15120131CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19975 PEAR TREE CT
CONTRACTOR: SEARS HOME PERMIT NO: 15120131
IMPROVEMENT
OWNER'S NAME: GRANT TERRY L
1024 FLORIDA CENTRAL PKWY DATE ISSUED: 12/15/2015
OWNER'S PHONE: 4082573189
LONGWOOD, FL 32750 PHONE NO: (925)245-2000
A LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMODEL (E) KITCHEN (150 S.F.), NO STRUCTURAL
Z
ZCiLic .#% / %
License Class C 1 O��
CHANGES
((C
��L S 0[01F V4Dat�!L 1 t
Contractor1'1
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
Sq. Ft Floor Area:
Valuation: $9406
pe mlance of the work for which this permit is issued.
r "ve and will maintain Worker's Compensation Insurance, as provided for by
s e tion 3700 of the Labor Code, for the performance of the work for which this
pe
APN Number: 31630088.00
Occupancy Type:
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 agreecomply with all city and county ordinances and state laws relating
WITHIN 180 DAY IT 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 M CALLED INSPECTION.
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 understan�•����d`will comp y
sued Date:
with all non -point source regulations per the Cupertin nifi cipal Code, Section
9.18.
RE -ROOFS:
Signature Date`0A1eL I f S
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.
❑ OW"- tTLDER 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)
I, 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 ManagementDistrictI
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, C ap a{r 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 25 34.
r
Owner or authorized agent: Date:
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
CONSTRUC IO NDING AGENCY�-
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CUPERTIN0
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 • buildingacupertino.orcl ,y
V< PT.I IMRTN(T F-1 MF(-14ANT(-AT �T P( TI?T( AT
F�TATC( PT T AT�Tp()T m
PROJECT ADDRESS r�
APN #
OWNER NAME / 2,4,J
PHONE 25 7`3 1 q
E-MAIL
STREET ADDRESS
Pe/1-7- I FLC-L C�
CITY, STATE, ZIP
c -2'T IA)0 /� fsdf
FAX
CONTACT NAME BERNIE MATHESON
PHONE925-245-2013
E-MAIL
STREET ADDRESS
283 E. AIRWAY BLVD.
CITY, STATE, ZIP .
LIVERMORE,CA 94551
FAX
925-245-2017
y
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT LJ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
BERNIE MATHESON
LICENSENUMBER 721379
LICENSE TYPE B,C10
C17 C6
BUS. LIC#
COMPANY NAME SEARS HOME IMPROVEMENT
E-MAIL
FAX 925-245-2017
STREETADDRESS 283 E. AIRWAY BLVD.
CITY, STATE, ZIP LIVERMORE, CA 94551
PHONE 925-245-2013
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF 0_SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK `AjeAZ
/
TOTAL VALUATION: 06
EIVEDB
By my signature below, I certify to each of the following: I am the property own orizcd agent to act on tilpio Ter's behalf. I have read this
application and the information I have provided is correct. I have read the De Iption of Work and verify it is acc . agree to comply with all applicable local
ordinances and state laws relating to building construction. epresentatives of Cu ertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 1 Z /I S Ll S
SUPPLEMENTAL INF
ION REQUIRED
OFFICE USE ONLY
w
❑ OVER-THE-COUNTER
o.
❑ EXPRESS
U•
x
❑ STANDARD
zU
a
a
❑ LARGE
❑ MAJOR
MEPMiscApp_201 1. doc revised 06121/1 /
CITY OF CUPERTINO
W�WDJE FFF, ESTIMATOR - BUILDING DIVISION
,.
