B-2016-1501 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR; PERMIT NO:B-2016-1501
19928 PORTAL PLZ CUPERTINO,CA 95014-3366(369 45 016) (RECON360 LLC)
SAN JOSE,CA 95118
OWNER'S NAME: BIELAS DANIEL ET AL DATE ISSUED:03/11/2016
OWNER`S PHONE:888-277-5580 PHONE NO:408416-5000
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B.C-39 Lic.#950805
Contractor(RECON360 LLC)Date 03/11/2016 X BLDG _ELECT —PLUMB
_MECH X RESIDENTIAL._COMMERCIAL
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. JOB DESCRIPTION:
REPLACE(E)STU(CO PRIVACY FENCE AND REPLACE WITH(N)
I hereby affirm under penalty of perjury one of the following two declarations: (LIKE FOR LIKE): 11 LINEAR FT.
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.
_ 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. Sq.Ft Floor Area: Valuation:$5499.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county APN Number:. Occupancy Type:
ordinances and state laws relating to building,construction,and hereby 369 45 016
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 PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN lSb DAYS OF PERMIT ISSUANCE OR
granting of this permit. Addition a applicant understands and will
comply with all non-point sou r01regul 'ons per a Cupertino Municipal180 DAYS FROM LAST CALLED INSPECTION.
Code,Section 9.18.
Issued by:ALEX VALLELUNGA
Signature, 1Date 03111/2016, Date:03/11/2016
O R-B Til D RDF ARATION RE ROOFS
I hereby affirm that I am exempt from t Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered
for sale(Sec.7044,Business&Professions Code) Signature of Applicant'
2. I,as owner of the property,am exclusively contracting with licensed Date:03/11/2016 ,
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROO COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE'
performance of the work for which this permit is issued.. I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will
by Section 3,700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Mana ement District I
shall not employ any person in any manner so as to become subject to the will maintain compliance with the Cupertino Municipal Cod ,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Healthl&Safety ode,Sec' hs 25505 25533 and 25534.
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 Owner or authorized agent:
be deemed revoked. Date:03/11/2016
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending gqficy for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.309 iv C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION
understands and will comply with all non-point source regulafions per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date 03/11/2016
rvt_
CONSTRUCTION PERMIT APPLICATION
i
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
.2. i
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228•FAX(408)777-3333•buifding(,cupertino.o q ��
CUPERTINO
❑NEW CONSTRUCTION El ADDITION
ALTERATION/TI F-1REVISIO /DEFERRED ORIGINAL P RMIT
PROJECT ADDRESS ' 21620,
APN#
O
p
n w,,,a � PHONE E-MAIL
STREET ADDRESS t �d
C STATE,ZIP 4 FAX
l e S", 2W_ I ,
CONTACT NAME
PHONE IS � E-MAIL
S(REFT ADDRESS CITY,STATIP FAX ®.--
b[.G1vk,o L-W Sit. f>05
11 OWNER 0 OWNER-BUILDER ❑ :OWNER AGENT ACONTRACTOR ❑CONTRACTOR AGENT ❑ :ARCHITECT ❑ENGINEER ❑ DEVELOPER. ❑ TENANT
CONTRACTOR NAME Raf LICEN E ER LTCEI��S�RE TYPE BUS.LIC#
COMPANY NAME E-MAIL -p Y y ' FAX
e /CITY,ST. IP ^wd �+��67 P OIQE 1i t3 V
STREET ADDRESS
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP '�
PHOh
DESCRIPTION OF RrORK
� t
1,r 2:1
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT.. VALUATION(S)
EXISTG NEIA,r FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER _
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH .
[]ATTACH
#DWELLINGUNITS: IS A SECOND UNIT []YES SECOND STGRY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICAT101Q ❑YES IF YES.PROVIDE COPY OF IS THE BLDG AN ❑YE TT. VALUATIO.
PLAN 1INGAPPL9 []NO PLANTNINGAPPROVAL LETTER EiCHLERAOR4E? a %
sa
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have piovide s orrect. I have read the Descrl*ptIoLp,of Work and verify it is accurate. I agree to comply 10th all applicable local
ordinances and state lairs relating to buu ding onst ction. I au rize epr natives of Cupertino to enter the above-identified property fol inspection purposes.
