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15100193CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10605 FARALLONE DR CONTRACTOR: SCOTT & SABRINA ELLIS PERMIT NO: 15100193 10605 FARAL.ONE DR DATE ISSUED: 10/23/2015 CUPERTINO, CA 95014 OWNER'S NAME: SCOTT & SABRINA ELLIS OWNER'S PHONE: 6502551975 PHONE NO: JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL ❑ ® LICENSED CONTRACTOR'S DECLARATION License Class Lic.4 BACKYARD PAVILION (239 SF) i Contractor Date 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: Sq. Ft Floor Area: Valuation: $12830 �. I have and will maintain a certificate of consent to self -insure for Worker's APN Number: 36939037.00 Occupancy Type: ' 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. PERMIrT EXPIRES IF WORK IS NOT STARTED WITHIIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION I certify that I have read this application and state that the above information. is 180 DA`VS F M YS LAST CALLED INSPECTION. correct. I agree to comply with ail city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to Issued enter upon the above mentioned property for inspection purposes. (We) agree to save by. Date: 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 RE -ROOFS: all non -point source regulations per the Cupertino Municipal Code, Section 9.18. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed withoutfirst obtaining an inspection, I agree to remove all new materials for Signature Date inspection. C Signature of Applicant: Date: OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: - 1. 1, as owner of the property, or my employees with wages as their sole - HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offeredfor sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, 2. I, as owner of the property, am exclusively contracting with licensed contractors to and 25534. Iwill maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & construct the project (Sec.7044, Business & Professions Code). Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as! defined by the Bay Area Air Quality Management District I will t I have and will maintain a Certificate of Consent to self -insure for Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation, as provided for by Section 3700 of the Labor Code, for the Health & SafetyCode, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, Compensation for b Ow F or auflbo�ized a nt: ' as provided p y Iter .�' / Date: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3.,J certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY Griot employ any person in any manner so as to become subject to the Worker's I hereby affirm ttyat there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name Lender's Address must forthwith comply with such provisions or this permit shall be deemed revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Profess ;ional 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, c z Signature - —�� Date 1�13 i i CUPEEi'I INO ❑ NEW CONSTRI PROJECTADDRESS CONSTRUCTION PERMIT APPLI(CATION COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-32'P,5 (408) 777-3228 • FAX (408) 777-3333 • building aocupe`rtino oro Ea "ADDITION ADDITION ❑ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # OWNERNAME r i &A 92 10 Ar j APN # 13 -P-HOONEEH- 4IL0c_`zSig-�%`3 1_nrarr Bldgtlpp 201i.doc revised 06/21/11 STREET ADDRESS 7 CITY, STAT FAX E, ZI(s� Eu 0 s(�1 CONTACT NAME''N PHONE EMAIL _ GlS-4) -X5S ;I G STREET ADDRESS CITY, STATE �y ZIP g yI CIU C'9 � D 6 " d a C -A 5T cA FAX ID OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER El TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC ig COMPANYNAME E-MAIL FAX STREET ADDRESS CrrY, STATE, ZIP PHONE DESCRIPTION OF WORK Tt I EXISTING USE - PROPOSED USE CONSTR- TYPE 9 STORIES ker I a - C,�ti exec � 6 USE TYPE OCC. SQ:FT. VALUATION ($) EXISTR DEMO TOTAL AREAG { AREA OO °V AREA! NET AREA P BATHROOM 6 4h KITCHEN OTHER OTHER REMODEL AREA,. (� REMODEL AREA REMODEL AREA - PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH - - Z ["ATTACH # DWELL INGUNUS: IS A SECOND UNTr El YES SECOND STORY - ❑YES BEING ADDED? �O ADDITION? F940 i PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # MifM PLANNING APPROVAL LEITER is THE BLDG AN ❑YES EICHLER HOME? NO G - t t �,.' y' t TOTAL VALUATION: v lie- yL, N. 1.4 �W _ _._ - .. v By my signature below, I certify to each of the following: I am the property owner or authori d a nt to ac 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 v s accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to eater the above -identified property for inspection purposes. Signature of ApplicantlAgent: 17 Date: /a O/Z /7-015, SUPPLEMENTAL INFORMATION REQUIRED E �LAN_CHECKa;YPE._ . sy.' amu,:, iZ07TTlNGSLIP3 ?N New SFD or Multifamily dwellings: Apply for demolition permit for ❑ existing buiIding(s). Demolition permit is required prior to issuance of building aOYER�rA?iCOIINTERz x4 'H+ ,4� k� z g' BIIILDINGPLANREVSER;t 2z �tzt y r L permit for new building. HE! 0 Exr.Imss' e 4 M. SHE!',- efi ❑ I t�NNINGrS ANxEVIEw' r`x erg MRS. �..�'4 i i r.S�,x.�`�s -sk-<40,105 �'��� ^'y rsz�. t � d•'.��"'�"�.x r; 1t'� _Commercial Bldgs:: Provide a completed Hazardous Materials Disclosure ❑ sTA2 4'' 'ter s � ' ❑u YT]BLIRM C WORHS01"N"11t ' farm if any Hazardous Materials are being used as part of this project. ? I $ t 5f+ s _ {? Y` ❑ `LA`RG,E t�-� -. r �� ❑ EIRE EPT��-,.- ` � r2, Copy of Planning Approval Letter or Afeeting with Planning prior to _ submittal of Building Permit application. ❑rox� t ' �K �4 sT SEj�ER zSTRiOT «-.�•�` ❑aENYII2b1�T1V1ENTe(Z'AF•A7.TH - �''' � `- °.1�h.._ r;`•�' Bldgtlpp 201i.doc revised 06/21/11 CITY OF CUPERT�INO I"10-10 FFF. F.CTIM A Tali? s 2TTTT ilTNl- n1X7TCc1r1AAT 1AADDRESS: 10605 FARALLONE FEE DATE: 1Q123/2015 REVIEWED BY: PHUONG APN: 369-39-037 BP#: Plan Check Fee: *VA:LUATION: 1$12,830 —� 1s.f Patio Cover / Sun Room $716 00 IPATIOWOOD Wood Suppl. PC Fee: Reg. 0 OT0.0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex USE: JPENTAMATION 1 PERMIT TYPE: 1 R3SFDADD WORK BACKYARD PAVILION 239 SF Permit Fee: SCOPE Suppl. Insp. Feer Reg. 0 OT i j -tech, Plan Check Numb. Plan Check � 1 IErC. fli( t Chock llech. Permit b e: hi C �crrrz!