ADDRESS: 19975 PEAR TREE CT
FDATE: 12/15/2015
REVIEWED BY: melissa
C?t:1t. ix;ti?i
APN: 316 30 088
BP#:
'EVALUATION: 1$9,406 -1
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
Suppl. PC Fee: Q Reg. C) OT
PENTAMATION 1 R3SFDREM
USE:
$0.00
PERMIT TYPE:
WORK
REMODEL E KITCHEN 150 S.F.),NO STRUCTURAL CHANGES
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, sanitary sewer utstrict, scnoot
11:cfr:nf afn 1 Thaca fooc nra hnevd mi iho nralitninary i"Mrmatinn availahlP and arP nnly an Ps imatP_ Contact the Dent for addn'l info.
FEE ITEMS (Fee Resohrtion 1.1-053 Eff. 7/1/132
FEE
QTY/FEE
MISC ITEMS
C?t:1t. ix;ti?i
('r.�!!;fy
$0.00
= s.£
$645.00
%1 } . lyitiit �. ie`i'n':
T7
Suppl. PC Fee: Q Reg. C) OT
0.0
Plan ("he'c
$0.00
PME Plan Check:
:ji•':
Nlf7L. x ii71iI
$0.00
(L. ItNft%Ir 'S4:
YJ:ch.
hrs
$0.00
_T
01he!Jh!r;i,, ns..,.
$0.00
PME Permit Fee:
$0.00
7'Ie'.!%i'
('Onsirveli n
IY' r)
:1:'s,. IzL.
[�b;i.I.
�.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, sanitary sewer utstrict, scnoot
11:cfr:nf afn 1 Thaca fooc nra hnevd mi iho nralitninary i"Mrmatinn availahlP and arP nnly an Ps imatP_ Contact the Dent for addn'l info.
FEE ITEMS (Fee Resohrtion 1.1-053 Eff. 7/1/132
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s.£
$645.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee: Q Reg. C) OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
_T
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
('Onsirveli n
G
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G).ir�.-�r/
0
A
/)rpt-tr¢rc°artrl/{� /a'yx>:
Strom Motion Fee:
IBSEISMICR
$1.22
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTAI;S:
$2.22
$645.00
TOTAL FEE: •
$647.22
Revised: 10/01/2015
'" TY DE`-LOPI*.! EHJT DEPARTMENT
BLUILDiNG DIVIS!ON - CUPERTINO
�/�R`.'
li.(1 SIS Gp'a' �'U
F!, ;c. F - t Of Plans and specifications MUST be kept at
consfiuetion. It Is unlawful to make e
-s nr U!Le, tiOi`IS on same, or to deviate
gni, witl gout approval from the Building Offici
T!,:). «,'., i C3inG! of this plan and specifications SHALL P
k?C: ",�:Id 'i0 p -e! -unit or to be an =��val of t!�e violatiC
of 1-,ny ^rovI^+ dinance or State La,
-ATE
PERi'01T NO.
NOTES:
1. TWO OR MORE 20 -AMPERE CIRCUITS FOR ALL
F"
RECEPTACLE OUTLETS FOR ALL SMALL -APPLIANCES DROP (N) WASTE LINE FOR
w
LOADS, INCLUDING REFRIGERATION EQUIPMENT, IN THEF&'`
KITCHEN, DINING ROOM, PANTRY AND BREAKFAST ROOM /� i �7 /a/ ��Q
T
0 LO
o�
OF A DWELLING UNIT. THE COUNTERTOP RECEPTACLE (N) (E) (E) (E) (E) (N) (E)i`i _ �q
LO
j
m
OUTLETS IN THE KITCHEN MUST BE SUPPLIED BY NO
FEWER THAN SMALL APPLIANCE BRANCH CIRCUITS.
