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B-2016-1414 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS; CONTRACTOR: PERMIT NO:B-2016-1414 11507 SILVER'S RING CT CUPERTINO,CA 95014-5132(366 51 025) (AMERICAN KITCHEN &BATH INC) SAN JOSE,CA 95112 OWNER'S NAME: NIU CHIN-HAU AND XIN XIAO PING DATE ISSUED:62/23/2010 OWNER'S PHONE:4086935463 PHONE NO:4094169151 LICENSED CONTRACTOR'SDECLARATION BUILDING PER19']fIT INFO: LicensesClassB Lic.#. Contractor(AMERICAN KITCHEN&BATH INC)Date 212312016 X BLDG _ELECT •_PLUMB R ltorebyaftvm that I am licensed under the provisions of Chapter9(commencing MY CH 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: REMODEL MASTER BATHROOM(7,5 S.F.)-NO STRUCTURAL OR I hereby affirm under penalty of'perjury one of the following two declarations: EXTERIOR CHANGES 2. d have nd will mahitain a certificate of consent to self-insure for Worker's Conifn asation,as provided for by Section 3700 of the Labor Code,for the perforr iance of the work for which this permit is issued. z, I have aid will maintain Worker's Compensation Insurance,as provided for by SecIon 3700 of the Labor Code,for the performance of the work for which this pagmit ig issued. Sq.14 Floor Area: Valuation.$15000.01) AEPL ICANT CERTIFICATION I certify that I have read this application and state that the above information is co rect.I agree to comply with all city and county APN Number: Occupancy Type; ordinances.and tate laws relating to building construction,and hereby 366 51 025 authorize repres ntatives of this eky to enter upon the above mentioned property for insp ation purposes. (We)agree to save indemnify and keep harmless the Cit Cupertino against liabilities,judgments,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which m y accrue ago' stsaid City to consequence at the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this p i Addif a ,the appiicant understands and will comply with all - o s r ulations per the Cupertino Municipal 180 DAYS FROM LA v ALLED INSPECTION. Code,Section Issued by:PAUL O'SUL LIVAN l Signature Date 212312016 Date;2/23/2016 J r _ 0WNER-BUTILD E DECLARATION s R&ROOFS: I hereby affirm ti Bat I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.if a roof is following two rea ons: installed without first obtaining.an inspection,l agree to remove all new materinls for z, I,as o her of the property,or my einployees with wages as their sole inspection. comp sation,will do rite work,and the structure is not intended or offered for sal ($ee,7044,Business&Professions Code) Signature orApplicant: z, f,as o nor of the property,am exclusively contracting with licensed Date:2123/201 contrallors to construct the project(Sec.7044,Business&Professions Code), I hereby affirm aBider penalty of perjury one of the following three declarations: ALL ROOT'COVERLNGS TO BE CLASS"All OR BETTER 1. I have imd 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 perfori iance of the work for which this permit is issued. I have read the hazardous materials requirernicnts under Chapter 6.95 of the 2. 1 have ind will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. 1 will by See'on 3700 of the Labor Code,for the performance of the work for whicli maintain compliance with the Cupertino Municipal Code,Chapter,9.12 and the this pe'auit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3_ 1 certi 'that in the performance of the work for which this permit is issued,I material, Additionally,should I usI utment or de, which emit hazardous shall not em to an rson iu an manner so as to become sub'ect to the air cmntaminants as defined bea Air Quality Management District I P y Pe y I 4vi11 maintain;compliance within 3' Code,Chapter 9.12 send Workers Compensation laws of California. If,after