B-2016-1718CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMITNO: B-2016-1718
20788 HANFORD DR CUPERTINO, CA 95014-1824 (326 30 065) B L BUILDERS INC
REDWOOD CITY, CA
94061
OWNER'S NAME: VAN BUREN JUSTIN LU AND ZHANG YU I J DATE ISSUED: 09/30/2016 1
OWNER'S PHONE: 408-830-7141
LICENSED ONT A TOR' DECLARATION
License Class a Lic. #659504
Contractor B L BUILDERS INC Date 05/31/2017
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. 1 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.
)Pe -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
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 non -point
source regulations_Rer the CupertinWMunicippl__'cfie, Section 9.18.
Date 9/30/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, 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. I, 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:
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.
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. 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
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.
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 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 9/30/2016
PHONE NO: (650) 363-2300
BUILDING PERMIT INFO:
X BLDG —ELECT _ PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
CONSTRUCT (N) ATTACHED 2ND UNIT (577 S.F.)
Sq. Ft Floor Area: 577 1 Valuation: $900.00
APN Number: Occupancy Type:
326 30 065 1 Deferred Submittal (R -3),R-3 (Custom)
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: AbbyAvende
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: 9/30/2016
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 Management District I
will maintain compliance with the Cupertino Municip ode, Chapte 9.12 and
the Health &Safety Codeonsp�5505, 533, and 21� –
r or authorized
9/30/2016
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
understand my plans shall be used as public records.
Licensed
CONSTRUCTION PERMIT APPLICATION
paa-" COMMUNITY DEVELOPMEI ..`.DEPARTMENT ® BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, OA x_,014-3255
(408) 777-3228 • F&(408) 777-3333 • bI 7ing(a.cupertino.orq
CUPERTINO
PKI. VFW ('.n-K-.gTRT.i(-TTo' j F7 AT)T)TtTrl?i I I 6T ID A.'t'Tni.T I 7 I 1 n=17TVTn�- incrr,,rr..
PROJECTADDRESS .' n
OIWNTER KANE < ` F 33OA�F' �' (.�� E-h24IL
STREET ADDRESS. L CIT: 'TA' FAX
6 6 Ct- /VCA 7981
CO *TACT NAME I PHO:' ( E-rLAIL,
411 °J
STREET ADDRESS
CITY, ST.,kTn' ZIP /
FAX
�KO'WNIER ❑ CA ER-BL-TLDER ❑ OWER AGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGLNEPR ❑ ❑
DEVELOPER TENANT
CONTRACTOR NAhE I LICENSE,,NLTFIBBR LiCEN$E TYPE
BUS. LIC n
COMJ?AnY NIA\ E
F_hti4IL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT,'ENGINEER NAh4E LICENSE NU1 IBER
BUS. LIC f
COAiPANFY NAME E-NILAIL —
FAX —
STREET ADDRESS I CITY, STATE, ZIP
PHONE _
DESCRIPTION OF WORK
EXIISsTING L'SE m - PROPOSED L'SE CONSTR. Tl: E = STORIES
-
USEY�E
-
OCC.
-
SQ.FT.
-
\rpLLATION
re V`- . s 6 V� �'_
I
(S)
EXISTG
AREA141W
NEW FLOO,rJ r/�
AREA D / 7/'
DEMO 7`
AREA
TOTAL
)\ET.4P.E.4 - '%`�
p( f(j�
/�/�
110,000
BATHROOM
RE:140DEL AREA
KITCHEN
REMODEL ARTA
OTHER - -
REMODEL AREA
-
�� %
TO
J (�
(
PORCH AREA
DECK AREA
TOTAL DECK,POP.CHAREA
GA3AGEAREA..DETACH
aATTACH
—S
DWELLING UNITS:
IS A SECOND UNIT
SECOND iY
2
)ES
AELNGADDED? O
ADDITION? ❑NO
PRE-A-PPLICATION ❑ FES IF YES, IDE COPY OF
PL.ANlKrNG APPL' ANO PL hTTNG APPROVAL LETTER
IS THE BLDG A\ E3YFS
E3PRO\
EICHLER HOME? NO
CEI ED :3
� TOT4L VALLA T ION:
t+
O400 no
By
By my signature below, I certify to each ofthe following: I am the property owner or authorized agen� to act Nn the property owners behalf. I have read this
application and the information I have provided is correct. I have read the Description ofWork- and verify it is accurate. I agree to comply -,with all applicable local
ordinances and state laws relating to building construction. I authorize represe-ntatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Appllcant!Agent: Date: _ 1�
SUPPLEI ENTAL INTFORMATION QUIRED
%,µK ..PLA\ CHECF�,TlPE't`W.a,, _
a ROIJTIG.SLIP..
_ I�Te«- SFD or �iulti amily d}, ellirgs; Apply for demolition perir it foT
N
Cj2 O} ER TFE COII\TER,
EUILDI\G PLA\ RE}
existing building(s). Demolition perTRit is required prior to issuance of building
fm.
k,
l�
I
x;
permit or new building.