(2)
THESE CIRCUITS MAY ALSO SUPPLY OUTLETS IN THE i a (E} FRIDGE �\ e�8 00 y�
PANTRY, DINING ROOM AND BREAKFAST ROOM, AS WELL 1 0 0 (N) ELEC. D/W L F
' � �
CD
AS AN ELECTRIC CLOCK RECEPTACLE AND ELECTRICAL �� z (NO CHANGE) �\
�
A`
\\�
CLi
M
LOADS ASSOCIATED W/ GAS FIRED APPLIANCES, BUTM
() /��1�,
co
THESE CIRCUITS ARE NOT PERMITTED TO SERVE ANY
(E) LED
u
OTHER OUTLETS, SUCH AS MIGHT BE CONNECTED TO
(NO CHANGE) (N) COUNTER -TOPS, (N) SINK, �\
o
EXHAUST HOODS OR FANS, GARBAGE DISPOSAL AND
DISHWASHER. RECEPTACLES IN KITCHEN SHALL BE GFCI (N) SINK FAUCET HOOK-UP
cn
PROTECTED. (E)
w
J
2. SEPARATE BRANCH CIRCUITS SUITABLE FOR THE LOAD
cn
$
ARE REQUIRED FOR EACH APPLIANCE; DISHWASHER ( E) (E) LIGHTING ��
(20amps) GARBAGE DISPOSAL (20amps), TRASH
LU )
COMPACTOR, ETC. PROVIDE DISCONNECTING MEANS o ¢ w (NO CHANGE z LIGHTING
WITHIN THE LOCATION OF THE UNIT. THEY MAY BE CORD ¢ (E)
cc I 6
_ >�
o W:
CONNECTED RECEPTACLES OR A SWITCH WITHIN THE (220) °C (NO CHANGE)
"'' "
LOCATION OF THE UNIT.
\�
(N)
3. A RECEPTACLE SHALL BE INSTALLED AT EACH SPACE
THAT IS 12 INCHES OR WIDER. RECEPTACLE OUTLETS
m
SHALL BE INSTALLED SO THAT AT NO POINT ALONG THE
g =
Z
WALL IS MORE THAN 24 INCHES MEASURED (E) OVEN
(220)
HORIZONTALLY FROM A RECEPTACLE OUTLET IN THAT (NO CHANGE)
SPACE. OR 48 INCHES FROM RECEPTACLE TO
RECEPTACLE.
4. RECEPTACLE OUTLETS SHALL BE LOCATED ABOVE,O
BUT NO MORE THAN 20 INCHES ABOVE THE (E) (E) (E)
U rn
COUNTERTOP. RECEPTACLE OUTLETS SHALL BE
z L.J
PERMITTED TO BE MOUNTED NOT MORE THAN 12 INCHES
Cr_ � U
be
BELOW THE COUNTERTOP. IT SHALL BE PLACED NOT IN A
BELOW
F__
! Y
FACE -UP POSITION ON THE COUNTERTOP.
PROPOSED KITCHEN = 150OT
FFICE COPW
O
w
5. ALL 125V 15 AND 20 amps RECEPTACLES IN THE
°-
�.
KITCHEN AND DINING ROOM SHALL BE LISTED AS KITCHEN DETAIL
LO w
d :)TTAMPER
RESISTANT RECEPTACLES.
Cn
6. IF ADDING OR REPLACING LIGHTING IN THE KITCHEN, A
U
,--
MINIMUM OF 50% OF THE TOTAL RATED WATTAGE OF
°"'B 12.10.15
PERMANENTLY INSTALLED LIGHTING IN KITCHEN SHALL SCOPE OF WORK:
sCAE NTS
BE HIGH EFFICACY. ALL LOW EFFICACY LUMINARIES IN INSTALL (N) IN SAME LOCATION AS (E);
THE KITCHEN ARE CONTROLLED BY A MANUAL -ON N COUNTER -TOPS, (N) SINK, (N) SINK FAUCET HOOK-UP. 3) (N)
OCCUPANCY SENSOR, DIMMER OR AMULTI-SCENE ( ) (
DBawNBY DKW
PROGRAMMABLE CONTROL SYSTEM. SWITCHED GFCI OUTLETS ON (E) LINE, W/(2) CIRCUIT UP -GRADE TO COMPLY
SEPARATELY FROM ANY HIGH EFFICACY LIGHTING. W/ CURRENT CODE. DROP (N) WASTE LINE FOR (N) GARBAGE
J°B 19536253
sH.R
DISPOSAL & ELECTRIC DISHWASHER. INSTALL (N) ELECTRIC RANGE.
