B-2016-1794CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1794
10341 N BLANEYAVE CUPERTINO, CA 95014-2331 (316 33 006)
PAULARNOLD
CONSTRUCTION INC
SAN JOSE, CA 95123-
3412
OWNER'S NAME: KHOO MAUREEN O TRUSTEE
DATE ISSUED: 04/19/2016
OWNER'S PHONE: 408-203-8616
PHONE NO: (408) 690-5013
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INTO:
License Class f Lie. #394567
Contractor PAUL ARNOLD CONSTRUCTION INC Date 03/31/2018
X BLDG —ELECT —PLUMB
—
MECH X RESIDENTIAL — COMMERCIAL
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.
JOB DESCRIPTION:
REMODEL 1 ST FLOOR MASTER BATH (48 S.F.), 2ND FLOOR
I hereby affirm under penalty of perjury one of the following two declarations:
MASTER BATH (104 S.F.), POWDER ROOM (43 S.F.), LAUNDRY
I. I have and will maintain a certificate of consent to self -insure for Worker's
ROOM (51 S.F.); REPLACE FDCED WINDOW TO (N) FRENCH DOOR
Compensation, as provided for by Section 3700of the Labor Code, for the
AT DINING ROOM; REPLACE (E) SLIDING DOOR TO (N) WINDOW
performance of the work for which this permit is issued.
AT FAMILY ROOM; REPLACE (E) SLIDING DOOR WITH (N)
2. I have and will maintain Worker's Compensation Insurance; as provided for by
SLIDING DOOR AT LIVING ROOM.
Section 3700 of the Labor Code, for the performance of the work for which this
REV # 1 - ADD (N) DESIGNATED GAS LINE TO FIREPLACE INSERT
permit is issued.
- ISSUED 8/12/16
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 ordinances
Sq. Ft Floor Area:
Valuation: $98000.00
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
APN Number:
Occupancy Type:
inspection purposes. (We) agree to save indemnify and keep harmless the
316 33 006
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.
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
, Signature&JZ 4eDate os/12/2016
180 DAYS FROM L ST + INSPECTION.
OWNER -BUILDER DE L R TION
Issued by:MELISSA
I hereby affirm that I am exempt from the Contractor's License Law for one of the
Dated all 2
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
RE
compensation, will do the work, and the structure is not intended or offered for
-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
sale (Sec.7044, Business &Professions Code)
4
le
Pr fessio s Codively e)
installed without first obtaining an inspection, I agree to remove allnew materials for
2. I, owner the property, with licensed
inspection.
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
Signature -of Applicant:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Date: 08/12/2016
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
3. I certify that in the performance of the work for which this permit is issued, I
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
shall not employ any person in any manner so as to become subject to the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Worker's Compensation laws of California. If, after making this certificate of
Health & Safety Code, Section 25532(x) should I store or handle hazardous
exemption, I become subject to the Worker's Compensation provisions of the
material. Additionally, should I use equipment or devices which emit hazardous
Labor Code, I must forthwith comply with such provisions or this permit shall
air contaminants as defined by the Bay Area Air Quality Management District I
be deemed revoked.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety C , Sections 25505, 25533, and 25534.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
or authorized agent:
correct. I agree to comply with all city and county ordinances and state laws
Date: 08/12/2016
relating to building construction, and hereby authorize representatives of this city
CONSTRUCTION I ENDING AGENCY
to enter upon the above mentioned property for inspection purposes. (We) agree
I hereb affirm that there is a construction lending agency for the performance
Y
to save indemnify and keep harmless the City of Cupertino against liabilities,
of work's for which this permit is issued (Sec. 3097, Civ C.)
judgments, costs, and expenses which may accrue against said City in
this Additionally, the applicant understands
Lender's Name
consequence of the granting of permit.
and will comply with all non -point source regulations per the Cupertino Municipal
Lender's Address
Code, Section 9.18.
Signature Date 08/12/2016
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 • building
Qcupertino.org
+G1.1PERTtltlOI
NEW CONSTRUCTION ❑ADDITION ALTERATION/ TI REVISION/ DEFERRED ORIGINAL PERMIT it(I— � I U — 14
PROJECT ADDRESS M-3 7 ' 7 ,(.(ve +
APN #
OWNER NAMEPHO
Z03
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP I FAX
CONTACT NAME
PHONE. J ��JI/
O
E-MAIL
(Q
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OVINTER-BUIIAER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT
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LIC SE
LICEIQSE T E
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COMPANY NAME
-MAIL
FAX
STREET ADDRESSZIP
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E
CITY, STAT, Ci
PHONE
ARCHITECT/ENGINTEER NAME
LICENSE NUMBER
BUS. LIC n
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
1
DESCRIPTION OF WORK
EXISTING USE - PROPOSED USE CONSTR. TYPE # STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
..
