B-2016-2701CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2701
10120 UNITED PL CUPERTINO, CA95014-5712 (326 53 021) FULL SPECTRUM
CONSTRUCTION
CAMPBELL, CA 95009-
1179
I OWNER'S NAME: BRADFORD JEANNE A I I DATE ISSUED: 09/15/2016 I
OWNER'S PHONE: 408-828-5168 I I I PHONE NO: (408) 568-3764 I
LICENSED CONT A TOR' D ARATION
License Class GENERAL BUILDING CONTRACTOR Lic. #706177
Contractor FULL SPECTRUM CONSTRUCTION Date 02/28/2018
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.
I hereby affirm under penalty of perjury one of the following two declarations:
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.
4 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.
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
and state laws relating to building construction, and hereby 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 expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all n -point
source regulations per the Cupertino Municipal Code„ Sectio8.
Signature
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business &-;Professions Code)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
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
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.
3... 1 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
;Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked,
APP .I NT .ERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby 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 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.
Signature Date 09/15/2016
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
KITCHEN REMODEL - M,E,P (75 S.F.)
Sq. Ft Floor Area: Valuation: $75000.00
APN Number: Occupancy Type:
326 53 021
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: PAUL O'SULLTVAN
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 09/15/2016
n ,fin
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Manage ent District I
will maintain compliance with the Cupertino Municipal Code, C _ter 9.12 and
the Health & Safety Code, Sectio 25505 533, and 5534.
Owner or authorized agent � +✓L
Date: 09/15/2016
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued, (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
GUPER'i"fNt (408) 777-3228 • FAX (408P77-3333 • building(cfcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION VALTERATION/TI ❑ REVISION /DEFERRED
PROJECT ADDRESS1 ` APN R
IC)owNERNang rx
STREET ADDRESS CITY TATE; ZIfi CA
CONTACT NAME r b — PHQ -T- ,
STREET ADDRESS ^ ° I CITYrSTATE, ZIP
PERMIT ft
11owNER. ❑DOWNER-BLuDER ElOWNER.AGENT ElCONTRACTOR ❑ CONTRACTOR AGENT "u � } u ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENI NL ER LICENSE TYPE BUS. LIC # R
YhAn, `�a (�D+1n bot CSM I
COMPANY NAME %
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E-MAIL
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FAX
STRFTyS1)DRESS
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CI STATE, IP n
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fdk=CT/EAIGINEER NAME LICENSE NUMBER
BUS. LIC r
COMPANY N?AME E -MME, r
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ST'REE9DDRESSD
112 �
CITY, STATE,
DESCRIPTI J OF WORK
7-57
EXISTING USE PROPOSED USE CONSTR. TYPE = STORIES
USE TYPE OCC. SQ.FT. VALUATION (S)
BldgApp_2011.doc revised 06/21%11
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMITNO:B-2.016-2701
10120 UNITED PL CUPERTINO, CA 95014-5712 (326 53 021)
FULL SPECTRUM
CONSTRUCTION
CAMPBELL, CA 95009-
1179
OWNER'S NAME: BRADFORD JEANNEA
DATE ISSUED: 09/15/2016
OWNER'S PHONE: 408-828-5168
PHONE NO: (408) 568-3764
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class ]a Lic. #706177
Contractor FULL SPECTRUM CONSTRUCTION Date 02/28/2018
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:
KITCHEN REMODEL - M,E,P (75 S.F.)
I hereby affirm under penalty of perjury one of the following two declarations:
REV#1 - (I) SUB-PANEL (100 AMPS) - STAIRWELL- ISSUED
1. I have and will maintain a certificate of consent to self-insure for Worker's
12/02/2016
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
Sq. Ft Floor Area:
Valuation: $75000.00
permit is issued.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
3
and state laws relating to building construction, and hereby authorize
26
326 53 021
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 nd will comply with all non-point
source regulations per the Cupe 'no nicip Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
z
Cf'
Signature Date C
Issued by: KIM DUNBAR
Date: L. 2<fL.g
OWNER-BLTn DER DECLARATION
I hereby affirm that I' am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. 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 of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date:
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
a. 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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS DISCLOSURE
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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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, 255 - , and 534.