A-2
5 SMOKE I CARBON MONOXIDE ALARMS
0WRER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 n FAX (408) 777-3333 • buildinaCcDcupertino.org
b R.'&UT CANNOT BE j('I1r ALED AND CO.MPLJC).Y troy UNTIL TMS S CERTIFICL'1 E
HAS
.1L1;6J.L V "1 . _ L`{.iy TICTRE;B,fL! u n r :0. '1 L 'ON
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 each sleeping room
X
Carbon Monoxide alarms are not required iz dwellings which do not contain fuel-burnilg 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 dweHkag. 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 rust be connected to the building wiring.
As owner: of the above -referenced property, I hereby certify that tl`ae alarms) referenced above has/have been
imstal'led in, accordance with the � � �anufac � �rer s instructions and in c o-m-p-11anice with the California Build'< < ,g
and Califonda! Residenstial Codes. The alarms have been tested and I are operational, as of the date signed
below.
11 have, read and agree> f'o? comply with then ter<<s.' andl rz ori diflnnq. of ffiihc. cf.•'aiam znb
Smoke and COf form.dbc revised 03/1-8f1i4l
_. ... . -
006 actor'Mame:
06 ___,,..... ....................................................... ... •:...... Dater � w
Smoke and COf form.dbc revised 03/1-8f1i4l
' OWNER CERTIFICA E OF C-OMPL AN CE
COMMUNITY DEVELOPMENT DEPARTMENT e, BUILDING DIVISION FILE
' CUPERTINO10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 q>7/b'
(408) 777-3228 FAX (408) 777-3333 - bull ding(kmertlno.oro
Owner Name', R y --6--A A.Aw- Permit No
Address _ ®� 9,r_= - G U1
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 fon-n.
MR 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 fonn and sign bottom of form.
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.
9 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.
fK Yes Ivey 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:
.l 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-
com, plianti plumbing fixtures shall be reptaced with water -conserving Plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
D My property is a mutt family residential real property. See Civil Code Section 1101.5.
On and after January 1, 20114, specified, building alterations or irnproveinents shall require non- compliant
plumnbingfix t : reg to be replaced with water -conserving plumbing fixtures.
0`a or before January 1,, 2019,,. all non-compliant plumbing fixtures shall be replaced with water -
conserving pluinbing fixtures tfiroughout the building (regardless of whether, propt- Cy undergoes alterations or
improveinents)�
0 M-yproperty. is a coni-nzeiceat real pr•.operty. See Civil Code Section 1101.5.
On and after January 1, 2014,. specified bunldimng alterations or hmprovtrnents shall require non- compliant
plumbing. fixtures to be replaced withwater-con-serving plumbing fixtures.
On or before Jlanuary 1, 201:9', all non-coinpliarnt plumbing fixtures shall be replaced with waiter- conserving
plumbing fixtures throughout the building (regardless of wlnether-property undergoes alterations or tiriproveiments).
I,. as the; owner or owner's agent of this property, certify under penalty, of perjury that cion -compliant plumbing fixtures will be
replaced) prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
throug�l 1011.$, the, current Califoni�naa Plumbing Code and. Califoniia Green Building Standards. Code, and rnanufacturer's
insta ,'&tion Fequi-heirients,, and that the water -conserving plumbing fixtures comply with the regia i.-ement& as: indicated in the
table on, the- follbwing, page:_
Owner or, Owner Agent"s SignatrJrc >
Lipon: completing, and signing this; Certificate, please return it to the Building Division. in order to final your buildin.g.perrnit.
SB'40,7 2015.doc revised 08126115