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B-2016-1402 i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1402 22311 REGNART RD CUPERTINO,CA 95014-4824(366 47 012) MCGUIRE WILLIAM M AND RUTH TRUSTEE 22311 REGNART RD CUPERTINO CA 95014 OWNER'S NAME: MCGUIRE WILLIAM M AND RUTH E TRUSTEE DATE ISSUED:02/2212016 OWNER'S PHONE:4082574456 PIIONE No:4082574456 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor MG-GUIRE WILLIAM M AND RUTH TRUSTEE Date 2/22/2016 BLDG _ELECT _PLUMB I hereby affirm that 1 ant licensed under the provisions of Chaptcr9(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: CONSTRUCT(N)WOOD DECI{(536 S.F.)ON THE SIDE OF THE I hereby affirm under penalty of perjury one of the following two declarations: PROPERTY 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 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.ht Floor Area: Valuation:$5000.00 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 366 47 012 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 DAYSFROM LAST CALLED INSPECTION. Code,Section 9.18. Issued by:PAUL O'SULLIVAN Signature Date2/2212016 Date:2122!20 6 O WNER-BUILDER DECLARATION U-ROOFS• I hereby at'tirm that I am exampt train the Coutractor'.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 fust obtaining an inspection.I agree to remove all new materials for i. I,as owner of the property,or my employees with:wages as their sole inspection. I compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature ofApplicant: 1,as owner of the property,am exclusively contracting with licensed Datc:212212016 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 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 HAZARDOUS MATERIALS DISCLOSURE performance of Cho work for which[his permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and wilt 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 Coda,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the ITealth&Safety Code,Section 25532(a)should I store or handle hazardous this pernut is issued. I certify that in die performance of the work for tivhich this permit is issued,I material. Additionally,should I use equipment or devices which erupt hazardous shall not employ any person in any manner so as[o 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 Codo,,Seetions 25505,25533,and 25534. exemption,l become subject to the Worker's Compensation provisions of the 4LCa r Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent: f �A�& be deemed revoked. Date:212212016 APPLICANT CERI'IOCATION 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 hbreby 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 ARIITECT'S DECLARATION consequence of the granting of this permit. Additionally,the applicant {understand my plans shalt be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed t Professional Signature' Date 212212016 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 E[t t(Ko (408)777-3228• FAX(408)777-3333•building�cupertino.orq NE W CONSTRUCTION ❑ AAAIZ-ION ❑ ALTERATION f TI ❑ REVISION/DEFERnD ORIGINAL PERMIT# PROJECTADARFSS2-S3/ 1 ,�7C /V ART RS CO" OC*v7-.AId } OWNT RNAME ` f 1 PHONE STREETADDRESS CITY STATE,ZIP 2FAX C 23 t l T �`�' C la's F CONTA NAME PHONE E-MA 1 TAI 1q, t�C u Ott '� �?-- r'� M clr e-ae,$41 co" STREET ADDRESS CITY,STATS,Z!P FAX )(OWNER OWNER-BUILDER OWNERAGENT 11 CONTRACTOR ❑CONTRACTORAOENT ❑ ARCHITECT ❑ENGFNEER ❑ DEVELOPER 13 TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS.LIC# vto �i COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITE(.'TIENGINEER NAMELICENSB NUMBER BUS.LIC e- # ' COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF AIORK-_ EXISTING USE PROPOSED USE CONSTR.TYPE M STORIES - pP,ek,f,ep6tm w.c.o� . f USE TYPE OCG SQ.FT. VALUATION (} EXISTGai NEW FLOOR DEMO TOTAL 'v AREA N,4 AREA �V//.V- AREA 0.4-- NET AR C-5 ir BATHROOM KITCHEN - OTHER b REMODFLARPA4 REMODEL AREA ,r/'/ REMODEL AREA PORCH AREA DECK AREA TOTAL DEC/KIPPOORCH AREA CARAGE AREA: DETACH `5. �c� 5, VZ4 E]ATTACH #DWELLING UNITS: �j IS A SECOND UNIT YES SECONNDD STORY EIYES BEL\G ADDED? ZNO ADDITJON4 PNO PRE-APPLICATION ❑ITS IF YFS,PROVIDE COPY OF IS THE BLDG AN ❑YES : VEI3 BI' - - s--" TOTAL VALUATION; PLANNtNGAPPLS ©.NU PLANNING APPROWLI,LETTER EICHLERHOME? RNONO By my signature below,I certify to each of the following: I am the property owner or authori d agent to act on the propel Ly owner's behalf. l have read this application and the inforriation I have providcd is correct. I have read the Description of`York and verify it is accurate. I agree to cornply with all applicable local ordinances and state laws relating to build' onstivctioonn.. authorize�I aauthorrriiizzee representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicanttAgent:--* 1f�E "r i C/o i f�Uc Date: SUPPLEMENTAL INFORMATION REQ3IREI ---- - }:gin�cici=r�Pi: - r�it New SFD or Multifamily dwellings: Apply for demolition permit for `"OVHR THE CQU\TER SUILDIIG P.LAI�RENTER � existing buildina_(s). Demolition permit is required prior to.issuance of building s , pennit for new building, E7a'RESS ` , , PLA\vL\G PLaRtE�IE�F ,:,:,,,::.�..�,.,_,:�,.,:.• ter,._ = - - _Commercial Bldgs; Provide a completed Hazardous Materials Disclosure PtIBLlcrxoRxs; Form if any Hazardous Materials are being used as.pant of this project, LalxcE © FIREDIsPT xs 0-v t•Ig o in t11 Piamm� prior to - Co of PlanningApproval Letter 1 Meet :..D'L4JOii.,__,..._,•-..�,`:-,:_.__:;-. �'.-.._cSA-1IT1R1:SE«'ER,DISTRICTr_;; '?`;-. submittal of Building Permit application. '- - =�-:� Bldg_4pp_2011.doc revised 06121/11 i Y - r •Q OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 T'ORRE AVENUE-CUPERTINO,CA 95014-3255 +rUPERTiAC4 (408)777-3228 • FAX(408) i 777.3333•buildinQ(8cuoer no.orq — 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: SITE ADDRESS - � r APN•3�J`�' I Ota BP# OWNER NA E ] / ,p O tNER ADD ESS C'LL L=am ryt/� := DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment 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 off iclal 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- Builder"building permit that erroneously implies that the property owner is providing his or her own labor and material personally.I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage.for those injuries.l am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. f2. 