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B-2016-1572CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20697 HANFORD DR CUPERTINO, CA 95014-1909 (326 33 024) OWNER'S NAME: BHATTANSUYAAND BELA OWNER'S PHONE: 408-464-4095 LICENSED CONTRACTOR'S DECLARATION License Class 8 C-36 Lic. #962879 ContractorA N CONSTRUCTION INC Date 07/31/2017 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. 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 jperformance 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 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 p , the Cupertino Municipal Code, Section 9.18. Xiiignature Date 3/18/16 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. 1, 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 tself-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, 3. 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 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 revolted. 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 ordinances and state laws relatingto 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 3/18/16 , CONTRACTOR: AN CONSTRUCTION INC SAN JOSE, CA 95117 PERMIT NO: B-2016-1572 DATE ISSUED: 03/18/2016 NO: (408) 426-6343 BUILDING PERMIT INFO; X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REMOVE (E)WINDOW IN THE BEDROOM AND INSTALL (N) DOOR AND WINDOW - NO STRUCTURAL CHANGE Sq, Ft Floor Area: I Valuation: $2000.00 APN Number: Occupancy Type: 326 33 024 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBYAYENDE Date: 3/18/16 RE -ROOFS - All All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 3/18/16 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Secti 25505, 25533, and 25534. Owner or authorized agent: Date: 3/18/16 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION . COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 F'AX (408) 777-3333 . building (a.cupertino. org ❑ NEW CONSTRliCTION 171 ADDITION f1 ; AT.TFTZ ATTCIN / TT I I R FVTQTn / TItT7-P D V STI nnrr_n TAT Bldgy4pp-,2011,doc revised 06/21/11 1 PROJECT ADDRESS APNnl�ll 0@TTERNAME � � PHONE �C �p J^ �R E-MAIL STREET .SDDRES$ G q ! �'�"�s� �l `"� D-(' CITY, STATE, ZIP FAX CONTACT NAME y( PHONE ��r�Y�E-MAIL a"10�yU A t - STREET ADDRESS yam \ CITY, STATE, ZIP �� �g c FAx 0 NER ❑ OVWtR-BUILDER it OgNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGLNTEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM% LICENSE NUBER 9 � ICENf S.LICR�"'jo ( .6 C01 IPANY NA1 E�, s ` ox� E_Mp I FAX STREET ADDRESS 'V a CITY, STATE, ZIP _ y PHONE ARCHITECT,ENGLN'EERNAME LICENSE NUMBER BUS. LIC' COMPANY NAME E-vii.AIL ( FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF 16'01 � C� 0 C✓ (5 V1, f�/ ✓Q –/Z EXISTING USE PROPOSED USE CONSTR. TYPE 'STORIES I USE TYPE OCC. SQ.FT. I VALtiATIOiQ (5) 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: DETACH - - ❑ ATTACH ' DWELLING U?QITS:: IS A SECOND U\Fr ❑ YES SECOND STORY ❑ YES BELNGADDED? ANO .ADDITION? [].NO PRF -APPLICATION -❑ YES IF YES. PROVIDE COPY OF PLANNING APPL' ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO REC VEIy BZ > .� _.; h TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent 0act 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 state laws relating to buil . g const actio I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 15 RE URED SUPPLEMEN INFORIAATIONT I Q I\TenIT SFD or Multifamily dwellings: Apply for demolition permit for 01 ER TFIE COULTER SUILDI\G Pi A\ REI IEII' — existing building(s). Demolition peiTrrrt is required prior to Issuance of buildung permit for neNA, building. x LIE xEss PLA\\L\ GPi 3n REI IE« m Comercial Bldgs: Provide a Completed Hazardous Materials Disclosure e 40 D sT�i�aRD" ❑ PUBLIC _ form if any Hazardous Materials are being used as part of this project. a k f Copy of Plarming Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. © 1 ZAJOR I] sA�IraR� sESi ERnlsrxicT ` =.❑: E\TIRO\\iENT'ALHE.ALTH �y Bldgy4pp-,2011,doc revised 06/21/11 1 4j T-, 121 0 6 CS i9 A A) TO CID -b ZI 'Y Q % a U J') )00P lY he -J) 't 7&'M COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications MUST be kept at he job situ during construction. It 18 UnISM111 to make'at ,haingss or alteratjor,,s on same, o rto,,devi iellll t c Chi hor, �Fro ni, without approval from the B Aldinq 'he s'.'� rnping of this plan and specifications 81 IALL NOT be h,, ld to papa it or to be an approval of the /16ation as provisions of any CH Ordinance )�e or&l-aw. % Y M rn—pa...-Mial CUPERTINO Wwr- Building Department Rig, "m MAR 18 2016 REVIEWED FOR CODE COMPLIANCE Reviewed By: <74m 4 AVff /I- - , J - UY'7boop"C) C-1 CUPERTINO ress 2.112 6 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a-cupertino.org ;�r_'4 by. &2-016 X72. 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 bedrooms) 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 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. l have read and agree to comply with the terms and conditions of this statement (Owner or Ownerf�s-ame: f 0o (Si nat r ........... ........ . ..................................................... r_acT1 (Con r�or Name: U....3..TS ( (Z J 10f (SinatHe) ....AAAA...... , .. 4U1&-#). Pate.. ....AAA A :. v Smoke and CO form.doc revised 03/18114 CUIP RTINO wner ame WATER-CONSERVINGPLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c)-cupertino.om ... n n n. 2-61j�7-1972: 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 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 plumbing, installation of water -conserving plumbing fixtures is not technically feasible? Yes Civil Code Sections 1101.1 through 1101.8 do not apply. 11 The licensed plumber'.s certification 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? El Yes Civil Code Sections 1101;1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ><' No Go to Question 4. (4) Is your real property built and available for use or occupancy on or before January 1, 1994? `,.4 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.. (5D Please check ONE of the following: My property is a single-family residential realproperty. 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). El 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 Daae. er or owner Agent's Signature:) K -.2hAz- -- pate: 4 Upon completing and signing this Certificate, please return it to the Building Division in order to final vour building hermit. SB4072015.doc revised 08/26/15