Signature of Applicant/Ager Date
SUPPLEMENTAL INFORMATION REQUI D s riAi,ciiEcx �E R0uTiN1 stir F
New SFD or Multifamily du-ellings: Apply for demolit o ermit for of ER TxE eou�TER � BUILDI�GPLA\RESIES
4Mfffi .iT '�
existing building(s). Demolition permit is required prior to issuance ofbuilding
permit for new building. Ea�Rss�
a l PL4Nt �rLaI.REAIEAV
fl£PusLicv,'oRi,s
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �sTAizz s �,
form if any Hazardous Materials are being used as part of this project. LRCS I_IFiREDEPT
: g �� _
_Copy of Planning Approval Letter or Meetinj with Planning prior to 10IVL�aox � I] sA SITkRY5,Ht3 ERDISTRICT`
submittal of Building Permit application. a '
v,... �., 4 t�.,, �. . , ..:.x- ., z'�.E\'VIRO\MEItTtiLHE�LTH. t •;
BldgApp_2011.doc revised 06/21/11
1
4
Portal Plaza Homeowners Association
r
March 09,2016
To whom it may concern,
Portal Plaza Homeowners Association located at 19800-19982 Portal Plaza,Cupertino CA hereby
authorizes Recon360,LLC located at 99 Almaden Blvd,Suite 600 San Jose CA 95113 to pull permits for
the affected unit(19928 Portal Plaza)where repairs are to take place.
If there are any questions or concerns please feel free to contact Grayson Community Management at
888-277-5580 x 110 helpdesk@eraVsoncm.com
Sincerely,
Graham Cramb,
Grayson Community Management
Board of Directors
Portal Plaza Homeowners Association
c.c.Board of Directors
c/o Grayson Community Management
65 Washington Avenue,Suite 268,Santa Clara,CA 95050
1-888-277-5580* helpdesk@graysoncrn.com
V r 12 16. 08:30a MARK SCHLEICHER 408 298 8308 �.
....{��•p��.L«z�-y- ��•aaempa� pace �Il4J���yt.F�:IB.Y.�
OWNER CERTIFICATE OF COMPLIANCE
` �}��
La
i�v�UW3
COMMUNITY DEVELOPMENT[DEPARTMENT•BUILDING DIVISION
�, �NQ 10308 TORRE AVENUE•CUPERT O,CA 05014-3255
(408)777-3228-FAX(408)777-3333-buiidinaCacupertino orgPa r+a
22
vire. �t1bi PF,"UT CANNOT Dr FINALUM A ND COWL BD f]TITIGT:.`f ff13 CWi>1C.ATIv
RAS M29
PURPOSE
This affidavit is a self-cextafication for the installaticoxz of all required Smoke and Carbon Monoxide Alarms for
compliance with 21113 CRC Section R314,9-013 CBC Sections 420.6 and 907.2,11.2 where no interior access for
inspections are iequired.
GV,N-MAL IINF€3Rllr$.PATION
Existing single-family and m-alii family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling uxtit exceeds
$1.000.00,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 followirq locations-
AREA SMOKE ALARM CO-ALARM
Outside of each separate sleeping area!--.v the immediate vicinity of the X X
bedxoom(s)
On eve levet of a dwelling unit includin basements X X
Within each slee,in room X
Carbon Monoxide alarms are not required in dwellings which do not contain fa el bum&ag ap.?fiances and that
do not have an attached garage. Carb on monoxide alarms combined w l&smoke alarms Shoal comply with
CSC Section 4.20.6 and shall•be approved by the Office of the State Fire Marsh-
al-Power Supply,.In dweBixtg units with no commercial power supply,alarms)may be solely battery operated-
In existing dwellitx-&md- ,alarms are permitted to be solely battery operated where repairs o:-alterations do
not result in,the rersmoval of wall and ceiling.fishes or there is no access by means of attic,basement or exawt.
