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B-2016-1142 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR- PERMIT NO;B-2016-1142 922 SEPTEMBER DR CUPERTINO,CA 95014-4143(362 14 007) (AMERICAN KITCHEN &BATH INC) SAN JOSE,CA 95112 OWNER'S NAME: GIOVANNONI TONY G AND JOANN M DATE ISSUED;02(1212016 OWNER'S PHONE:408-888-0563 PIIONE NO:408-826-1205 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.P03838 Contractor(AMERICAN KITCHEN&BATH INC)Date 0 211 212 01 6 X BLDG X ELECT —PLUMB 1 hereby affirm that I am licensed ander the provisimts of Chapter 9(commencingMECH X RESIDENTIAL—COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Cade and that my license Is in full force and effect. JOB DESCRIPTION: � Kitchen Remodel(276 sq ft);Install(1)light in dining room;Install new I hereby affirm ander penalty of perjury one of the foliowhrg two declarations: veneer on fireplace. r, 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 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:857000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN information is correct.I agree to comply with all city and county Nunnbcr; Occupancy Type: 362 ordinances and state laws relating to building construction,and hereby 3G2 l4 007 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 WORD 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: ALIS I+IA1vI>S5�1111 Signature (f� .r fiLfi( yti{� -4 Date 02/121?476 Date:02/12 16 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 ibllowiug two reasons: installed without first obtaining an inspection,I agree to remove all new materials For 1. 1,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(Sce.7044,Business&Professions Code) Signature of Applicant: 2. t,as owner of the property,am exclusively contracting with licensed Date,0 21 1 2120 16 contractors to construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm ander penalty of perjury one of the fallowing three declarations; ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 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. 1 will by Section 3700 of the Labor Code,for the perfornnanee of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the is Health&Safety Code,Suction 25532(a)should I store or handle hazardous this permitissued.ithe performance of the work for which this permit is issued,I material.Additionally,should I use equipment or devices which emit hazardous a. I certify that all-contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject to the 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,aqd 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:92/12/2016 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 Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in ARC HI1 C'1"S DECLARATION consequence of the granting of this permit. Additionally,the applicant I understand my plans shall be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Cade,Section 9.18. Licensed Professional Signature Date 02/1212016 CONSTRUCTION PERMIT APPLICATION - COMI%AUNMl DEVELOPKIiEN DEPAPiMENT BUILDING DIVISION 10300 TORRE AVENUE CUPER T INO,CA 95014-3255loam } CUPERTINqP- (408)777-3228 FAX(408)771.3333 buildlna{�,cunGLIR0.ora -6,d f �NEW CON ST2UC-DON lVDDTTION -r.L.T R:4LT1'0N TI ❑ RE�S]ONlDEFirRRBD O�IG1NeI i'��l� PROit?bDRESS 6 4 2lif"'j1'1 -. 41 h?N y s9 t 7. Lrt IOVAtW Ott ( ( Macs239 d 3 s7REET P.DDRzss L CriY, 5TAli,ZiP at FAX COMACT NIA PiiOhe w}qtr✓ ^ f9J2�J4 (16.4 I �huc ate c2+ tt - STRs�i ADDRESS Cr!'Y,ST'A rE, Z1P PAX -19? �/�JLLl �7G11�f � t1flP.UJ r GA ®Ovirm Q oN7wR-3L LD_Zi ❑Own-m AcmiT Q co\-R&croa I�CONS iCTOR AMI,r ❑ aCI—CT ^}•'GD.==R ❑ D�SLOP ❑ i_}:E -x CON RACTORKA.h rl LIC_} ahlJh R L)CE?tiS_-1 B BUS.LIC ✓ t� 1 1 moi' � C// J!ems✓ cola E-w-kIL FAX STFZPTADDRESS Cri pSTAf�, P (� 22 Pe%Olvr t-d-U'ti' boo,0,6 5 7.y _ tPcinyjEGirENGn TR:i?liB - T I LICENSEh�JI ER I BUS.LIC CQ}J3Ah^.'hl-}✓=i; 4 � n•1�?:�L � iA .