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B-2016-1617 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1617 21902 LINDY LN CUPERTINO,CA 95014-4832(356 24 016) JEMICO LLC HAYWARD,CA 94544 OWNER'S NAME: ARZENO HUMBERTO BAND SARA DATE ISSUED:03/24/2016 OWNER'S PHONE:408-623-1824 PHONE NO:(866)420-4109 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B/C-17 Lic.#972702 Contractor JEMICO LLC Date 05/31/2016 X BLDG _ELECT —PLUMB I hereby affirm that 1 am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL 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)WINDOW IN LIVING ROOM WITH A BAY WINDOW I hereby affirm under penalty of perjury one of the following two declarations: t. 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:$10008.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 356 24 016 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulationr the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature 7 Date 3/24/2016 Issued by:ABBY AYENDE Date:3/24/2016 am cutVY14 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. 1,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:3/24/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:3/24/201 G AGENCY I certify that I have read this application and state that the above information is N TI DIN correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date 3/24/2016 Professional i CONSTRUCTION PERMIT APPLICATION 1-4! '` COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 ?)-�A(D— i� l CUPERTINO (408) 777-3228• FAX(408)777-3333 •building a.cupertino.org 1✓✓ ❑NEW CONSTRUCTION ❑ ADDITION Z ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS 219 O Z L 11Nb LN I APN OWNER NAME S v�QiA 122(.,rtj 4 PHOlI.'F Oa ` Z 2 _ I Z E-MAIL STREET.4DDRESSJ21 Q Z LN �� L CITY, ST"A'[TE,ZIP 7 FAX 1 GLtPCrut•vi 0 6 5014 CONTACT NAME PHONEW", L510�Z83-12c � re.,ewof �,✓cF� � , STREET ADDRESS 3CITY,STATE, ZIP r��7�� k t' J e'A 9,( 5 -I ❑OWNER ❑ OVINNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Qat,)7 ^N��S�N LICENSENU74BER 7L Toz LICENSE TYPF� 1 BUS.LIC# COMPANY NAME 47 I /`'^ / EMAIL s[' t r� FAX r� /�yllK r 7 k �� .Ib .��. .r�r., STREET ADDRESS30td,) SA9IANA L CITY,STAT ,ZIP � C Q`I5yo 5IO PHONE63'3193 ARCHITECT/ENGLNEER NAME ,+ Cy LICENSE NUMBER / BUS.LIC COMPANY NAME E-\,.AIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK (o A (3AB L✓Wd O LJ 1� (ftp �i✓�rJ C, n-�ooM EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. V.ALUATION(S) EXISTG NEW 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 r DWELLTNG LNTTS: IS A SECOND UNTT YES SECOND STORY ❑YES BELNGADDED? NO ADDITION? NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑I-Es WEI 'BY: y i T4AL VALUATION: PLANTING APPL R ❑NO PLAN'NiNG APPROVAL LETTER EICHLER HOME? ❑NO �{ +O 11�Q L 11JM By my signature below,I certify to each of the following: I am the property owner or authorized agent to act n the p opery owner's behalf I have read this application and the information I have provided is correct. I have read the Description of Rork and verify it is accurate. I agree to comply tvith all applicable local ordinances and state laves relating to bu' ing construction. I authorize representatives of Cupertino to enter the above-identif d property,for inspection purposes. Signature of Applicant/Agent: Date:—T� SUPPLEMENTAL fNFOKMATION REQUIRED PLaNcl:r-chrrPr_ ROUTING sLlr New SFD or Multifamily dwellings: Apply for demolition permit for £-cu R: ❑ 1;UILDINc PLAN FL\IER existing building(s). Demolition permit is required prior to issuance of buildin. permit for new building. PL:k-NNi`G PLAN REVIF�\ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure = ,TANI>A :u PUBLIC w uRES Too—nn if any Hazardous Materials are being used as part of this project. .— LARGE J EIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal � s.—Nir^.Rr s£` 2 v:STI:It T of Building Permit application. I, .iuR _ —� £NYIRONN,ENT^.L 13E=_LTN Bldg.4pp_2011.doc revised 06/31/11 Project name: 44_16_9687-ARZENO,Sara OFFICE al 21902 Lindy Ln Wmen. Cupertino,CA 95014 ��♦ Backyard/Rear Setback ,.00w .E •-�E-E�• w� Ground floor ,...., a .. . .. ,"T FP,4R"rMENT Setback 8 EiUIL:iING JIVE;:,_-c U ER71N0 Living room rAr Setback 6 J� }of,clan ti ic7 be kr,^t at tl„ ENTRY rens:Tr.ct;on. Itis samG�,Oc�lcto o r�Oxw an t ons on 101a Garage r, wi'Lilout approval from the BuildirVAcial. cf this plan and specifications SHALL NOT to ba an approval of the violation a>>7 Cit;Ordinance or State Law. 3�Ilk ttv 1J— 01(L'- wli Street/Front Setback Floor I-Overfit,I-Ltrim, Current Current Exact Order Exact Order Room Description Plan Style NF=FFrame,or Handing Opening Opening Width Height 113# Stock Door Width Height Living room Bay 101 Bay window NF 45'1:2:1 ratio 1191/2 591/2 LR Bay(flanker) 101a CS NF R LR Bay(center) 101b FW NF LR Bay(flanker) 101c CS NF L w -UPERTINC r ` uildinq Denarirnen;. G a N KE — MAR 2 201 6 PLOT (.)k CUUE CONINLI 3 Z T Scope of work: eV1ewed ay c,� Op,TE P�NNk ND GUP�R'Tl F STOKE / CARBON MONOXIDE ALARMS �J= OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CIUPr'kvl 0, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building gl,cupertino.org Permit No. B806 IeN Address `.Z #of Alarms Smoke: Carbon Monoxide: � -A aI A A fl�11 Ij" CHIS �P+BTII�' TES 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 X X bedroom(s) 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. I have read and agree to comply with the terms and conditions of this statement owneri �(oor7O_wner Agent's) Name: / / 1�' z P� Si nature............L��...A .Date: ....°.,�.w Contractor Name: - Sinature...................................................................Lic.*......................................Date: ................... Smoke and CO form.doc revised 03/18/14 WATER-CONSERVING PLUMBING FIXTURES FI l. : OWNER CERTIFICATE OF COMPLIANCE 16 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERINEQ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 X408)77 -3228•FAX(408)777-3333•buildha(cDcup4rtino.org Owner Name ti A ! Permit No. Address `L - 1. Is your real propertya registered historica site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ' 40 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. 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. 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. F--'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:` 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- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether. property undergoes alterations or improvements). El 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 iCivil 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 plum'ing fixtures comply with the requirements as indicated in the table on the following page. (' Owner or Owner Agent's Signature: Date: Upon completing and signing this Certificate,please return it t Building Division in order to final your building permit. SB407 2015.doc revised 08/26/15