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
- GARAGE AREA: ❑ DETACH
❑ ATTACH
,#.-DWELLING UNTITS:.
IS A SECOND UNIT ❑.YES
SECOND STORY DYES
BEING ADDED? ONO
ADDITION? ❑ NO-
PRE -APPLICATION ❑ YES. IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES C £DBI' ` TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following: I am the property own onze t to act on the property owner's behalf. I have read this
application and the information I have provide rs orrect. 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 str;cGttin.authsize repr,e tives of Cupertino to enter the above -identified roperty for inspection purposes.
Signature of Applicant/Agent: Date: /,
PLAii CHECK TIDE , , x _ ROlrru.c
SUPPLEMENTAL INFORMATION REQUIRED .,,.
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovER TiE couNTER ❑ suILDING PLaN RES tEw
_
existing building(s). Demolition pen -nit is required prior to issuance of building ;
permit for new building. EXPRESS ❑ PLAi NIN, TI ,AVREVIEW
�� `� ❑ PABLIG u ORBS
Colnlnercial Bldgs: Provide a completed Hazardous Materials Disclosure sTArmARD
_
form if any Hazardous Materials are being used as part of this project. LAIicE:`] `i IRE SEPT x
Copy of Planning Approval Letter or Meeting with Planning prior to I]IAaoR- ❑ s�NrrARY sE«ERvisTRlcT a
_
submittal of Building Permit application.
r ❑<z ENVIRONIIiENTAT HEALTH
BldgApp_2011.doc revised 06121!11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PEI2rl2IT NO: B-2016-1794
10341 N BLANEY AVE CUPERTINO, CA 95014-2331 (316 33 006)
PAULARNOLD
CONSTRUCTION INC
SAN JOSE, CA 95123-
3412
OWNER'S NAME: ICIIOO MAUREEN O TRUSTEE
DATE ISSUED: 04119/2016
OWNER'S PHONE: 408.203-8616
PHONE NO: (402) 690-5013
LICENSED ONTRA.CTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class E Lic. #39 6U
Contractor PAUL ARNOLD CONSTRUCTION INC Date 0313112018
� BLDG _ELECT LECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
I hereby affirm that I ant licensed under the provisions of Chapter 9 (commencing
with Section 7000) of ]Division 3 of tine Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
REMODEL 1ST FLOOR MASTER BATH (48 S.F.), 2ND FLOOR
I hereby affirm under penalty of Perjury one of the following two declarations: 'MASTER
BATH (104 S.F.); POWDER ROOM (43 S.F.); LAUNDRY
r. I have and will maintain a certificate of consent to self -insure for Worker's
ROOM (51 S.F.); REPLACE FIXER WINDOW TO (N) FRENCH DOOR
Compensation, as provided for by Section 3700 of the Labor Code, for the
AT DINING ROOM; REPLACE (E) SLIDING DOOR TO (N) WINDOW
performance of the work for which this permit is issued.
AT FAMILY ROOM; REPLACE (E) SLIDING DOOR WITH (N)
JV 2. I have and will maintain Worker's Compensation Insurance, as provided for by
SLIDING DOOR AT LIVING ROOM,
Section 3700 of the Labor Code, for the performance of the work for which this
perinit is issued,
APPI ICANT CFRTIFiCAT7ON
I certify that I have read this.application and state that the above
Sq. Ft Floor Area: 246
Valuation: $98000,00
Information is correct. i agree to comply with all city and county ordinances
APNNumber:
occupancy e:
y Typ
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
31ti 33 006
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 to consequence of the granting of this permit,
Additionally, the applicant understands and will comply with all non -point
PERMIT EXPIRES IF WORK IS NOT STARTED
source regulatiopaper the Cupertino Municipal Code, Section 9.18.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CITED SP CTION.
Signature ( Date 411912016
Issued by: ALEX VALLELLINGA
OWNER -BUILDER TIL<•CI�AIIA't'TON
pato: 04![972016
I hereby affirm that I um exempt from the Contractor's License Law for one of the
followinrg two reasons:
1, I, as owner of the property, or my employees wits, wages as their sole
RFrROQE88,
All roofs shall be inspected prior to any roofing. material being installed, if a roof is
compensation, will do the work, and.the structure is not intended or offered for
installed without fust obtaining an inspeotion, I afnc.:, to remove all new materials for
sale (Sec.7044, Business & Professions Code)
inspection.
