B-2016-2346 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2346
10198 TONI CT CUPERTINO,CA 95014-2073(316 23 103) DELSUR
CONSTRUCTION
ENTERPRISES
SOUTHSAN
FRANCISCO,CA 94083
OWNER'S NAME: BALAKRISHNAN ARAVIND AND ARASU VENMAL TRUST DATE ISSUED:08/10/2016
OWNER'S PHONE:408-621-3098 PHONE NO:(415)305-7638
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#932251
Contractor DELSUR CONSTRUCTION ENTERPRISES Date 05/31/2017 X BLDG _ELECT PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL_COMMERCL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
WORK WITHOUT PERMIT/REMODEL BATHROOM AND ADD
I hereby affirm under-penalty of perjury one of the following two declarations: SHOWER DOWNSTAIRS(28 S.F.);CHANGE LOCATION OF
t. I have and will maintain a certificate of consent to self-insure for Worker's LAUNDRY TO GARAGE
Compensation,as provided for by Section 3700 of the Labor Code,for the
�jPerformance 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:$9000.00
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 316 23 103
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 understands and will comply with all non-point
source regulations
per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLEDMiSPECTION.
Signature'�/�` ---� _Date 08/10/2016 Issued by:MEL
``– Date:08/10/2016
OWNER-BUILDER 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
x. 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. I,as owner of the property,am exclusively contracting with licensed Signature ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/10/2016
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 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. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 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 Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: rei—
APPLICANT CERTIFICATION Date:08/10/2016 -01
certify that I have read this application and state that the above information is CON
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit 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.
Signature Date 08/10/2016 Licensed
CC-` STRUCTION PERMIT APPLICATION
CO `.JN1TY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10306TORRE AVENUE•CUPERTINO,CA 95014-3255
1.1 i EtTltwi{�' (408)777-3228•FAX(408)777-3333-buildlnra{a_cut)ertino,.org
NEW CONSTRUCTION ❑ .ADDITION ALTERATION 7 T1 ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS `�8Il l APN#316 `0 .
OWNERNAME g��777 / ry / ^� t
PHONE t f0 JS (�+ ( J E-MAIL
STREETADDRESS -,/ f �� CITY,STATE,ZIP FAX
CONTACT NAME / / PHONE
Cx. E-MAIL
STREETADDRESS .CITY,STATE,ZIP -"C
FAX
❑OWNER ❑ OwNER-BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ARC.ECr ❑ENGINEER ❑ DEVELOPER TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME / E-MAIL
FA7C
STREET ADDRESS r CITY,STATE,ZIP PRONE
ARCHITECVPNGINEER NAME LICF,NSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL
, PAX
STREET ADDRESS CITY,STATE,ZIP PRONE
G4s(f2'L- s7nrr+•�] f E.•'s"� dLwl. i f'"'Ytr•Gi:� Ez
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES --
USE TYPE OCC. SQ.FT. VALUATION($)
FXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
f`—
BATIIROOM KrFCHEN OTHER
REMODELAREA. { ��. REMODELAREA REMODELAREA
PORCH)REA DECK AREA TOTALDECKIPORCHAREA I GAIIAGEARF.A: ❑I)ETACII
❑ATTACH
try 5��f
!F DWELLING UNITS: 1S A SECOND UNIT []YES SECOND STORY [:]YES
-
BEING ADDED? []NO ADDITION? LNo
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES r;R EDBY ; ;.; - _.., T• VALUATION:
APPL N ❑NO PLANNING APPROVAL LETTER laC HLER AOME? ❑NO _ - -
By my signature:below,I certify to each of the following: I ant the property owner or autbord agent to act on the property owner's behalf Ila a read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constnlc ion. I authorize representatives of Cupertino to enteribe above-identified property for inspection proposes.
Signature ofApplicantlAgent: 4
- Date:
SUPPLEMENTAL INFORMA OTT RE UIRED v,; :•..• = :. ,....•.:. ':'
Q
_New SFD or Multifamily dwellings: Apply for demolition permit forTILE CounTER 1�'BvrLpivlEtt
existing building(s). Demolition permit is required prior to issuance of building _;.,, ,;_._. __,• ,' ,.. - ._._.
permit for new building. 0-;EXPRESS_ ❑.PLAtVNING.PI
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sra�DAtiD ❑ PueLlc}}ottl(S -
forrn if any Hazardous Materials are being used as part of this project. p LARGE 1]- Flit EPr .
