OC) Q BP#v foU g.3 OWNER NAME OWNER ADD.RESs_ 9W DESCRIPTION OF WORK. [ AWKI `*r" VVd`ft We are providing you with an Owner -Builder Acknowledgment 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.) I I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- B`ulld r" building permit that erroneously implies that the property owner is providing his or her own labor and material pers ally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an uricensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurs nce coverage for injuries to workers on my property. '2. 1 understand. building permits are not required to be signed by property owners unless they are responsible for the donstruction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may _rot'' ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her na & instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license nuriibers on permits and contracts. . I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tot''I value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. I understand if I am considered an "employer" under state and federal law, I must register with the state and fede�al 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 meserious financial risk. . I understand under California Contractors' State License Law, an Owner -Builder who builds single-family reside. tial structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensd subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pert- rmed under contract with a licensed general building Contractor. P 8 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for nancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defect in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 I understand I may obtain more information regarding my obligations as an "employer' from the Internal s Service, the United States Small Business Administration, the California Department of Benefit Payments, California Division of Industrial Accidents. I also understand I may contact the California Contractors' State Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed 0. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I party legally and financially responsible for proposed construction activity at the site address listed above. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide plicable laws and requirements that govern Owner -Builders as well as employers. 1 . I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the inform ion -I -have -provided on this form. Licensed contractors are regulated by-laws 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 may sustain as a. result of a complaint.. -Your only remedy against unlicensed Contractors maybe in civil court. If is -also important for you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured .while working ori your property, you may be held liable for damages. If you obtain'a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or note 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.) I hereby affirm that there is aconstru ' n 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 verifv the property owner's signature. „ w Property Owner's Signature' ,sem l(ffn�!L'//✓''-4,, Date:_;-�_ I --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE. The following Authorization Form is required to be completed by the properly 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: Address of Authorized Agent: Tel No 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 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 signature. Property Owner's Signature: Date: OwnerBuilderForm. 2010.doc revised 04/14/10 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: Wto''D 51WV9 -6 C'� ;5LVV. *-� WV 7 PERMIT # ('5 OWNER'S NAME: 1;1CjVA-D J® "E) 0 _ PHONE # GENERAL CONTRACTOR: v �-� K i?L MRN BUSINESS LICENSE # ADDRESS: ?Q. 3 23Zl1 4A _ Cj�- cjs),S,-7 CITY/ZIPCODE: your 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 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 / Contractor Signature 1-2-, 10. 2,D/S Date OWNER CE:RTIFICA E O6= COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION CUP E6 T1 0 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 > FAX (408) 777-3333 - building(@cupertino.oro Owner Name " WN-It�z> J 8 M SD r4 Permit Address _ ��i -�-Tuy" S a-yur1c. B Lxis� , 160 1. Is your real property a registered historical site? 2es Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn. 0 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. 61 A CZ No Go to Question 33. 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. r i�rNo Go to Question 4. 4. Is your real property built and available for use or occupancy on or before Janus, 1, 1994? VNo 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 affer January 1, 2014, specified building. alterations or improvements shall require non- compliant plumbing. fixtures to be replaced with water -conserving plumbing fixtures. Oh, or before January 1,, 2019,. all non-compliant plumbing fixtures shall be replaced with water- conservk,gplumbing fixtures throughout the building (regardless of whether pToperter undergoes alterations or iinprovernents). ❑ M.y property is a comnier•cial` 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-corripliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or r nproveluents). 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 tlu:ough P 101.8, the-cun!ent California Plumbing Code and California Green Building Standards. Code, and manufacturer's installation., requi+reinen•ts,, andi that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the foll"owine• na,ee. Owner orOwnerAgent''s SignDatea 14., Zvj r Upon, completing and, signing, this Certificate, please return it to the Building Division i -n order to final your building permit. SB407201'5.doc revised 08/26/15 fCUPIERTONQ - iiJ i i *� �" y � •moi ' i ', [ � i 7YJ a � �7 t�, ! ri COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • building (d)cu pe rtino.org 2Q 408 s�v� s c Ir- $�,vb . � ��:�� 1 S ► Z as � 3 PE)[R.'WT CANNOT BE FINALED AND COINP LETED UNTIL TQM CERTIFICATE 5 BE, F ' a Y '� ..tilR.D rE TO '7[" E BUILD1�1� .�D�'4TISIO.1'il 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 AILARM 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 )( 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 Calfonlia Residential Codes. The alarms have been tested and are operational, as of the date signed below. r have read and agree to, comn1v with, thi- fPr/ ,.q and'' r`nnril-flnn_z n{ thfe cfakomonf '�Q�ftc��o�a9tzx�rAgen�s)�lam�: Si" hare .............. 3 Con a fort ame: si......................................... ........................ Lic.................................... Date:` .... Smoke and CO form.doc revised 0311'8/1.41