B-2016-1776 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1776
7589 HEATHERWOOD DR CUPERTINO,CA 95014-5840(359 26 059) RICARDO REMODEL
SAN JOSE,CA 95117
OWNER'S NAME: COLLOTON ROBERT AND JUDY TRUSTEE DATE ISSUED:04/18/2016
OWNER'S PHONE:408-865-0193 PHONE NO:(408)260-8602
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Clas$GENERAL BUILDING CONTRACTOR Lic.#781043
Contractor 5611CARDO REMODEL Date 06/30/2016 X BLDG —ELECT -PLUMB
I hereby a fi in that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL
with Sec of 7000)of Division 3 of the Business&Professions Code and that my
licens i 'h full force and effect. JOB DESCRIPTION:
REMODEL(E)MASTER BATH(50 S,.F.),LIKE FOR LIKE
I h y a i nder penalty of perjury one of he following two declarations:
I have and will maintain a certificate of onsent to self-insure for Worker's
Compensation,as providedfor by Sectio 3700 of the Labor Code,for the
performance of the workor which this permit is issued.
2'� 1 have and will min Waintaorker's Co�m/�cnsation Insurance,as provided for by
Section 3700 of the La ode,for the performance of the work for which this
permit is issued. / f Sq.Ft Floor Area: Valuation:$18000.00
AP /�:C T16 ERTIFICATI N
I certify that I have read this"p APN Number: Occupancy Type:
Ali afion and state that the above
information is correct.I agr�e•�t mply with all city and county ordinances 35926059
and state laws relating--t �ildin construction,and hereby authorize
representatives oflhis cit/lto/e er upon the above mentioned property for
inspection pt�rposes. (V) a ee to save indemnify and keep harmless the
City of Cup ftino agai �f Iia��flities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue againsI salty in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, he appliF�n understands and will comply with all non-point
source regula'ons ge, fie Cupertino Municipal Code,Section 9.18. 180 DAYS FROM L ED PECTION.
Signatur ,fJ� Date 04/18/2016 Issued by: SANAMES
Date:04/18/2016
OWNER
IL
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. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove al aterials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:04/18/2016
f
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS A"OR BETTR
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 DI C-OSURIS/
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirem t'Ander 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 2 50;25533 and 25534. 1 will
permit is issued. maintain compliance with the Cupertino,Mugit�' 'I Code,Chapter 9.12 and the
1�ut
a. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(01s P I store or handle hazardous
material. Additionally,should I use eg1 ip h "r devices which emit hazardous
shall not employ any person in any manner so as to became subject to the air contaminants as defined by the My eqf`r Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the C e�(runicipal Code,Chapter 9.12 and
:�
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,, chons 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:04/18/2016
I certify that I have read this application and state that the above information is CONSTRICTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that thereon
cstruction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this mit 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
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 04/18/2016
Professional
CONSTRUCTION PERMIT APPLICATION