2. i, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Proressions Code).
Signature ofApplicaof:
i hereby zMrm under penalty of perjury one of the following three declarations:
Date: I
1, I have and will maintain a Certificate of Consent to self insure for Warker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
perrotmanee of the work for which this permit is issued.
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS (DISCLOSURE
Section 3700 of the Labor Code, for the performance of the work for which this
I have read the hazardous materials requirements under Chapter 695 of tiro
permit is issued.
California Idealth & Safety Code, Sections 25505, 25533, and 25534. 1 will
3. 1 certify that in the performance of tiro work for which this permit is issued, !
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Worker's Compensation laws of California. If, after making this certificate of
material. Additiona1ly, should I use equipment or devices which emit hazardous
.exemption, I become subject to the Worker's Compensation provisions of the
air eontandaRnts as defined by the Tray Area Air Duality Management District I
with tine Cupertino Mnnfeipal Code, Chapter 9.12 and
Labor Code, I must forthwith comply with such provisions or this permit shall
will mahttain compliance
fire Health & Safety Code ect' us 25505, 25533, and 25534.
be deemed revoked,
APPLICANT -CERTIFICATION
I certify that I have read this application and state that the above information is
Owner or authorized agent:
r ora 016
correct. I agree to comply with all city and county ordinances and state laws
Date:
CON cTRucmioN LENDING AC>;NCY
relating to building construction, and hereby authorize representatives of this city
I hereby affirm that there is a construction lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We) agree
of work's for which this permlt is issued (Sec, 3097, ON C.)
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Name
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
Lender's Address
Code, Section -3.18.
ARCHITECT'S DECLAR HON
I understand my plans shall be used as public records.
Signature Date 4119/201.
P
CONSTRUCTION PERMIT APPLICATION
s COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUIpERi"IN® (408) 777-3228 • FAX (408) 777-3333 • building0—cupertino.org
NFW ['.CINSTRUcTF IN F1 AT)I3mow I O ATNERATIC}N I T'I F1 REVISIQN f DEp'ERRED
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13 OWNER 13 OWNHR-BUILDER 13 OWNERAGENTi',' CONTRACTOR ❑ CONTRACTORACRur ❑ ARC[I.6TECT 13 ENGINEER 13 DEVELOPER 13 TENANT
CONTRACTORNAME jig-
LICHNSENUMHER
LICENSETYPE
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EXISTW G USE
5;ilC eS.
PROPOSED USE
1�
CONSTR. TY PR
` f>
# STORIE5
2..
USEi
TYPE
C.
S(I.F"T'.
VALUATION ($)
-F
I, (.lcoi •
_iit -
AREA
NEW FLOW
AREA
DEMO
AREA
TOTAL
NETAREA
DATHROOM KITCHEN
L2EMODEL +` - REMODEL AREA. ��
4 (9
OTHER
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�GARAGRAREA:
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#1)WEId.ENCrUNiT5
ISASECEVNDUNIT ❑YES
BRINGADDFD? M10
SRCONDSTORY DYHS
ADDITION? MPO
PRE -APPLICATION OYES II=YES,PROVIDE COPY Or
PLANNI4GAPPL9 220 PLANNING. APPROVALLQITER
ISTHE BLDG AN OYES
KICULLRIiOME7 0-gO
RECENti
TOTAL VALUATION:
000
By my signature below, I certify to each of the following: I. am the property owner or authorized agent to act on t e property behalf. I have read this
application and the information t have provided is correct I nave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to In di construction. I authorize rep; sentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant(Agent: a Date: (L,.
SUPPLEMENTAL Il FORMATIONREQULRED eLANCRECKTYPE
ROUTING SLIP
❑ BUILDING ELAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition petmii for p OVER R'HE-COUrMR
existing building(s). Demolition permit is required prior to issuance of building
permit for new building, 0 EXPRESS -
:� PL&NNING PIAN REVMW .
° Comlmercial Bldgs: Provide a completed Hazardous Materials Disclosure E1 STANDARD
D PUBLIC WORKS
form if any Hazardous Materials are being used as part o€this project. ❑ LARGE
� FMED�f
Copy of Planning Approval Letter or Meeting with Pinning prior to I] MAJOR
11 SeONfi'ARY SEWER DISTRICT
submittal of Building Permit application.
