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16010035G�� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10585 MILLER AVE CONTRACTOR: BAY AREA FUN SPACE PERMIT NO: 16010035 DIRECT DAB OWNER'S NAME: CHEN HSI-PAO ET AL 2179 STONE AVE STE 17 DATE ISSUED: 01/06/2016 OWNER'S PHONE: 4088389935 SAN JOSE, CA 95125 PHONE NO: (408) 753-9638 LTJ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL INSTALL (N) OPEN PATIO COVER ON (E) SLAB AT REAR License Class Lic. N /00 Z b/ 6 9'_ OF PROPERTY (550 S.F.); INSTALL 3 LIGHT FIXTURES Contractor Date o& --?."licensed UNDER PATIO COVER I hereby affirm that 1 under the provisions of Chapter (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 9 have and will maintain a certificate of consent to self -insure for Worker's otmpensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Arca: Valuation: $8500 I rformance of the work for which this permit is issued. 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: 36916025.00 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 latus relating WITHIN 180 DAYS OF PERMIT 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 PYS FROM LAST CALLED IN PE TION, indemnity and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 1 ii ��) Additionally, Issued b W 6v 1� y: Date: granting of this permit. the applicant understands and will comply with all non-point`source regulations per the Cupertino Municipal Code, Section � / Signature �� // DatedG �U�Iri 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: [ hereby affirm that 1 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). f have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 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 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use uipment or devices which emit hazardous 7, 7,. Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Air Quality Management District 1 performance of the work for which this permit is issued. will maintain compliance with tino Municipal Code, Chapter 9,12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ,y Owner or authorized agent: Date: wr 7 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 CONSTRUCTION LENDING 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 perl'ormance 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 1 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 CUPER-riNo CONSTRUCTION PERMIT APPLICATION CONIdiUNITY DEVELCPI\4ENT DEPARTIVENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 05014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildinw—mcuoet,ino.ora ❑ NEW CONSTRUCTION ❑ ADDITION - ❑ .=.LT1–RATl0N / Til ❑ REVISION / DEFEND OZIGINAL PEi-',I-1 1 PROitCf ADDRESS l M i A2N 14 6 36,2 OWNER NA.I✓E i` L e 1 j�{G _ 17,j1p1 � � "Ohm ? R.II STREET ADDRESS Ci i Y, STATE, ZIP /o s g s /11,' / t ie FAX ��,/7 L) 5 o I �Cc,,o � CONiAC7 N.LUE wap �� P'ON= Vb E-h2.SII - / Qe-rILS6' 1 oC-, G SeR.cI ADDRESS 4 7- 1� l- CITY, STAT =, Zip f o� qS-/,Z J FAX 11OWTcR 13. O\R=R-BUMPER 13OHT—RAG�'T J�CO?'7�RI❑ CTOR CONTRACTORAGD.7 T ❑ AACI=, ❑:NG?��R ❑ D1rLOPZz?, ❑ TL7\/�7 CON'T'ii ACTOR NAI✓,E ! , ��� F,,A 5j©�p�_ LICENS M1]✓3ER ✓'/% LICD\1Sz E BUS. LIC FAX C-UaAIYNAa-. E-NVL(�� STREET ADDRESS Q # CITY, STATE, ZIP S017 U � S PHONE 402 O 1641 ARC' 7FECTrNGTEER NA-IVE / , LICFIN S BE NIJ? JcR BUS. LIC 4 COMT, Y KI -MZ E-MA?L FA.X STREET ADDR-ESS i CITY, STATE, ZIP PHONE DESCRY TION OF WORK 5�rr - � f ` r� Gi , /� l / �� -7 ,�� � ,1.11- � � � � ��� H (/i (+ (�,� a( WIocovig. E)3STING USE FRO?OSED UEE CONSTR TYPE ?' STORES USE TY -PE OCC. SQ.FT. VALUATION(S) =>a-gTG NrFW FLOOR DEMO TOTAL AREA AREA A ZEA N -T A.ZEA •- BATFROOM KTTC1MN OlKER REMOD .L AR5.A, TREMODEL.tiR.EA RS1.;ODEL AZEA PORCH AT`.. --.A DECK APEA TOT,11 DECKIFORQI AREA G .RAGE P.REA: DETAC}I ❑ A TTA CH DR•T_LLIkG i1Nii S: Is A SECOND UNIT ❑ YES SECOND STORY ❑1=S BEING ADDED' ❑NO ADDITION' NO P7C--r-?LIC1TjON ❑1=S EF 1--S. PROVIDE COPY OF IS THE BLDG/ -N ❑1-5 TOT.-.