, E� R£ss
PL \\L\G PLA\ REi I£S}
k
r
_ Commercial Bldgs; Provide a coirpl-eted Hazardous Disclosure
N.STS\73aRD f
PLEIIC}tORT�
form if any Hazardous -Materials are being used as Dart of this project,
❑
w.
1;ARGE
f
, FIRE DEPT -
_ Copy of Planning ApDro}-a1 Letter or ?fleeting }� ith Planning prior to
Bunning
—�
=V 7sLAJOR
SA\IT Rl �ET3ERDIS RICT
submittal of Permit application.
ENi IRON.MENTAL HEALTH
Bldg. pp_?011.doc revised 06121111
fiUA
CAPEX ENGINEENNG INC.
P-0 BOX 14198, FREMONT, CA 94539
Tel: (510) 668-1815 Fax: (510) 490-869
0
r--YdFf-- . GWffl
City' of Cupertino
10300 Torre Ave.
QT j "iL 11`, a•F.�' -�'
December 21, 2016
subject.. Van Buren residence
20788 Hanford Dr
Cupertino, CA 95014
SPECIAL INSPECTION SERVICES FINAL AFFIDAVIT FOR
STRUCTURAL STEEL WELDING
Dear Sir
CAPEX ENtires EERM MC., has provided testing and special inspection services at the
subject site in accordance with section 1701 of the California Building Code (201.-3 Uition) as
listed below:
(1) Check Mill certification and welder's certification.
(2) Inspection of welding procedure (FCAW) specifications qualification and
equipment -
(3) Check structural members for thickness adjacent to welds.
(4) Check the tape and size of wire (NIR 232) to be used for the various joints and
positions,
(5) Observe the technique of ea6h welder periodically with the use of a welding
inspection shield. ,
(6) Observe fillet welds on (1) W 12x117 Beam Mth 1/2" stiffeners, 1/4" Plate Saddles
mid IA .5" Tabs.
W-isdiincLundef'the -general snip &visi6n--6f -a -regisf6i6d-C
inspections. used. on the inspections performed and upon -our substantiating reports that
the inspected work was performed, to the best oeour knowledge, in conformance with the
approved plans and specifications and the applicable workmanship provisions of the
California Building Code.
Sincerely,
TC
GAP EX !G
M
E
-RING IN
WMe.
s P.E
14
Principal
i�
'`,.\,: tify SMOKE i CARBON MONOXIDE ALARMS
(_:*) OWNER CERTIFICATE OF COMPLIANCE
0 s,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CuPERT NO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinqOcupertino.orq
Address - 4.- s ;, t �,1"
_ ,'th - .
PERMIT CANNOT BE FINALED AND=COMPLETED TIL THIS CERTIFICATE
4-4-4_.
4. ,, =EE .t.`C al ie ,B t tat ® 4D €a iNoo nB IULa r":G SION.
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 , -
bedroom(s) X ITh
On every level of a dwelling unit including basements
Within each slsepiri, roottt 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.
In 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 907.2.114 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 manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below
1 have read and.a.ree to coa with the terms end co ditions of this statement
{..(erti;, A i* arr:
A
Y 1 ! St#i}atuc
AllOr"lii le Ampr'*.' _
.. :,€[ - c • of c,
Smoke and CO form.doc revised 03/18/14
\+ , WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ClJl'ERTIIw1A 10300 TORRE AVENUE o CUPERTINO,CA 95014-3255
(40:) 7 3228.1=AX(408)777-3333•buildingCti)cuoertino.org
Owner Nam
N�/1 /'
19r , Permit No ��6 /7��Address .► '� �1 r�,, 4 I
1. Is your real property a registered historical site?
❑ Y Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
I'i'No Go to Question 2.
1
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.
❑ No 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.
ffia Ergo Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
Ergo 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.
ow ❑ 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. Plea check ONE of the following:
qI My property is a single-family residential real property. See Civil Code Section 1101.4.
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).
❑ 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. ` [.
Owner or Owner Agent's Signature: ` �k ! Dated I
Upon completing and signing this Certificate,please return it to he Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15
SMOKE / CARBON MONOXIDE ALARMS
-. OWNER CERTIFICATE OF COMPLIANCE
,iii,. COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE. CUPERTINO, CA 95014-3255 ,
(408)777-3228•FAX(408)777-3333• buildinq(a.cupertino.orq
r itictoibid p� endgl, °iC- 17/B
IA,
lawsteowar 4141,,
4wr RiAwa a1 r 4 K. . . “- .: t 4 -:ma ).',+,s,
4F:t x..:sst ^.we
a L',
i ,
k PER11WCANOTSE;FINALED AND COMPLED UNTL THIS;CER1IF KATE
' �; ' HAS BEEN SIGNEDAND RETURN
ATOHE:BUILDINGDIVISION
v,; d' f. 41.. 1 — fi yz
,
w F
, : �.., s' *' , Jam' fit
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.
In 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 manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement ' '
' _ 6TgAr er:`A b'et's Na> e. .';
t V A ' ilr F81,11:Ora (ikeifil " - , , , [
,,c' _�_actir�fam. v_ q,�,_ (.0
IL
, _ Air
(3 ra`( TiM --c
Smoke and CO form.doc revised 03/18/14
f„