making this certificate of the Health&Safety oa 3,and 25534. excmp ion,I become subject to the WorIcer's Compensation provisions of the Labor ode,I must forthwith comply with such provisions or this permit shall owner or authorized agent: bedee odrevoked. Date:2123MOM, APPLICANT CERTIFICATION CONSTRUCTION LENDING ACEN Y certify that I ha a read this application and state that the above information is 1 hereby affirm that(here is a construction lending agency r the performance correctJl agree a comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3057,Civ C.) relating to build!Ig construction,and hereby authorize representatives of this city L'ender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save m emniy and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,cost ,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant ARCHITECT"S DE CLARATIOIN, understands an will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Munipat Code,Section 3.18. Licensed Professiona Signature Date 212312016 l I I I I CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 6JIP15RTINO (408) .777-3228•FAX(408)777-3333•bul d1ncj(fDoupertlno.Org 0 NEW CONSTRUCTION Q ADDITION ❑ALTERATION/T1 REVISION/DEFERRED ORIGINAL PER1vI1T# PROJECT ADDRESS Y 4.✓ L cAPN# 3,6.6 OR ' OWNER NAMEE-MAII, t42%3 -54L� STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME [n� 7 elm t4E-3vTA[L STREET ADbRES$ CITY,STATE,,ZIP d FAQ �.OWNER E3 O�NER-BUILDER ❑ OWNERAGENT El CONTRAcToR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER CI LtEVELOPFF ❑TENANT CONTL _.(Z LISE� LICENSETYPE r B 9 n� COMPANY NAME 4-! l v v ' [E-MAI (, p 1L✓ _ E STREET ADDRESS ? PHONE `" ARCHITECTIENGMEE RNAME LICENSENUMBER BUS.Lie# COWANY14AME E-MAIL FAX i STREET ADDRESS i CITY,STATE,ZIP PHONE DESCRIPTION OF WO;t1C �j/ La� L� kc, -Yn s.,=) X EXISTING USE PROPOSED USE CONSTR:TYPE #STORIES USE TYPE GCC. SQYT. VALUATION($) rXISTG .. NEWFLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER -• _ . REMODEL AREA REMODELAREA REMODELAREA PORCHAREA, - DECKARFA TOTAL DEWPORCH AREA I GAItAGEAREA: EIDETACH. - - ®ATTACH #DWELLING UNITS:. ISA SECOND UNIT ❑YES - SECOND STORY M YES - B EL'VG ADDED? []NO ADDITION? []NO I . PRH-APPLICA'T}ON S }F YES,PROVIDE COPY OF IS THE BLDG AN YES ••=. >•_ TOTAL VALUATION: ❑ ❑ PLANNING APPL# [] O PLANNING APPROVAL LETTER EICHLER HOATF.? ❑NO By my signature bel t.,I ccrafy to eac the fall , I a}n the property owner or author' ed agent to act on the property owner's behalf. l Dave read this application at}d tlnefornlafsan III a rot'$ed is o 1 have read the Description of Work and verify if is accurate. T agree to comply with all applicable local ordinances and state laws relating t Iit in t . I authorize representatives of Cupertino to enter the above-Identified property for inspection proposes. SignatureofAppliemt/Agent: L Nil 1-1 Date: o- S PLEMENTA' ORMATIONQ UIR.ED New SFD or!Aultifamily dwellings: Apply for demolition permit for oYER xxE Cf9LIlTER 1IILDI xG tLai�RE1}E\V existing build n.- ). Demolition permit is required prior to issuance of building permit for=new bu lding, 1aL4 rI AnT<It7Et� _CoInn ercial idgs: Provide a completed Hazardous Materials Disclosure ai LTo�IOR},s Torm if any Hazari lous Materials are being used as part of this project, dy 1 ARGE FIRE D —Copy of Plain ing Approval Letter or Meeting with Planning prior to submittal of Build ng Permit application. �.NLA70R S L dITAkL SE}}EDD}STRICT --- I =EN1'%M. ONMENT. I}EALTH i h1 c,,Ap11 2011.doc revised 06121111 . j I i I NIU EXISTING 11507 SILVER SPRIN&8yCE COPY CUPERTINO, CSA 0501 CUPERTINO ?I 3VI dng Department Ltc kLT GC9 Revi e By. FY{l9 CllLl ;?: -' -2210- 2TVSDS7221 2210 EXP PAN-1 e0!MEUIDIA^IrM NGUN 0. CUF TIVO . ` _ �uS n9 Tv tet P!nre entl sP cP :!ortsP-1576 k tat the L ` �yyi1 Ll biT- l0 1 -7c�t Hi It.sii v io ::o any ,.