�. 1' $t,r�i .0"er:: � I � ��. PermFee i Other Ade ch. ,h2s}:. _ Other Phzlilb bi p, j 01,her Eiec. t/-tsp. r'ium;>. hup. Fe{: j Elec. Inst, hi>e: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. Ptr_)_ Thova foot nro h"cod n" tho nro)ir,.,:r-s..r.,, :u in .ns,;.. ,.�1"Al- ,,,,J�,. -A. 0-4-4 4L- n, 4 -.4.4-yl —r - FEE ITEMS (Fee Resolution 11-053 ff 7/If13) FEE QTY/FSE MISC ITEMS Plan Check Fee: $0.00 1s.f Patio Cover / Sun Room $716 00 IPATIOWOOD Wood Suppl. PC Fee: Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 1 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction 1-GLv: ACl)nti?7;5`l1'tX Zi%E? Fee: Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee.$0.00 i, Select a Non -Residential Building or Structure 1'rt;tvel Docurnenlalion Fe'ev: Strong Motion Fee: IBSEISMICR $1.67 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 777 7_7.777_7 -ITBTOTALS: $2.671 $716.000AEE: $718.67 Revised: 10/01/2015 SMOKE d CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 a FAX (408) 777-3333 o building(a.cupertino.org AJPgtl:a / 5/ v a 1,9 3 EMUob 10 too S Fa �ry�yN� D f� • � CuP61er1N016,0 . A a RESeke: b Apno� de: -2 PERMIT CANNOT BE I+INALED AND COMPLETED UNTIL YETIS CERTITICATE HAS BEEN ,� 'hTLE, AND RETITRNVD TO THE BUILDING DIVISION 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 $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement ti©, rrEr? o Owc�,er,Agent-s.).Name: Sf13 Q t NA ALL/S `......../•:........./l //3o�lvf5 {Si na_1ure...................................................................................�ba e� C�nfr;�cfbr�Name: F$ — SiE cat'6re........................:.........................................:Linc?.................................... Date: Smoke and CO foam. doc revised 03/18/14 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 v PQ5 l'd, (408) 777-3228 • FAX (408) 777-3333 ^ buildingpcupertino.org Owner Name 11S A 6 a l NA 6 Lt i S Permit No. & /5 / o U! g 3 Address Ill0(0OS 4:: - kLL�uNE _Dtz, WvOE-e-T i Nus CA 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 fonn. EKNo 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. R(No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. C'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. IR [✓ 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. Pl se check ONE of the following: + 9 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). ❑ 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 comntercial 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 110 1. 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 followiniz page. Owner or Owner Agent's Signature _(may Datel-L/J 130 /?v1; Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08/26/15 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ing(8cuoertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: We are providing you with an Ownei-Builder Ackhovdledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS; Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - ler" building permit that erroneously implies that the property owner is providing his or her own labor and material onally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by nlicensed person and his or her employees while working on my property. My homeowner's insurance may not ide coverage for those injuries. I am willfully acting as, an Owner -Builder and am aware of the limits of my -ance coverage for injuries to workers on my property. �2. 1 understand. building permits are not required to be signed by property owners unless they are responsible for construction and are not hiring a licensed Contractor to assume this responsibility. . I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may t myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license bars on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the value of my construction is at least five hundred dollars ($500), including labor and materials, I maybe idered an "employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and al government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to iployment compensation for each "employee." I also understand my failure to abide by these laws may subject serious financial risk. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by sed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work rformed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which, this permit is issued, I may be held liable for inancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction ;ts in the workmanship or materials. OwnerBuilderForm 2010.doe revised 09/19/10 3. I understand I may obtain more information regarding my obligations as an "employer" from the Internal :sue Service, the United States Small Business Administration, the California Department of Benefit Payments, ie California Division of Industrial Accidents. I also understand I may contact the California Contractors' State se Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide I applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ifiOrmation-1-have-provided on this form. Licensed contractors are regulated bylaws designed to protect.the.public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a. result of a complaint... Your only remedy against unlicensed Contractors maybe in- civil court. Itis also important for you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you maybe held liable for damages. If you -obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not-- those otethose Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to veri,J the property owners si nat re. Property Owner's Signature: Date: d' lS zvl --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10