space,Defer to CRiC Section R314 and CBC Sections 9072,11..4 and 420;6,2.An electrical permit is res est far
ala-aw whic1n must be cormected to the buil.dimg wizin&
As owner of the abGve-xeferencedproperlyy,Iherebp cex[ifiy ah blhe at m{s)referenced abQ�►e l�as(haue teem
i s ed
in aero daAce with.th,e m anufactarer's ins>�.�cq-ons amd in cam.pliiance wiHf,the Cal-siom.ia?Rma g
amd Cafifamie Residexntial Codes.The aThTms have r9een.tested an-A are operational,as of ffie dole sigmed
belbw.
f baee:reae'g tdragree•fee wrfflpk Wilk,fie:lbrms�an,dcomdffinns of-this slafem- eot
HeIv(// tL� s;nit GY J.......................................
s; riatur ......3 tZ t
.SmoJ;c ar�tbCO�f�xm,dbe revised 03l!•fitl_q
LWPLUum CER ATE OF COMPLIANCE
UM6 FIXTURES
C.o.AllsuuMTY of VF-LGM I';MPARWEtiT-B..UILIDRMG.oM:SIaf4
9(30JOtREPl ( a T1�C,CA950 � " '
- 255CJRC#i ► f:n
fbs
(4` 777-3228•.FAX�,408)777-3333 4 buitdLgg :�.��v�#ir�ate 4113,
vnerNam i j i 1 6
Permit No
1dress
Is your real proKdy a registered historical site?
�<❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the fonn and sign bottom of form.
No Go to Question 2.
Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
dumbing,installation of Water-conserving plutubing futures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
D The licensed plumber's ceztification has been provided to the Building Division,
skip the rest of the form and sign bottom of form.
%%No Go to Question 3.
Is water service permanently disconnected.for your building?
❑ Yes Civil Cade Sections 1101.1 through 1101.8 do not apply. Skip the zest of the form and sign bottom of form.
z' No Go to Question 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 throru&1101.8 do not apply. Skip the rest of the form and sign bottom of fo
Yes My real property is built and available for use or occupancy on or before January 1,1994. rm.
Civil Code Sections 1101.1 tbrorigh;1101.8 apply. Check one of the three following statements and sign
bottom of form..
Please check ONE of the following.,
El Myprope 09 aloingle fa-roily residential real property. See Civil Code Section 1101.4.
09 al atter January 1,2€114,building alterations or improvements shall require all non-compliant pinrnbing futures
to 6e replaced with water-conserving plumbing fixtures throughout the buff-Ring Oir or before January 1,2017,aillion-
coiiiglxant plumbing fixtures shall be replaced with water-conserving plumbkg fmtmies (regardless of whether
h property undergoes alterations or zproavewerits).
n\�\ MYpropertyis a mulErfarrrily eesi'den€ial real property. See Civil.Code Section 1101.5.
On and after Jan.uary 1,2014,specified,brYilding alterations or improvernents sfr-a rEgnire noon-compliant
Plumbing.fixtures to be replaced with;waterconserving plumbing fixtures.
On or before January 1,291%all non-compliant plumVtAg fixture$sha15 be replace&with water
conserving plw.nibing fixtures throughout the briildiirg{regardlon of whether property u dorgoes alterations or
irriproverxrests}.-
MY property is a commercial real property. See Civil Code Section 110-1.5.
0-n and after Yanuary 1,2014,.speeified buil-ding&tevati.o_ts or improvements skall require non-compliant
plumbing fixtures,to be replaced with water-eons erving plumbing fixtures.
Ch or befase.Yammy 1,, 2019, all holt:compliant pliuxibm-g fixtures shall be replaced with water- eeaservurg
plumbrirg fiXt hires fih-TonghoiOt_lie building fregar&ess of whether property undergoes alieration&or Improy-ements):
Ail, c ' GJ jC
I,as rile owner or,owner's agent of flair property,cerfi%fy under Pena ty of perjury'that tion-eamphant plumbing fixtures wif b
re0aced pr,rr to date speeified above with,water-conserving plumbing fixwm in aceordanee with Civil Code Sections 11`01.1
tkough it lw 8,the current California Plumbing Code and.California Green.Building Stai:darrd-s Code,and manu€acturees
installa#ien requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated_in the
table on the foTlnwiri . a e.
Owheror•OWrenAgonVs Signatur Date:
upas eornpi`et agand signing this Ce,tufieate,pieaso retain q the Building Division,irr order to final your builda. peri r
SB-4072011 doc revised 08126115