+( . S I Win' t St i_resa,vilua_i a provN tram llie B�dc i.c Gifclal. �' - us Th+ m nj oftlgrl plan and Ir—piCedoas SWUl7CT � 4 p,o.swons of any Cry.na.fm,ua Or n.w. • O) PIfY Tid'J. D v i -RECEIVED All dimensions-size designations FRYER This is an original design and must '.Designed:2/23/2016 given are subject to.verification on not be released of copied unless Printed:2/23/2016 .job site and adjustment to fit job applicable fee has been»aid or job. conditions. order placed _ BEFORE PERMLT INFO.kit All Drawing#:1 No Scale. i f I I I i i I NIU PRO-POSED CUPERTINO l 6u(ding Department 11507 SILVER SPRING CT �� ; Ire z3 zinc UPERTINO, �� 95014 REVIEWED FOR CODCCOMPLIANGE Reviewed BY:`.��aovwf" o REPLACING SHOWER VALVE AND TILE 2NSD57221 -229 . EXP PAN-1 3 �': REPLACING TLB VALVE AND TILE x` REPLACING FLOORING WITH TILE 1 ---- -----• H ---- NOELECTRICAL, MECHANICAL OR ----------- DINGBUIL I� Cod t All dimensions_size designations FRYER Taus is an original design and must Designed:2/23/2016 given are subject to verification on. not be released or copied unless Printed:2/23/2016 job site and adjustment to fit job applicable fee has been paid or job conditions.. order placed. PROPOSED PERMIT LNFO.Idt All Drawing#:1 No Scale. I I I j I i. – ._ - —–+ _ � ,•• .:v se�rawa.�i?p8'�Ali�iisi d+°'ibi�w�JI�:ADs'- �fi COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIO F r F1, L � E" � 10300TO:RRE.AVEIVU�®Cl1PERT6N0,CA95014-355 (408)i 777-3228 FAX(408)777-3333 0 buildinQ0cuaeitino:or4 i ISO ? - cr1 141T CALNT O-r-8F,"NAM LETED UNTIL TIHS CriRpC Alm x � PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Ala=s for compliance vrth 013 Curr Section 8314,2013 CBC Sections 420.-6 and 907.2.11.2 where no terior access for inspections are rei aired. GM,MAL WTOR—MATION Exist-m g single f "y and uiti family dwellings shall be provided with Smoke Alarms and Carbon Mortaxide alarm . When the valuation of additzOns,alterations, or repairs to existing dwelling xrigts exceeds $1000.00,CRC Se t M R314 and CBC Sections 907.2.11.5 and 420.6 require that'Smoke Ajar m artdlor Carbon Monoxide Alarm;;be installed in,the following locations. ---AREA SMOKE ALARM CG AUR."N Outside f ea `Separate sleeping area in the immediate vicinity of the X bedroom(s7 , On every leve o£a dwellznunit includin, basements } Within each see r .room X Carbon Mklonuxidr alarms are not required in, dwellings which do not conta fuel burn-hag appliances and that c o not Have an attached garage Carbon monoxide alarms conib�i�ned with.stroke alarm shall eorrjply wi:& CBC Sectitan 420. and:shall be approved.by the 0fzce of the State Fire YMarshalr.. Power Supplyo In dveI i€s withro conmercial porer: supply alarms rnae soler batter o; ra�fedt. � f y y P Iii exs"ting `welT;�Y�g:uxuts>,��rrts are pertru�ecl to he solely b aitezy apexateet�nxl�ere repays car alter:attons�dog not resuh in the i t o aal of walil and ce lnlg finishes or there is no access,by,�,.eamxs of attic,basement ax crawl space.,Refer to,CSC Sectioon 114 and CBC Sectzon gf.2.1Z 4 t d 42x1. 2..Axe elects. E permit.zs: equired f© al'a�s Wh is;_.si e c'a�x�.ecfied to the build �e�g wiring;.. .A`s%owzler�©f thet�:',Mce bene referenced property,l hereby certify tial time alarm(s)reIereneed' above hasAhave.-Been 1xisfafliet.inwmgJ � ,`,,o wntl�.the rmazttzfact�rer s�struc��©1i�s arEcl»c©�tpl�!a�nce wui�u the Cazliforrila r� Bu�?cl!ii�g, a d Callifara�a XFSi en;�al rvo d fes.The alarms,have,lueen tes4e�di and are ap rafi Anal,as Of the date sig.�ed 1i hr ue a dFa bcorns ` oft Azr?ms rOn,diftn's;Q� ,ss� Wan S_i"cif e. _ L7 i5�fM.'.'.'fd WI�../ Snwk�t�i�t:�Q)fUi rrr;dar.r�i�i�ed:Q3✓18�Is`5�i I OWNERCERrOICATE OF COMPLY CIE �V 3 (�9, '�J pk.;��yI - .