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B-2016-1446 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1446 1132 HUNTERSTON PL CUPERTINO,CA 95014-5069(362 22 027) JENNINGS CONSTRUCTION COMPANY SAN JOSE,CA 95136 OWNER'S NAME: Robert Zalusky DATE ISSUED:02/29/2016 OWNER'S PHONE:408-255-3642 PHONE NO:(408)265-5862 LICENSED CONIRACTORIS DECLARATION BUILDING PERMIT INFO: License Class_QENERAL BUILDING CONTRACTOR Lic.#385805 Contractor JENNINGS CONSTRUCTION COMPANY Date 12/31/2017 X BLDG —ELECT _PLUMB _ I hereby affirm that I 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: REMODEL/RECONFIGURE MASTER BEDROOM&CLOSET AND I hereby affirm under penalty of perjury one of the following two declarations: LIVING ROOM AREA(RAISE CONCRETE FLOOR)(534 S.F.TOTAL). i. I have and will maintain a certificate of consent to self-insure for Worker's REMOVE 4(E)W OWS Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued c-RE V-&- - SE OFFERED-CEILING'ISSUED 4/14%16 C 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 ermit is issued. 5q.F� loot Area:I Valuation:$30000..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 ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 362 22 027 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 nderstands and will comply with all non-point source regulatioi s er th upertino Municipal Code,Section 9.18. 180 DAYS FROM LAS CALLED INSPECTION. Signature `9-10-i4ate Issued by:MELISSA NAMES t Date:02/29/2016 R-B ER DECARAT O 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 i I,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: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 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 ofthe 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. I 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 Cup 'no Mu . ipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Se ons 255 5 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: I certify that I have read this application and state that the above information is CON TRUCTIOJLENDING ENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constribion lending ency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.309 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 Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date Professional ON CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMiiENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 C[IPERTfNIO I (408) 777-3228• FAX(408)777-3333•building(1cupertino.org El �' 1,T-Yq CONSTRUCTION ❑ ADDITION ❑ ALTERATION'/TI U VISIO -/DEFERRED ORIGNAL,PERNdi T PRO ECT.ADDRESS 1/3Z tvN6-� F c �PT R OWNQER NAME PHONE E-NL4IL LieSTREETADDRESS CITY, STATE,ZIP FAX I 3 t9 S `I J 1�� I �n' C:� CA- LI) P CONTACT N.9?JE PHO xc E-DZAIL STREET:DDRESS CITY,STATE, ZIP C=� qqc? L4. I S nfi ��� r.*`— `7 �l�(® n� �S 5,; �6 ❑ OVTNER ❑ O'NNEtR-BLUDER ❑ DW ERAGENT [r5�ON-1 KACTOR ❑Cox-R4CTORAGEN`T ❑ ARCHITECT ❑ENGINEER ❑ DELtLOPER ❑ TEKANT CONTRACTOR NAME LICENSE NLTBER LICEINSE TYPE BUS.LIC n COMPAI,Y NA.),E E-1,WT- FAX .''fie:.. a -)Cm ' C�1,4 I ^7-e e-,5 `V&�,e S 9 Q 6,2E7 e A-z ,,a.{ STREETADDRESS CITY,STATE;ZIP PHONE ` C tem �: S�r�a C 4Jf I fd aS � ARCHITECTM\7GDMER /J I LICENSE NUNBER BUS.LIC J COI.iPAn,NAME E-h AIL I FAX STREET ADDPESS I CITY,STATE,ZIP I PHONE DESCRIPTION OF WOi%?: EMSTINGtiSE PROPOSED USE CONSTR.TYPE =STORIES USE TYPE OCC. I SQ.FT. I V a_Lli AT:C'\'(S) EXISTC, NEW'FLOOR DEMO TOTAL AREA .AREA AREA I NET AREA - - BAT-ROO1,4r ( KITCHEN I OTHER i.rO REDEL:AR-A REIAODELAREA REIAODELAREA PORCH AREA DECK AREA TOT??DECKTORCH AREA G.-3 SGE AREA: DETACH ❑.ATTACH DWELLING LTiTS: IS A SECOND UNIT ❑YES SECOND STORY Q YES BEING ADDED? E]NO ADDITION'. F]NO Pr :AP?LCti10\ ❑YES F)TS,PROVIDE CO?Y OF ISTP.EBLDG.4\ ❑; S R CFI TOTAL VALUAI IONI PL Alh'T NG APPL 1 ❑NO PLATN1NG APPROVAL LETTER EICHLER HOAIE? E3O � � �g y fr� � By nay signature below,I certify to each of the oilo;,=ing: I am the property owner or authorizede t k act the property oilmer's behalf. I have read this application and the info znaton I �>e pro\ide 's co rect. I have read the Descriptor of Work and re ify Itis accurate. I agree to comply\z ith all applicable local ordinances at;d statela\ s relating o bui ira stl action. I authorize representati\es of Cupel no to enter the zbo,e-identified p-ope,-ty for inspection poroses. SignatrreofApplicantlARent: Date: S1J7PPLE,,4- ,rAL ri u0 MATIGN REQUIRED r A PT 4�CHECK TI PEn,,, .I,a ROLA\G.SLIP New SFD or 1\iuiti slily dt,ellin.s: Apply for demolition permit for s ODER TU-E COD\TER rLiILDI\GPL�\R�lIEV