4 =VMUNI T Y DEVELOPMENT DEPARTMiEN'T- BUILDING DIVISION
10300 T ORRE AVENUE • CUPER T INO, CA 05014-3255'
(408) 777-3228 • FAX(408)777-3333 • building c-Dcugertino,orq
CUPERTINO 4 — 0-016,-
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❑ 1\°E\%1 COT'S I RUCTION ❑ ADDITION ❑ J-TFR4TI0N/TI ❑ REVISION/DEFERRED 0RIG-2NAL PF-P—�,Ii T
PROJECT.4DDRESS/� Vf- I .4Pld R 5 9 r 7 / O
01\NER T.41✓E � �s Xe-7L—iJ Yd'
STRrET. CI c,4
CONTACT NAME / 1
STREET ADDRESS CITY,STATE, ZIP FA�7 t� Z pJ
❑ OR'NER ❑ ONk ER-31JIL.DER ❑ ORNERAGENT �-' CONTR?CTOR ❑CON7R4CTORAGENT ❑ P.RCHITECT ❑ENGL1.rER ❑ DEVELOPFR ❑ T�PAT
CONTtZSCTORN.4, /�n /1� y LICENSENLl\ridER f�L/� LICENSE F 3liS.LlC4
CON'fp.6-Y.. iE f y( ✓'/ '✓ E-IdAIL /
STRL lir 1/ �J ITY,S-L�TlygZIP ���y O 9HQj c. J
AACHITECTlENGL'�=ER NAME LICENSE\M,1BER l BUS.(LII C.4 L�
COMPANY NAME i E-!",AIL I FAX
STREET ADDRESS I CITY,STATE,ZIP I PHONE —
DESCRIPTIOX OF WORKi
Mg �"T' %
Pepe -7—
EXISTING USE PROPOSED USE I CONSTR.P;P- ' =STORIES
� L'SE TYPE OCC. SQ.FT. \:S.LliATiO'\'(S)
EXISTG NEW,FLOOR. DFMO I TOT!S.L=
R_A AREA A.R_4�Q I NETI.4?A
BATHROOM KITCHEN OTHER i
RE31,10DELAREA RE1,50DELAREA :'P.EMODE LA.REA
PORCH AREA DECK AREA TOT.-1?DECKIPORC!'..I2ZA Gra=..Ga AREA: DETACH
1 ❑ATTACH
DWELLING UNITS: IS A SECOND UNIT ❑,Y,1=S SECOND STORY [])-FS
EEL\GADDED? 01j0 ADDITION° ❑NO
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PRE-A PPLICA T ION ❑YES IF 1=S,PROVIDE COPY Q5-- f IS THE BLDG AN (]'--S iiTOT." \:A L L'AlITIU?\':
PLAN INJ []NO PLA\?TNGAPPRO�LEER EICHLERHOME? � DD!/
By my sigr a ure belot�,T ce;i y to each.t l thC�'follovwing: I am the property m,ner or authonzed z ' a on the prop rte,owner's behalf. I have read this
application and the information Rave prA0 'ed is Correct. I have read the Description of\r rk an t e-ify it iS accurate. 7-
application t comply Nvith all applicable local
ol-d311211Ce5 eP.d Stale la1•,•S selating i0 U11L1,11aCfh [ :_. aUi Drize represelltatit•es of CepeliLT10 i0 enter The a�iJO\'e- ('iellil?1e I' Ii)!_Tor iIlspectioJ purJOses.
Signature of Applicant/Agent:7.
SL;YPLE4-V\'IAL INrOlclvl_AT1G REQUIRED z p
x w
LTI\G'SLIPV,r,
Ne`;r SFD Or l\/I'LltTfamily dyvellings: Apply for dernolidon permit for
-- Y❑7 01 ER T'sE COli\TrR k �y rL'ILDI\G PL4\REl IE\\ `
existing building(s). Demolition per' 1t is regLir-d prior t0 issula_Ce Of buildillQ 1 a
pz ;1litfernz\��bu1ldlnv, pl j �� u vx
EGRESS L u Pr
COiP T—cial Bldgs: Provide a Coli plzted T1cZel'dOL'S'_\/Iaterials DisclOSU_e J PI EL]C1 OR1.��
01:17 II 311\'Hazardous 1\/L:cl]3l5 are be l,c D
llSeO GS ci:0?lll'J Project. - f- b
L LARG5'5-
E4 t y s -d hFIREDEPT; c ,,
_ Copy.of Planing Approval Letter or 7\ eeting all Planning prior to
LJ 1,L4JOR ❑ S \IT R1 �Eti ER DISTRICT e
Snbmival of Building Penlrt application. k
;ENTAL HE.LTH:x }
Bldg. pp_?01l.doc revised 06121/11
COMMUNITY DEVELOPMENT DEPARTMENT
, �- -��- -�- - �-� - - �• ` �"r� _ -�� ».�. ... : - - _------ -' -___.- -_-�.___-.� t -- .. _ . . _ � -
DEPA
RTMEBUILDING DIVISIONCURTINO
APPROVED
set-of f-plans.aad,sp
i
flcatlons ti1L} be kept- - • at the--'-..
job site during construction, It is unlawf: to make an
_ . _ changes or alteration y
*.. - t'
son same-, or to deviate :
jq therefrom, without approval from the Building Official.
.. . . . Ste p g of this pla
_ . n and specificauocis SHALL NOT_,._ -----------_ _�_:------__-. _ � be held tolpermit proval of the violation
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umbing Notes: �,. ..