#C.�.-'¢t}�iytMUNf�}'.t['']�'DEVF-,L��WE,?ig7 p TUSi�, O.'BU, D..ING DIV]SIO , :.'y , 65 �k8 17-3'2213 ro F { 0877 3333 buil€lingruperfscin oig owner Nam Plot ermit No �. address ®i. \ ti �. . . - r.At � l, Is your real prop ei ly a ftgistered histwical site ❑ Yes Civiil C de`flections 1:101.1 through 11f..i do not apply. Skip.the rest of the foxir�and sgt�'batito of forte. No CJo to :uestiori 2: h g ' 2. Does year real pre ei Cy have licensed plumber cerCifyirtg thatdue to ilia a e or configuration ofthe properi=�r or its plumbing,installs bh ofwater=conserving plumbing futures is nottechnicallyfeasible? El Yes Civil C de Sections 1101.1.through 1101:8 do not apply. The hcensed plumber's cerditcatioi.has been provided-to the Building Div siori. Skip tb,rest of the form and sign bottom of forint M-No Go to :-ueston 3, . ' 3. Is water service peiently disconnected for your building?, ❑ Yes Civil C de.Sectioris 1101.1 through 1101.9 do not apply. Skip the.rest af.the.for ,and sign bottom of fort. Cal pro Cao to ue5tim 4, 4. Is your real prop e built and axailable for arse or oCcugattcy on or before January 1,1994?. ❑ No Ivfy real property is built and ava lable for use or occupancy after January 1,1954. Civil Code Sections 1101.1 throup 11041.8 do not apply. Skip the rest of the form and sign bottom,of form- Ye s arm.Yes My reat property is built and available for rise or occupancy on or before,January 1,19 Ciel Code Sections 11010.1 ihrotigl311 1. apply Check one of the three following statements and sign .. _...�_. ... 5. Please check ONE of the followirog p>iopertyisil stngde-farlyresidential real property. dee Civil Code Sectiorrl10414 On and after J nary 1, 2014,building alterations or improvements shall require an noir compliant pltx ixi mg.fixtures to be replaced sritli water corisery g plumbing.f xtures,fteugho at the buil&g=Oh or before January 1,,2017,all non- replace Aliim17mg futures shall be reptace witl,water Conserving -10mbing futures egardless of whether property under goes alterations or inipramments). ❑ mypropertyis Ia,it uffifa ily re-sider rcct realpropeit'y, See Civil Code SectieS 11011.-S- on 1041?5 on.and afee>Ji�iiHary 1,2014,specified building alterations or itnprovennents shalt require non- com,pliant P1,11%mbing fixt4es to be.replaced with.water canstrvuigplumbing fixtures Oza or before January Y,2019,alT non mm phantplunibi4 fixtures shall fie replace'd<ve i&water- consezving plu aktg fixtures tffev&ut the birl,I nig�regardTess.of whefher.properCy iui ergoes,alterations or improvezrients}. C7= My property.isj a,eommercic€Z real property. See:Civil Cade Section l l On and atter,JEOUaiy 1,2014,specified blailding alterafrons or improvements shall xequiie noir-csizmp� plumbing.fig t res to be replaced with water conx'ervingplurnbi.g fixtures Oa or befior Jam aiy 1„ 2015, all.non=compliant plu�abing fixtures"shad be replaced uWith water- conserving phzmlxmg,fixti�es tilirorrgha�t idle l�iirlduig.(liega�dless ofwliet)ier pragertynnd�rg�es a;ktafibris.€iii iriipro'ezernertf���.. I,,as the owner oro +ner's agent of this limper „certify undbrpena-tty of perjury thatnaii;_comap Aant plum,bing. ht res w111b.4e reQlacectp lar tea ate:speer+ ed bene wit fil" water-conserving lxkcunhhig fin titres u .a;covdaa ce with:Cull 'odz Se, x. T I:01 I iluottglu 110'1;.8.„ 1. cuixent alrforn aPtumWm.g Code•and Cal:iffoin a Gl ee n�BUR ling Ria Aw,&Code,.�d rriarsiifaehizerys instalWiep,requi mats,and:that thie v/ater-coaservingpliimb,ing fixtures comply with the regw-cements;as indicated in tha table on,tho fo11b� 111 :P a:;er Tgoa c©mpletkg and tbam CenufrCatey please retu�ra it a tine 13uildiug Dives ont yan axe3er to final;yoar bun g,P.einai SOW 2'015.doc.reuiS2c'0&/2661