B-2016-2654 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2654
10393 COLBY AVE CUPERTINO,CA 95014-2421(316 29 020) LINDSTROM
CONSTRUCTION
CAMPBELL CA 95008
OWNER'S NAME: ROMANKEWICZ MARC AND PORCIUNCULAAUREA DATE ISSUED:09/06/2016
OWNER'S PHONE:408-8064584 PHONE NO:(408)823-7620
LICENSED ONT TOR' i R TION BUILDING PERMIT INFO:
License Class$ Lic.#868134
Contractor LINDSTROM CONSTRUCTION Date 11/30/2017 X BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(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:
WEST FACING,REAR SIDE-INSTALL 2(N)STRUCTURAL
I hereby affirm under penalty of perjury one of the following two declarations: SKYLIGHTS(TOTAL 13 S.R);LIVING RM&KITCHEN-INSTALL 11
/F I have and will maintain a certificate of consent to self-insure for Worker's (N)RECESSED LIGHTS
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.Ft Floor Area: Valuation:$9520.00
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 31629 020
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 CALLED INSPECTION.
Signatures-?�� Date 09/06/2016 Issue y:
Date:09/06/2016
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
s, 1,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:09/06/2016
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. I 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
. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued
Health&Safety Code,Section 25532(a)should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued,I
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,atter 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'./
APPLICANT CERTIFICATION Date:09/06/2016
certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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
relating to building construction,and hereby authorize representatives of this city t 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 ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 09/06/2016 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT*BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUOERT'INO (408)777-3228- FAX(408)777-3333-building@cupertino.org
(?-
�.L�IEW'CONSTRUCTION ❑ ADDITION ALTERATION/Ti_ ❑ REVISION/DEFERRED ORIGINAL PERMIT#
=PROJECT ADDRESS APN# 31629020
10393 Colbv Ave.
Dw NE
Marc � 7.&Aurea Ramank� cPH EMAIL
��8-806-4584 m.romankewicz@comcast.net
STREED S CIT STATE,ZIP FAX
bff Colb Ave. u ertino, CA. 95014
CONTACT NAME PHONE 6om�)indstrom@sbcglobal.net Bob 6
Lindstrom 408-823-7620 om)indstrom@sbc lobal.net
STREET ADDRESS CITY,STATE, ZIP FAX
4993 PonderosaTerrace Cam bell CA. 95008
El OWNER ❑ OWNER-BUILDER ❑OWNER AGENT CONTRACTOR ❑CONTRACTOR.AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER `❑TENANT
C'%T eA'Eindstrom T
CgI�S§TRR LICENSE TYPE B BUS.LIC#
��jj ll a�[} ,5?_
COMPq NY N E-MAIL FAX
h sYrom Construction bob.lindstrom@sbcglobal.net
STREE ,S TE, ONE
4g4,115CITY
onderosa Terrace CamZIP PHpbell, CA. 95008 408-823-7620
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK Install 2 new skylights with structural alterations, 11 new recessed LED light fixtures
EXISTING USE PROPOSED USE- CONSTR.TYPE #STORIES - - -
Residential Residential Alteration 1 USE 'TYPE OCC. SQ.FT. VALUATTON($>
EXISTG NEW FLOOR DEMO TOTAL
AREA. 1848 AREA 0 AREA 0 NET AREA 1848. 0 $8200
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA 0 $1320
PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES
BEING ADDED? UNO ADDITION? E3NO
PRE-APPLICATION ❑.YES IF YES;PROVIDE COPY OF IS THE BLDG AN ❑YF D "-;a� r TOTAL VAL
PLANNING APPL# ONO PLANNING APPROVAL LETTER EICHLER HOME? $95520 ,
By my signature below,I certify to each of the following: I am the property owner or authorized agent to e to rty owner's half. I have read this
application and the information I have provided is correct. I have read the Description of Work an y it is ac e. I agree to c ply with all applicable local
ordinances and state laws relating to b ' i constructs . Laut rize representatives of Cupertino to ent e above-identi" =operty for inspection purposes. z
Signature of Applicant/Agent: Date: ug.31,2016
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP .
New SFD Or Multifamily dwellings: Apply for demolition permit for El OVER-THE-COUNTER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. El EXP=RESS �ANNING PLAN V EW ,
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD El PUBLIC WORKSl t
form if any Hazardous Materials are being used as part of this project. E LARGE` ❑ PIREDEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR ❑' SANITARY SEwERDISTRICT
submittal of Building Permit application.