--.r. STREET Y1}DR SS I C„Y,STtin;ZIP � P•ri0'f M Y DES{Ci1 )?P01SO'rWO fM/`C t.'{, 1- -vC h/7� �.'!"��f^, - J�•,-'✓U 1 f"�'M1- �i( �,'UTw J• �.9 J� 10ir "Ive7 v . E.:IST!NGUSE PROO+POS)EDUSE Cok's-1%n7? I'$aopTRS sr_I- J 1 I VG i k USE TYPE I OCC. SQ-FT. I VALUA,T101\1 IS) �.-7'T r0 mEWFL.00K DEMO TOTAL I` I ` - PfR 14q-z, ' AF A I ? 1=rAZA Z L !a E�I V1 11Z3 l I DATI�LDOV rrjCI-1N 07HIR Itt'}:iODEGtR✓.S (� REISOpELAREA �"�r„ � r.T}:!ODSL.4.=A �( �roGf�G�' - ` 1R) CHA— DECK&RE " •r07-P.LD:.CK1ORC-1A.R3.A GARAGE/uZEA; DETACH ` I� 41. HATrAC3 IDAEW.WCUINTIS: ISASECONDUhrr ❑Y`_'S f SECOND STORY ❑�-S - '--' SEUNG ADDZDT mho mmn-ioh? Rt"O PPS?99_iCf.TiD'\' 2=5 tYms,PROvrmcOPY,DP ISTHzBLDGAN --S - '" � -`, T{7T VA1UATION: 1� ❑ -Culu 35 PLf?i?,71.GhPPLR ❑};O PL?T`TD.Gf3??OY?.7..I.c,i�R ETCEiLP,Z40h£ ' WVD = a d B•y sienature below,I ce;by to each of the fcl int,ing: I am the prepeq ov-T,er or aahorized exert to act on the prone,,~' 01A ner's behalf, I hay e read this anplicetion and the inron eon I have,provided is oo„ect, I have read the Description of'Work and verify it is 2ccu_ate I a ,w to comply-vdth all applicable local ordinerccs and state laws relating to ns ion. I authori-e represent tives'of Cupertino to enfer the shove-id„n iLad property.or inspection purposes. SiVnuh;eofnpplica7tlA:ant: Date: SUPPLE TION R7E-Q=1 ED .--�Y?-v.�Cry-.-C��-.1•Y��:r��3��, -�.0_L•'Ti"'4G�L- Y"� 7\CtV SFD or ML1tiT_"2.3P_lly dis.' l!?P cS: Apply aOr diF_1DIItiDel p-r?!2it rOr - i tr tr c e, 1� i t,fired r e ia. a +il`enc go •O'1 R r C TTrn e?I.Sti_, b 2l n{.) DeSolitioii p-mmit is, e q.ior io'_S_'U'R-n .OTbuildina WHO-- pc,-,nit for new buildings .. {rs�� = _ _ _ PI..�'��'Li PL 't x� r7 _Corm-erclalBldgs: Provide acoml:,lei dHzz2dousater?zlsDiscloses-e wry oar � U oY Y � form ifany Hzz2-rOOLs M t:-iaiS are being used-as parr OL this project. . _ �. � - E Copy ofPlamning Approval Letter or?Meeting tilt;!NaD.Dil±g prior to sub ittzloLBeildingPe rrlitapDlicaticn, � ` - � BL—'9 pp_201I.doaYEvise06/21/17 MA CITY OF CUPER.TINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 922 September Dr DATE: 01/11/2016 REVIEWED BY: Sean Q_S APN: BP#: WALUATION: 1$57,000 'PERMIT TYPE: Building Permit PLAN CHECKTYPE: Alteration 1 Repair PRIMARY SFD or Duplex PENTAMATION 1 R35FDREM USE: PERMIT TYPE: WORK Kitchen Remodel 276 sq ft • Install 1 light in dining room; Install new veneer on fireplace. SCOPE ;.fr:r f.1'J an Chcci; s:turf. r him(Jte.•t Elec.Plan Clieck 0.0 flirs $0.00 bl<<h.1'<r nit t irr: FF,.,,—m t; Prarw%'<< Elec,Perni tFee: IEPERRT !.jr,: , +:. tFf,t:• t)rl:s,'}>i ,,1;Isr3r. Other Elec.Insp, El hrs 112.1110 U ihnr F(,.e, NOTE: 774s estituate does not include fees Atte to other Departments(i.a Planning,Public lForlts,Fire,Sanitary SewtIr District,School District,da). These,fees tyre based on the preffininar information available and are only an estimate. Contact the De t or acldn l info, FEE ITEMS (Fee Resolution ll 053&Ir 71Y13) FEE QTY/FEE F MI,SC ITEMS Plan Check Fee: $0.00 276 81 Remodel,Kitchen(<=300 sf) Suppl. PC Fee: (E) Reg. 0 OT0,0 1rs $0.00 ./$645.001 1i?,, ?ESKiT PME Plan Cheek: $0A0 1 Electrical Permit Fee: Hourly Only? ()Yes Q No $0.00 ✓$72.00 1BRXMFIXT Fixtures,Lighting Suppl.hasp.Fee:(D Reg. C)OT LOU hrs $0.00 PME Unit Fee: $0.00 PME Perniit Fee: $48.00 t.•7orn1rucilon lcs.s: Administrative Fee: 1AI)MN $45,00 0 Work Without Permit? 0 Yes (E) No $0.00 0 Advanced_Pig unjn�l=ec: $0.00 hours Inspections E) Travel Documentation Fee: ITRF1 moc ,/$48.00 x$143.00 IS'TINSP Inspection,Hourly O® Strong lirlotion:F`ee: IBSEL�MICR ,% $7.41 Select an,Administrative Item 131d x Stds Coin assign Fee' 1BCBSC ✓ $3.00 SUff 13TAI.S: $151.41 $860 00 ' OIAL LE:r; $1,011.41 Revised: 01/01/2016 Building Department III City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-.3255 Telephone: 408.777-3228 L U P E RT IN D Fax:408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: t[ PERMIT# S— Lf 2-- OWNER'S OWNER'S NAM : GENERAL CONTRACTO � BUSINESS