El EITVIIIONMENTALREALTH
BfdgApp2011.doc revised 06121111
411
View Ac' iF �tw
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PUUDT PLANS t l D BY
DATE yti
P?ANNlNG D PT
CUPERTINO
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17:
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General Electrical Notes-
S- RacePtatle outlets are regupd as fdiaas
12 feet C.C. maz 8 within6 feet of the end of any was,
CEC 21052(.)
any ,It space 2 feet or more
CEG 210 52(a)
- kitchen & counter space wide than 12' 1—te so that nn
paint along the counter wall's aver 24 from a receptacle.
CEC 210 52(.)
2. install conductor wires Win an Insulated neutral & a four prong
-flet at all doyens and Corning units.
CEC 260-60
3. Dedicated circuits required for btchen walls, countem ps & refrigerator
Outlets range hoods disposal_ dining Nom and outside outlets Dishwasher or
m.crawave ovens cannot be served by these eacmts
CEC 210-62(b)
4. Bathroom outlets require a dedicated 20 amp circuft & cannot serve any other
lights, fans, receptentes, etc. -
5,
mvide the minimum 30X36" service work access immediately in treat of
disconnects (i,. at A/Crrompra .,, service equipment panels, subpanels, etc.)
CEC 510-16
5. &athr-om fans shall be capable of providing five air changes Per hour & 50 CFM minium,
CEC See 1203.3
7- Light fixtures in tub ac shower enclosures shall be labaled'sudable for damp conditons
8- New outlets (ncluding racepaides, switches, lighting and hard woad smoke detectors)
In Eadreome must be on circuits protected with a combination arafault breaker
-
CEC 210.12 2013
g. All new cutlets (receptad., switches, lighting, etc) In the family, dmvg Irving bedrooms,
Hallways etc. shall be on clrcuits protected of a combination aro-iauk ci—R irate . pter-
CEC210.12 2013
10. All new and replaced receptacles shall be listed tamper-resistant (1R).
CEC 40612. 2013
11, Enure alt existing bedrooms are fiftea with Listed smoke alarms.
New smoke detectors E reeve construction to be hotanred with baiterp backup.
Combination plane mon cadshaacke dead or to HalMays loading to steeping areas.
/ �'I. [5I6'1Nei Avebwc, .
I
s 60 6
62 64
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General Electrical Notes-
S- RacePtatle outlets are regupd as fdiaas
12 feet C.C. maz 8 within6 feet of the end of any was,
CEC 21052(.)
any ,It space 2 feet or more
CEG 210 52(a)
- kitchen & counter space wide than 12' 1—te so that nn
paint along the counter wall's aver 24 from a receptacle.
CEC 210 52(.)
2. install conductor wires Win an Insulated neutral & a four prong
-flet at all doyens and Corning units.
CEC 260-60
3. Dedicated circuits required for btchen walls, countem ps & refrigerator
Outlets range hoods disposal_ dining Nom and outside outlets Dishwasher or
m.crawave ovens cannot be served by these eacmts
CEC 210-62(b)
4. Bathroom outlets require a dedicated 20 amp circuft & cannot serve any other
lights, fans, receptentes, etc. -
5,
mvide the minimum 30X36" service work access immediately in treat of
disconnects (i,. at A/Crrompra .,, service equipment panels, subpanels, etc.)
CEC 510-16
5. &athr-om fans shall be capable of providing five air changes Per hour & 50 CFM minium,
CEC See 1203.3
7- Light fixtures in tub ac shower enclosures shall be labaled'sudable for damp conditons
8- New outlets (ncluding racepaides, switches, lighting and hard woad smoke detectors)
In Eadreome must be on circuits protected with a combination arafault breaker
-
CEC 210.12 2013
g. All new cutlets (receptad., switches, lighting, etc) In the family, dmvg Irving bedrooms,
Hallways etc. shall be on clrcuits protected of a combination aro-iauk ci—R irate . pter-
CEC210.12 2013
10. All new and replaced receptacles shall be listed tamper-resistant (1R).
CEC 40612. 2013
11, Enure alt existing bedrooms are fiftea with Listed smoke alarms.
New smoke detectors E reeve construction to be hotanred with baiterp backup.
Combination plane mon cadshaacke dead or to HalMays loading to steeping areas.
/ �'I. [5I6'1Nei Avebwc, .
I
s 60 6
62 64
W
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ANE
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