1. water closets shall have an average water consumption of not more Eben 1.28 gallons per effective flush,(CPC 403.2)
2. Shower heads shall have a water flow not exceed 2.0 gallons per minutes @ 80 psi.(CPC 408.2) = - - - - -- -
3. Faucets in lavatories shall have a ureter flow not exceed 1.5 gallons per minutes @ 60 psi and shall not be less than:8 gallons per minutes at 20 psi,(CPC 403.8) $
- �;<
4. Shower stalls shall have a clear inferior finish area of 7.1 sq. and be able to accommodate a minimum 30 inch circle at the threshold level•These clearances shall be ++
maintained up 10 a height of 70 inches able the shower drain,(CPC 408.8) � I pp p
5. Shouter compartments and welts above bathtubs with installed shower heads shall be finished with a Smooth,nonabsorbent surface to a height not less than 72 inches 1.,1��1��I�M
(8$).(CRC 8307.2) 3
B. The maximum hot water temperature discharging from the bathtub,shouter and whirlpool bathtub filler shall be limited to 120 decrees IJI 1 g
- -
Fahrenheit.The water heater _..._. _..__... ........... �f
:_ i
ihermosia#shall not be considered a control for meeting this provision.(CPC 409,4&408,3} �^ g -" - "' ,. nr
l d•n DPn' �
. 7
7. Water closet shall be set minimum i5 Inches from its center to a side wall or obstruction and 241ngh clearance In front of water closet.{CPC 4025), ...-
�ctrical Notes: RET
1, The installation of smoke alarms in all of the following areas shall be provided: (R314.3) EWEU FOR Cep
a, on the ceiling or wall outside of each separate sleeping area in the Immediate vicinity of bedrooms• COPVIPL(A fyCE
b. In eaoh room used for sleeping purposes,
A Reviewed
BY
c: In each story within a dwelling unit,including basements but not including crawl spaces and uninhabitable attics.
_ i
c Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in the Immediate vicinity
basements in dwelling units that have fuel-fired appiisnces or atiached garages.(CRC R315,1) ) of the bedrooms and on every level including
3. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets.Such circuits shalt have no other outlets.(CEC 210,1 i(C}(3)} r�
. :
. All receptacles In bathrooms,garages,accessory buildings,outdoors,crawl spaces,unfinished base;;{encs,kitchens(where receptacles serve countertop surfaces), r
4 }
�c k
laundry,utility,wet bar sinks(vrithin 6 feet of the edge of the sink),shall have ground-fault circuit interrupter GFCi '
protection.
5. to all®ll areas specified in 210.52,all 125-volt, f5-and 20-ampere receptacles shall be listed tamper-rest tant recep receptacles. 91)0.8}
SMOKE / CARBON JVIONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CV ERTI<NO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(ccDcuoertino.org ri
1-13EXINALED AND,C 01 kb UN 'M'
O
TM 11
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 Carbo:
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 AILAKM CO ,,LARM
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. a
Power Supply:Indwelling g units with no commercial power supply, alarm(s)may be solely battery ,perated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or altera ',ans do
not result in-,the removal of wall and ceiling,finishes or there is no access by means of attic,basemen or crawl
space.Refer to CRC Section,R314 and CBC Sections 907.2'.11.4 and 420.6.2.A . lectrical permit is.req.sired for
alarms which must be connected to the building,wirii,g.
As owner of the above-referenced property,.I hereby certify that the al m(s)r ferenced above has/have ave been
installed in accordance with the manufacturer's instructions and in co ,ph ce with the California,B,ildung,
and California Residential Codes.The alarms.have been tested and e rational, as of the date signed
below.
t have read'and a. 'Lee.,to co m-ply,with the f-: ,s nd'conditions of this statement
4' t E49
)� 1 Si`natures ... ......... ......,LiG ,... ._ �.. / ... D,f� .. ....
WATER-CONSERVING PLUMBING FIXTURE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY"DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CU ERTINO 10300TO:RREAVENUE CUPERTINO,'CA95014-3255
777-32 F 4, Z77-3333•building(a)-cupertino.org
Owner Name _ L� ,(-JJ'
Permit Nods
Address 5
1. 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,
DNo 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,
i No Go to Question 3.
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.
I o Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
O 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 110 1.1 through 1101.8 apply. Check one of the three following statements and sig
bottom of form..
5. Ple e check ONE of the following:-
My
"ro ert is a sin le-anvil residential real property.e" See Civil Code Section 1101.4:
P p Y g f y P Pm'
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 buildinog.-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).
0 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 Sectic ns 1101.1
through 1101'.8,the current California Plumbing:Code and California Green Building Standards Code,and manufac rer'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 Signature,'—
Upon
ignature:Upon completing and signing this Certificate,plea e eturn it to the Building Division in order to final your building permit.
SB40 7 2015.doe rev sed 08126115
A/
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS; zib 1 PERMIT
OWNER'S NAME: p� ,�` ;� �I PHONE
GENERAL CONTRACTOR: ' -1
l�lY BUSINESS,LICENSE#
ADDRESS:
7 A A e P - g�' ? CITY/ZIPCODE: 5 0
*Our municipal-code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF F 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
Linoleum/Wood
Glass/Glazing
Heating
Insulation -
Landscapng
Lathing
Masonry
Painting/Walfpap r
Paving
Plastering
Plumbing/
Roofing
fe
ontractor Signature Date