- VA-UAT 0N: PLA'ZNT17G A,s?PL 4 ❑ NO PLAJNNTDIG 1,3PROVAL LETTER EICHLER HOME. ❑ NO[% U� By my sienature below, I ceriry to etch f the following: I am the grope ty owner or authorized agent to act on the proper-+ ov ner's behalf. I have read this application and the information I have rovided is collect. I have read the Description of lkork end verify it is accurate. I ag ee to comply with all applicable local ordirznces and state !zws rel:.ting to riidirg construction. I authorize representatives of Cupertino to enter the above -identified property for inspect puposes. Signatu,-eof-pplicznt./Agent: Date: v l SLPPLE? 4EN AL Ili ORMATION REQUIRED� .11 tPi R0.�w rER1�ELiDL4GL4NRE1Ii V :`fr: New SFD or Mu'-tiI^=ily d-,', e111inas: apply for demolition p --=if for —�a�hTcGt existingbuild:ng(s). Demolition pernitisrequiredprior toissuanceofbuilding permit for new buil-ding. Commercial Bldgs: Provide a completed H2-7ardous Materials Disclosure being porn tf zny Hazardous b'jaterials are used as part ofthis project. _Copy of Planning Approval Letter or Meeting with Planning prior to `'ZAP R „ " x^..aA?�TTtZs5:1T»R"DI$TRICTc Eu submitta of Building Permit application. 1 Bla'o,6pp_2011.doc revised 06/21/11 FM---7 CITY OF CUPERTINO 1GOIX35 FEE ESTIMATOR - BUILDING DIVISION ig ADDRESS: 10585 Miller Avenue DATE: 01/06/2016 REVIEWED BY: PAUL Other Elec. Insp. 0.0 hrs APN: 369 16 025 BP#: 'VALUATION: 1$8,500 `°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: (F) Reg. 0 OT PENTAMATION 1R3SFDADD PERMIT TYPE: WORK Install N open patio cover on E slab at rear of property (550 S.f. ; Install 3 light fixtures under patio SCOPE cover Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 0.0 hrs $48.00 NOTE: This estimate does not include fees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (I-ce 1?esolullon 11-053 kff' ,�-I;73) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 55 s.f. $716.00 Patio Cover / Sun Room 1PAl70,VE7,-1 Metal Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 3 $72.00 Electrical IBItEhIFIXT Fixtures, Lighting Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 Iirs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Administrative Fee: IADA,II,v $45.00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Q i Travel Documentation Fee: ITR,411DOC $48.00 Strom Motion Fee: IBSEISMICR $1.11 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $143.11 $788.00 TOTAL FEE: $931.11 Revised: X15 wst.�af� Address 'h PURPOSE SMOKE / CARBON MONOXIDE ALARMS f µ% OWNER CERTIFICATE OF COMPLIANCEL (,,,..I L� R G COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a cupertino.org Permit No. # of Alarms Smoke: Carbon Monoxide: PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION 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 X X bedroom(s) 1AA�. '-;r� f G. 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. 1 have read and agree to comply. with the terms and conditions of this statement Owner (or Owner Agent's) Name: t t olf l "'4 Z?kJA %f't Sign ture._................ ...... Date: ........ ... C ntractor Na e: 1AA�. '-;r� f G. Si natureffo... .. u. 4�. .... Dale. ...... -........... Smoke and CO forni.doe revised 03/18114 CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 777-32 8 • F 408) 777-3333 • buildingPeupertino.org , c Permit No, _ ( O Address�� s�� U(?4 fci ��� . �c vDp�^ i 1. Is yo r real property a registered historical site? es Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ❑ 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 110 1. 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. ❑/No Go to Question 3. 3. IIss 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. lr\ /1 Io 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 110 1. 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. v Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. I nN Please check ONE of the following: �5❑ /I�Iy 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 110 1.8, 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 page. Owner or Owner Agent's Signatures Date:. Upon comoletina and sianine this Certificate. vlease return it to the Build in216ivision in order to final vour hnildinu nermit SB407 2015. doc revised 08/26/15