Labor Code, I must forthwith comply with such provisions or this permit shall
vi
be deemed revoked. U
Owner or authorizegent l✓�
APPLICANT GFRTIFICATION
Date: i Z' �
certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
l 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 hereby authorize representatives of this city
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,
Lender's Address
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date
Professional,
CUPER T INCA•
i7 T ipwrn-KgTuTTrTTnN
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, GA 95014-3255
40 3
8 777 228 . FPX 408
( �)j �( ) 777-3333 • building cuaertm -lno,ora r 2—L11 Z - n
77-
14 T InTTMXT F7 A T TCD. A -mr%NT / TTiii�rrnrir-tl'j (i
PROJECT. RESS
of cl e o ?L tV!
PHONE r / E-1,QJL
iZIP
STREET ADDRESSp CITY; STATE, /� pj PAX
talzo l�)J41 1F—C)?L-1.upl e t
CONTACT NAME A � � � PAO\E
STREETADDRESS ,CITY; STATE, ZIP n�
&x- I ; (� '� FAX
0 OR'\ER ❑ OWNER-BUIIAER ❑- OWNER AGENT ONT.RACTOR ❑ CONTRACTOR. AGENT ❑ ARCHITECT ❑. ENGLKEER ❑ DEVELOPER TETAT�'T
CONTRACTORNA-MEISC
TSE �tiNBER yy LICT TYPE
BUS.
co' .AI Y NAME
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CITY; STATE; ZIP ! /s /J
PHONE �` f,
ARCHITECT/ENGAN'EER N.4t 4E' LICENSENUMBER BER
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BLS. LIC -.11
COWANY \?At\E
E-MAIL
FAX
STREETADDRESS
CITY, STATE, ZIP'
PHOIe
i
DESCRIPTION OF WORT ( `'�
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L 50 ` ` ed� 1 L A .�
6
EXISTM L SE PROPOSED USE ` CONST R TYPE = STORIES
USE
T1TE
OCC, f
I
SQ =T.
VALUATION (S)
EXISTG
NEW iL00R
DEMO _.
TOTAL
_
AREA
AREA
AREA.
I.'ETAREA
I
If
BATHROOtd ... - KITCHEN .OTHER
REMODELAREA - RE ODELAREA. REMODEL:AREA
-
-
PORCH.=.REA . DECD AREA TOTAL DECK'PORCH.;,REA GARAGE AREA: � DETACH
-
- -
' ❑ATTACH
D'1ATLLR4G�NITS:
ISASECONDUNIT ❑YES
SECOND STORY ❑YF.S
EELN�G:4DDED? No
ADDITION? []NO
i
R
PE -APPLICATION [1YES IFI'ES;PROVIDE COPY OF
ISTHE.SLDG.AN []YES
P SEAL
TOT L '--ION:
PLANNLNGAPPL.. ANO PL..k\-,'�GAPPROV.ALLETTER
EICHLERHOME? ANO
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By my signature below, I certify to each of.the following: I am the property owner or authorized agent to act on the property owner's behalf. i have 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 build;'; cons rig I authesentatives of Cupertino to enter the above -identified property for inspection purposes.,
Signature of Applicant Agent: ,�11' �- ._ Date: 2-
SUPPLEMENTAL INFORA�ATIJ?�T REQUIRED
r
.. .. _. PI A\ CHECK TYPE, :;,.,..
New SFD or Multifamily dwellings: Apply for demolition permit for
Y
OV ER rxE cqt^ rER
� � w
l]y BLIZD�G PL0. I2EY�EY1 r
existing buldinQ(s). Demolition permit is required prior to issuance of bulldlrQ
F
permit for new building. _
EXPRESS
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sr;DARD
1-] PLBLICliOR.S
form if any Hazardous Materials are being used as part of this project.
L0.RGE
FIRE DEPT!
Copy of Planning Approval Letter or Meeting with Planning prior to
❑ AL0.7DR
l
submittal of Building Permit application.
S��Ir'ARl SE«ERDI�TRICT
BldAApp_2011.docrevised 06/21!11
LrUI=7A'alm
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
- FAX (408) 777-3333 - building Rcupertino.ora
Address l o a _n 44 j
4
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
P9-1No 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 1101.1 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.
®'To 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. Skip the rest of the form and sign bottom of form.
+C- 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.
a'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:
Ox"My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January I, 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).
❑ 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 or improvements).
I, 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 following page. a .
Owner or Owner Agent's Signature: U.P_ /�?/�t�'�_ Date: 111'7 117 I
Upon completing and signing this Certihicate, pleaseireturn it td the Building Division in order to final your building permit.
SB4072015.doc revised 08126/15