existing bullding(S). Demolition p..i:t is required prior to iss lance of bn�lding _ _ pertTllt for new build:nL. ,I 1RESS Commercial Bldas: Provide a comipleted Hazardous Matemils Disclosure TL\bARD J P[DLICL�ORI.e A Y F 0�..1 if any h1azc1'I.Ous 1\fatel'_21s are beii}g used as p=.rt 0=this s project. . � Copy of Plci Appl o,al Letter or Meeting;,pith Planning prior to � r 1� i4JOR L� 54\IT Rl�E\ ERDI�TRICT Sulbi_7liial of BLlla.ng Peynait application. t �.E\A7R0\1iE.N—kLHEALTH Bldg pp_01 Ldoe revised 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1446 1132 HUNTERSTON PL CUPERTINO,CA 95014-5069(362 22 027) (JENNINGS CONSTRUCTION COMPANY) SAN JOSE,CA 95136 OWNER'S NAME: Robert Zalusky DATE ISSUED:02/29/2016 OWNER'S PHONE:408-255-3642 PHONE NO:408-265-5862 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lie.#385805 Contractor(JENNINGS CONSTRUCTION COMPANY)Date 02/29/2016 X BLDG —ELECT —PLUMB I hereby affirm that I 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: REMODEL/RECONFIGURE MASTER BEDROOM&CLOSET AND I hereby affirm under penalty of perjury one of the following two declarations: LIVING ROOM AREA(RAISE CONCRETE FLOOR)(534 S.F.TOTAL). 1. I have and will maintain a certificate of consent to self-insure for Worker's REMOVE 4(E)WINDOWS 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. Sq.Ft FloorArea: Valuation:$30000.00 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 APN Number:. Occupancy Type: ordinances and state laws relating to building construction,and hereby 362 22 027 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 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code,Section 9.18. Issued by:MELISSA NAMES Signature Date 02/29/2016 Date:02/29/2016 OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the 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(See-7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:02/29/2016 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL 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 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 3700 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(x)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 shall not employ any person in any manner so as to become subject to the 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 Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 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:02/29/20.16 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency 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.3097,Civ 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 ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 02/29/2016 Building Department City Of Cupertino 10300 Torre Avenue Cupertino;CA 95014-3255 Telephone: 408-777-3228 C U P S RTi N O Fax: 408-777-3333 CONTRACTOR I SUBCONTRACTOR LIST JOB ADDRESS: jj lj � '--�. PERMIT# OWNER'S NAME: i a4L�a PHONE# 4,v a D,s.5 1&q-2— GENERAL CONTRACTOR: �� r � BUSINESS LICENSE# aS55" ADDRESS: ciciq Siad CITY/ZIPCODE:-,,;l - G �6r14. *Our municipal code requires all businesses working in the city to have a City of Cupertino business license: NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE. GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE' OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical - Excavation Fencing Flooring/Carpeting 4;Laoc. 7ne&ff c Linoleum/Wood Glass/Glazing Heating l r-J4. Insulation Landscaping Lathing �� Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile -Own /Contractor Signature Date -._.�,.�..y..-..._ .._,..,. ............-:r•., •www wr.�,�.�t+a i�sb/;�.a.�F` A�:E'�GR:��Y GWNWER CE . E OF COMPLIAN, CE COMMUNITY DEVELOPMENT DEPARTMENT►BUILDING DIVISION C-UPPERTINI4 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228^FAX(408)777-3333._buildinQCacuperEino.or4 e: �f e: PERMIT CAKNOT BE VI-MU,lL D ANI)'COMPLETED UNTIL THIS CERT WICATF 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. GVNEKAt I1VTl ORMATION 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 SMOK-E AILARM CO AtANR Outside of each separate sleeping area in the immediate vicinity of the X X bedroarn(s) On every level of a dwelling unit including basements X X Within each slee2ing room X Carbone Monoxide allarms are not required in dwellings which do not contain fuel-burning appliances and:that do not:have an attached garage. Carbon monoxide alarms cornbiried with smoke alarms shall comply with. CBC Section 420.6 and shall be approved,by the Office of the State Byre Marshal.: Power.Supply:In dwelling units with no cornrnercial ower supply, alarms!, i,,a be solely batter o verated. p � ) Y ` y �battery F ' In existing,dweTlnng:Lmits,, alarms are permitted to be solely battery operated where repairs or alterations-do not,result,in.the r=etnoval of wall axed ceiling.fianshes or there is no access by means of attic,basezr ent or crawl= space.Defer,to CRC Section R314 and CBC Sections 907.2.11.4 and 420..6.2.An electrical permit is regui4red for afarans which muist be connected to the building wiring. As owner 4-the above-referenced property,I hereby certify thal thie alarm(s)refeirenced above ha.s/l, .v.