_Copy of Planning Approval Letter or Meeting with Planning prior to
S1117rit1ttaI of Building l'ei'lIllt application. -A4AJOR SA..... SES}ERDI53RICT
BldgRpp_2011.doe revised 06121111
4
COMPLIANCE
COM
MU'NITY QEVELOPMI-NT DEPARTMENT O BU.ILDIING DIVISION LE
-"u� 1 I 10300 TORRE AVENUE GUPERTINO,'CA 95)7143255
(408)777-3228 w FA7C`(408)771.3333 y burldrg,(ccuperfho:orq l
.r
" 3
UA k1S _
This affidavit is a elf--certification for the installation of all required Srnol<e and Carbon Monoxide Alarms for
cozripliar ce witli 013 CRC Section R314,2013 CBC Sections 420.6 and 907...11.2 wllere'ri0 interior access.for
inspections are required.
G,112N A L INTO RA,TIO
B sting single=fa ily niid inul ti-f amily dwellings shall be provided with Smoke Alarms and Carhali
IoYioxide alarms men the valuation of additions, alterations,or repairs to existing dwelling onits exceeds
$100GO,CTC Se,tion 83,14 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Atari is aiid/Dr Carbon
Monoxide AlarmE be installed in the following locatio2is:
AIMA SiVI0 Cif ALAR' COQ ALA
Outsnde of eat separate sleeping area in the immediate vicinity of the
x belie®orn s� �`'
Ont ever leve of a dwell'in thiit include .tease -eni s
. ;
Within each sle;int morn j
X
t
Carb-omMionoxidd alarms are not req p aired in,dwellings which do!not con,)tarn : gel burning appliance
d®r not haeme a� at ached agar e. Carbon ) �• . s and that
g g monoxide alarms combined with smol�e alarms shall ca'znpYy w%
CB'C Seci oli 4120. orad sl2all be approved by the Office of the State Fire Marshal. &
P`o�w�er Sup �L Iii. Iwelliils .uri�its�vitlt no co )� � ,
pp Y° g iYunercial p-ower supply,alarnn(s)iitiaybe satiety b ),E,ry operated..
Til;exi$sti�ag,dweiRE.I&antis, alarms are errnitted to be solel battei o••crate R
1' Y Y p d where repaEirs or<-<- arlteration;si dog
not result m tfie r moval!of wall amid ceiling,finishes or, there is no access by ineains of apt rc,Va+sevv n oar cra wl
s�>ace1 lief er to C C Sed,wm1 R3)1I4 ani ttar�is 90�T.2-1.1.4 and 420:6).2..Art electrical pe a
1' d CBC Sec r ! f rrrrirt is.reguued for
altara:ai s-�hkhi rnu t 6e c iutieeted fo ,�)e bu r I� ing wkkmg
As owner of the ove zefexenced[pl operty,l hereby certify that the alarzn(s)refer•e )cel.ab:ave lias,; ave,b:ee z
ra.stalledl: , actor ante wIth the"manufacturer`s ins,tructjons anal iru coalpJs;"
arice wst E,the CaIorni}a�Buil'd�io-
and Callirfammi,a:Re&identia>l; s. t° I.x b`
Code 'T'he alarms I�acre b:ee-ii;tesfecl ailcl are ap�eratlonal, as Of,the date sgiqecl
Below.,
Phave,readtand a:teeCo=com,:l w.1 the tlerma,arad,eond d s,ofMih ,afa mien'
Si naftfr
i
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION'
CUPER �� 90300 TORRE AVENUE o CUPERTINO,CA 95094-3255
(408)777-3228®FAX(408)777-3333 a buildingCa)cupertino org
Owner Name /" d &(Lrl Permit Nod '201(
Address tat ly' _.
1. Is your real property a registered historical site?
11 No G to Question 2. g apply. p and sign bottom of form.
Yes Civil Code Sections 1101.1 through 1101.8 do not a 1 . Ski the rest of the form
2. Does your re d property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,in tallation 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,,
St ip the rest of the form and sign bottom of form.
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.
Lj�6 No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
3 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 M 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
bo om of form..
5. Please check ONE of the following:
❑. My proper Ly is asinglefamilyresidential real property. See Civil Code Section 1101.4.
On and afl er January 1, 2014,building alterations or improvements shall require all non-compliant plumbing factures
to be rep. ed 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 u idergoes alterations or improvements).
Q Myproperly is a multifamily residential real property. See Civil Code Section 1101.5.
On,and aft r January 1,2014;specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
Orr or bef re January 1,2019,all non-compliant plumbing fixtures.shall be replaced with water-
conservinplumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvem nts),..
❑ Myproper y is a commercial'real property. See Civil Code Section 1101.5.
On and aft-,r January 1,,20.14;specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On cr 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 own 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 re uirements,and that the water-conserving plumbing fixtures,comply with the requirements asindicated in the
L
table on,the.f llowin :a
wner or Own' r Atinte..
9. 9 r Da' ! 3
's.Si' nature
Upon coin I feting,and signing this Certificate,please return it tot e Building-Division in order to final your building permit..
SB4072075.doc revised 08126115
i '