LICENSE# ADDRESS: �- p CITY/ZIPCODE: I—O d *Our municipal code requires all businesses worldng 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 LL SUBCONT ORS HAVE OB AIMED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors:.. � �� 2- Z-�✓ ignature Date Please check applicable subcontractor 'and complete the following information: V SUBCONTRACTOR BUSIN S NAME ` BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner t Contractor Signature Date Date: March 23, 2016` To: City of Cupertino - Building Inspector From: Joseph Zsutty RE Consulting Engineer Subject: Inspection Letter— 922 September Drive, Cupertino CA On March 23, 2016 we inspected the installation of(2) 5/8 inch diameter anchor bolts for installation of HDU2's. Work was performed in accordance with the manufacturers requirements.. Thank you for the opportunity to be of service. Sincerely, Joseph Zsutty PE - Consulting Engineer 04 3/23/16 -UNOXIDEALARMS 'OWER IWN CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION FILE '10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPPER1111410 (408)777-3228-FAX(408)777-3333- building(cDcupertino.or-g VARHMumi ?2 m2-01 NDcOMPLFTEDUNTIITIHSCLPTfFtCkTLi 11AS A"'W**-r j 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 $1000.0,CRC Section R-314 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 COA 11,A R JIMA , � 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 -I X Within-.each sleeping room X Carbon Monoxide alarms are not required in dwellings w1dch,do not contain fuel-burning appliances and that. dcvnot have an,attached garage. Carbon monoxide alarms combined with sinoke alarms shall comply with, CBC Section-420.6 and shall be approved by the Office of the State Fire Marshal. I . Power Supply:in dwelling units witli no commercial power supply,alarm(s)may be solely battery operated. In,existingdw ellirtgunftsalarms are permitted tobesolely battery operated where repairs or aliterat-lon's,.do'. not resuiltbt the removal of wall and ceiling,fimishes or there is no access,by m.,�eaas of attac,,basement or crawj! space.,Refer to CRC Section,8314 and CBC Sections,907.2.11.4,and 420.6.2.An electrical permit is required for a,Tariv,st wl-LIch mm,.aiistbe,cormected to,the building wiring. As owner of the above-referenced property,I hereby certify 61-4at 11ILie alarm(s>) referenced above lilasAtaveb'e-eiii, m ix,t,s-t,a,lqled'i,naccordance withthe and C'ec,lif,o-,nr-aia,,R,'es,idienti,,a,ICodes.T,,h-ea,la,rm,ahave,been Tested an-�da,reoperational,as.,orf-ffie,date's,itgA,edi below".. 11 haves read jand Mdee'tial cqmpk wft they Berms s aaeon,dftns of tWsstatement (OVA-" .......... Si .....................................L1. ................................ ....... Shwkeandi CO�ft'7rnz.,.dbc,i--ei?isediO3l,],'8YE4) CATER-CONSERWNG PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE FILE COMMUMTY DEVELOPMENT DEPARTMENT•BUILDING ING DIVISIOP CUPERTIN IV:: TORRE AVENUE o CUPERTINO,CA,95014-32,5 �f (408)777-3228,FAX 4408)777-3333 m building00.cuDertino.oro Owner Nam 1s "t c z, r�r,�c�T, Permit No 2-016 —f f to Address #A C!'oZ 7 fS tZ LlA -—ra n 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. 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 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. 6 V 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. V 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. �} 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: _i 19 Mypropertyis asingle 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 plumb%ng fixtures throughout the building(regardless of whether property undergoes alterations:or improvements). 1,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 1101.8,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 O.wnerAge nt's Signature Upon completing and signing this Certificate,please return it to the Building Division in order to finall your building permit. SB407 2015.doc revised 08126115