❑' ENVIRONMENTAL HEALTH
BldgApp_201 Ldoe revised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE R'
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION -C
CU'PERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(dcupertino.ong
C 3 ca-3 re 4,. � ! Ave
— CPerm t_No.t - G�1" Z e L
®�_Address- IS Q"#of_Marms Smok_e�'7Carbon -onoxide-
PERMIT CANNOT"BE FINALED AND'COMPEETED UNTIE,THIS;CERTIFICATE 4
HAS BEEN STG1Y ANIS I2 T 7RNFl)T O THE SL1a.17Il11 DTVI,SIOI�T
w
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
$1000.00, 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:
AREA SMOKE ALARM CO ALARM
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
Within each sleeping room X
Carbon Monoxide alarms are not 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 comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal
Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
h-i existing dwelling units, 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 to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturers instructions and in compliance whit the California Building
and California Residential Codes.The alarms have been tested and are operational,as of the date signed
below.
have read and agree to coMp/y comp/ywith the terms and conditions of this statement
"Ovuner(or Ow ee-rAgenfs)Name
Q Y r,PG) tcc 1� cq Eaf.�r" Z, ' Si nafure ... ........................................................... ........
- ......
-Contra(zfo_r_Nam6: ) ? y
Al -signruru e . ....... ..... L�c# �. � ! >..1......... Date. ia...3..J .
Smoke and CO forni.doc revised 03/18/14
WATER-CONSERVING PLUMBING FIXTURES
10 -L4,L-OWNER CERTIFICATE OF COMPLIANCE FILEr
COMMUNITY'DEVELOPMENT DEPARTMENTBU1LDlNG DIVISION t
CUPERTINO 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
X408)777-3228•FAX(408)777-3333 buildingftupertino.org
Owner Name ( e t! Kc4 s�0 in iC-C W i 0– Permit Not`, L' ``p�`?1 -®�
,Address
1. Is your real property a registered historical site?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.:
E 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 110 1.1 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.
(
lil 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.
®°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.
c7j� J0 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:
r— K My property is a single-family residential real property. See Civil Code Section 1101.4.
_J 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).
El 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
plumbing fixtures throughout the building(regardless of whether property undergoes alterations orimprovements).
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 followffig page.
Owner or Owner Agent's Signature Date:.
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doe revised 08126115
_ .,...,,�. '„s,�� .. � �.,_..."`-",.,..-^-°-•-. ....�:` :.'' '''vo"i.''�` �"' F``�" e X47 x�4_a�J'� e -1.5,x.
lYo-n ornpliant
Water Plumbing Fixture
Plum in Fixture � (Fixture Complying with Current Code Applicable to New Construction)
Fixture Type tlaxiraium UVater Asa a/Flow Rate
Water usage 2013 CIBC Ch.4 2013 CPC Ch.4 2013 CPC Ch,4
/Flow late 2013 CALGreen Div.4.3 2013 CALGreen Div.4.3 I 2013 CALGreen Div. 5.3
Single-Family MultiaFamily Cornrnercial
Water Closets Exceed 1.6
Residential ResidentiaQ
I (3 oilets} Gallons/flush Single flush toilets:. 1.28 gallons/flush
Dual flush toilets; 1.28 gallons/flush effective flush volume(the composite,
UrinalsExceed 1,0 avers e flush volume of fro reduced flushes and one full flush
Gallons/flush 0.5 gallons/flush
Showerheads Exceed 2,5 2.0 gallons.per minute @ 80
gallons per minute psi. Also certified to the performance criteria of
UaS, EPA s�,taferSense Specification for Showerheads
(A handheld shov�eris considered a showerhead,}
For multiple showerheads serving one shower,the combined flow rate of all
shorerheads and/or ofher shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow onlyone shower outlet to be in operation at a time:
Faucets— Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60
Lavatory per minutem.nute
Faucets � °�60 psi;minimum Maximum 1.5 gallons ;psi
j 0.8 gallons per minute @ per minute @ 60 psi;
20 psi minimum 0.8 gallons
per minute @ 20 psi
i
( in common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
Faucets— 60 psi
Exceed 2.2 gallons _.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60
Kitchen per minute # 60 psi @ 60 psi psi
# Faucets ; May temporarily increase May temporarily
l up to 2.2 gallons per increase up to 2.2
minute @ 60 psi, and must gallons per minute @
default to maximum 1 60 psi,and must
{
1.8 gallons per minute @ default to maximum
60 psi 1.8 gallons per minute
Where faucets meeting @ 60 psi
l the above are unavailable, Where faucets meeting
aerators or other means the above are
niay be used to achieve unavailable, aerators or
I reduction, other means may be
i used to achieve
reduction.
l, If the existing plumbing fixture water usage/slow rate is equal to or lower than the figure shown,it is not required to be upgraded.
aSB4072015.doe revised 08/26/15