1 understand building permits are not required to be signed by property owners unless they are responsible for 'TT construction and are not hiring a licensed Contractor to assume this responsibility. 'I/teci I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may pr myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name Instead of my own. 4I understand Contractors are required by law to be licensed and bonded in California and to list their license n mbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons,other than.California licensed Contractors, and the t a1 value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an"employer"under state and federal law. *6. I understand if I am considered an"employer"under state and federal law,I must register with the state and fderal government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to amide by these laws may subject me to serious financial risk. # I understand under California Contractors'State License Law,an Owner-Builder who builds single-family reldential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 3 understand as an Owner-Builder if 1 sell the property for which this permit is issued, 1 may be held liable for a financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. ownerBvilderForm 2010,doc revised 04/19/10 9. l understand I may obtain more information regarding my obligations as an"employer" from the Internal ~ Re entre Service,the United States Small Business Administration,the California Department of Benefit Payments, and the California Division of Industrial Accidents. i also understand I may contact the California Contractors' State License Board(CSLB)at 1-800-321-CSLB(2752)or www.cslb.ca.gov for more information about licensed contractors. - 0. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I Apanty legally and financially responsible for proposed construction activity at the site address listed above. 11. l agree that, as the party legally and financially responsible for this proposed construction activity, I will abide b ail applicable laws and requirements that govern Owner-Builders as well as employers. 2. l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the rnf mation-I-have-provided on this form. licensed contractors are regulated bylaws designed to protect the..pubi1c. if . you contract with-someone who does not have a license,the Contractors'State license Board may be unabie 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. If is also important for yo-u•to understand that if an unlicensed Contractor or employee of that individual or firm is injured.while w�rking on your property,you maybe held liable for damages, If _ you obtaln a perniit�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 verify thapMerfy owner's s nat re. Property Owner's Signature: Date: T: 2.2 !� --- - ------ - --------------- -- -- --- - ----- -- - - - ----------------------------- ----------- ------------- (NOTE: 7-he following Authorrzatibn Form is require----ri-fo--be----cam--pJ-eted by-the owner only when designating an agent of the properly ownerto 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 [ 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: Tel No Address of Authorized Agent: '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, forma notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner`s Signature:. Date: OwnerBuilderForm 2010,doo revised 04/14/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ,;:�3// PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: Gov-lei BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *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 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 j G/-111 /� " 0 D / Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 2e Owner/Contractor Signature ate OM"ER CERTIFICATE F COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION (CUP IN 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408)777-3228 G FAX(408)777-3333.building atcupertino.org eke: la'IEiRMIT CANNOT ISE rIN.Al,rID ANIS C"OI,IPLFTEl)UNTII3 THIS CF�PI-IFICATF PMPOSE 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. GI NERAL 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: A,RVA SMOKE AIIAIZM CO AURUM Outside of each separate sleeping area in the immediate vicinity of the X X bedrooms) On every level of a dwelling unit.including basements X X Within each Slee `in room X Carbon Monoxide alarms are 1-Lot 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 cornPY l with. CBC Section 420.6 and shall be approved by the Office of the State Pire Marshal. Power Supply In dwelling units with;no commercial power supply,alarm(s)may be solely battery operated. In exis:tilg dwellulgunits, 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 t©CRC Section 8314 and CBC Sections;907.2.11.4 and 420.6.2.An electrical permit is required for alanns which zstusf be connected to the burldhag wiring. As owner©fi the above-referenced property,I hereby certify that the,alarms)referenced above hasihavebeeli installed In accordance with the 4��anufacturer:'s instructions and in comzplilance with the.Californias Bu}ld!i tb.. axed Calsifox nig Residential Codes.The alaTimshavebeen tested amid ,,e,operational,asr of the date srgned bel'ow. t hav read'and+a, few fca com 4/,wrth,t7ne,f rru� a+ndr ondttjon o this st fervent � .a !wxn�tl�r ... e.... ConracEot Fiar�rae i i S.i" afurer ............ .r...Lbate.. ... Snwke an&CO)for:m:db.c r erised 03/18%114-, WATER-CONSERVING-PLUMBING FIXTURES LI OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 T, N (408)777-3228-FAX(408)777-3333 building(Qcupertino.org Owner Name W! H, Mc. &if l p � Permit No 13 '--2-0 11v Ll-e Z-- Address Lr2 % J �t �S4 .t° - �4�� �9,Ga�� / f�td Please refer to the attached California Civil Code Sections 1101,1-1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form, Owner' Signature: Date: 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? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. El The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. Owner'Signature: Date: f\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: Sign below and skip the rest of the form. Owner' Signature: Date: 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�'doo not apply. Sign below and skip the rest of the form. Owner' Signature: i '�/ s�l�( s i Date: El 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. Refer to the attached. 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.. SB407 2014.doc revised 0311'8114