-e-beeiti in,staffed,ins accord-anme°widi,the m-anufactairer"s ins {ctione ankd in,eomtp)fil-once with the Cailiforniat BiMild b, andl Cafilfemmia,Res dlenf al Codes.The alagrms,have°been testeddl axe operational► as,of the date signed; bel°ow:. U Fiiave?rEad amclf a :ee:Gbt cam (""�w(4;ilne>Perms U�c mci�a;ens orzt(}firs statemem (� s � U(j( ] v uret... .. ....... ......... ......... L/ . ; G�nt�"�tor�l�larne?� fA rJ�P��lG� Si:Mature;,_ . . ... C ��S o t J _ Da f Smoke and CO forni:dbe rei,ised=03/18/li4 X, PLUMBING FWTURES ELI OMER CE ,.AT'OF COMP M; OOA9MNITY,'D.E/IEL(YPSfE, TiD"EPART-MA-7-T, -B.f11LD.IN DIVISION CUPS TIN a 10300, TORRE AVENUE*Ct RTINO,CA't95ai4-3255 (444)777-3228-FAX�,4p 777-3333 pbUldincranumentno am Owner Namet 04 0r Permit No N Address ���aZ 1At..7,q-rC-r ® PC 0—A 9150 1. Is your real property a registered historical site? ❑ Yes Civil Cade Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. M 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 pluiiibirtg fixtures is not techiucally feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed:plumber's certif cation 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 per=neirtly 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. g IW No Go to Question 4. 4. Is your real property,built and available for use or Occupancy on or before January 1,']9941 ❑ No My real property is built acid availa$le for use or occupancy after January 1, 1994. .h Civil Code Sections 1101.1 throtigl 1101.8 do not apply. Skip the rest of the forra,and sign bottom of form. 19 Yes My real property is built and available for use or occupancy on or before January 1,1994. Civil Code Sections 1101.1.throitgh 1101.8 apply. Check one of the three following statements and sign bottom.ofform.. 5. Please check ONE of the following: My property k a single farr ik eesidenflal real property. See Civil Code Section 11101.4 On,and after=Janizary 1, 2014,building alterations or improvements shall require all non:-compliant Plumbing fixtures to be replaced,with water-eonserving plumbing f xfuress throughout the building..Ori ort before January 1,2017,alit non- compliant plmlm6ing fixtures shall be replaced with water-conserving plu mb og fixtures (regardless of whether Pro rhukdergoes alterations or inpftOve-ments) . M,Y prop'ertyis arm tlt far t[y residenrral real property: See Civil erode Seetiou 1101.5„ On and after January 1,2014,specified building alterations or irnpro-veriments shall require non-compliant plumbingfxturestosbereplaced,withwater conservingplu,mbingfixtures. On or before January. 1,,201%,all non.cornphantplumbing fixtures shatl be replaced with water- conserving pluimibing,fixtures throughout the building(regardless o€whether property t dlergoes;alterations or improvements). ❑ Mypropei is,ac©mmercialreal,property. See Civil Code Section I I Ot.5. Ori and after January,1,2014„specifiedbuilding alterations,or improvements s=hall reglu re non-compliant Flu mBing,fixtures,to be replaced with water conserving p�luiubing fixtures. Cir or before: ranuary I,:.20119;, all non-co mylian't plumbing, fixtures shall be replacedt with water:- conserving p`nnribirig fiwtures�throughout the;building,(regardless of whether property undergo es:alteration&or improveinents)l 11,as the owneror owner"s,agent of this property,certify under penalty,of perjury that non-compliant plum,bin, fixtures will be replacedC prior;to date speeiff ed'above.with water-conserving plumbing fixtures in accordance with Civil Code Sections I pal I through 110sL.8;the current Califom a fumbing Code and.Califom=ia Greeny Building Standu&d,,Code and,manufacturer's installation requirements.,,and that the:water=conserving ph ing fixtures comply with the requirements as indicated in the table on the folluwin: page, Owner or,CW.ner(A'gp t?s Signature Upont completing and.sigpingt this;Ceitifir;ate,please return it to the Building Division.in,ord'er to final:your braiding permit. ' SB9B'7 20,5',doc revised,'09126115-