B-2016-2903I CITY OF CUPERTINO BUILDING PERMIT'
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2015-2903
22216 CUPERTINO RD CUPERTINO, CA 95014-1017 (326 17 047) MIDLANDS
RESTORATION INC
CAMPBELL, CA 95008
OWNER'S -NAME: BALIGA SUNIL BANTVAL AND REKHA SUNIL TRUSTE
DATE ISSUED: 10/12/2016
OWNER'S PHONE: 408-314-2728 I (PHONE NO: (408) 379-9852
LICENSED CONTRACTOR'S DECLARATION
License Classy B Lie. #736056
Contractor MIDLANDS RESTORATION 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.
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.
2. jI 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
1 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-NunicipgTCode, Section 9.18.
Signature" Date 10/12/2016
hereby affirm that I am exempt from the Contractor's License Law for one of the
illowing two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
2. 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.
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.;'
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 CERTIFICAT
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 non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 10/12/2016
BUILDING PERMIT INFO:
BLDG —ELECT —PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
UPSTAIRS JACK & JILL BATHROOM; REPAIR WATER DAMAGE &
REMODEL, LIKE FOR LIKE (120 S.F.)
Sq. Ft Floor Area: I Valuation: $2500.00
APN Number: Occupancy Type:
326 17 047
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: ME
Date: 10/12/2016
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: 10/12/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 5 , nd 25 4.
Owner or authorized agent:
Date: 10/12/2016
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
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building0cupertino.ora
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION! Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 22216 Cupertino Road
APN# 326-17-047
olquni Baliga
PxoNE 408-314-2728
E -M
STREET ADDRESS
22216 Cupertino Road
CITY, STATE, ZIP
FAX
Cupertino, CA 95014
CONTACT' Dave Bieber/Shari Parker
PHONE 408-379-9852
E-KNI.
STREET ADDRESS 562 Division Street
CTI Y,STATE, Z
Camp ell, Ca 95008
FAX408-379-9857
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME JM Construction
LICENSE NUMBER 736056
LICENSE TYPE
Bus-Lc"
US.LC# 20955
B
COMPANY NAME JM Construction
E-MAIL
FAX 408-379-9857
s=TADDRESS 562 Division Street
CITY, STATE, ZIP Campbell, Ca 95008
PHoNE408-379-9852
ARCHITECUENGINEER NAME
LICENSE NUMBER
Bus. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
f
DESCRIPTION OF WORK G e �/ a�//
Plumbing repairs - water damage repairs.-
EMSTING USE
PROPOSED USE - CONSTR
TYPE
# STORIES
USE TYPE
OCC.
SQ.FT'.
VALUATION (S)
MOSTG
NEW FLOOR
DEMO
TOTAL
,
AREA
AREA
AREA
NET AREA
BATHROOM
MCHEN
OTHER
REMODEL AREA G
(
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DEMTORCH AREA
GARAGE AREA: 0 DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEINGADDED? ONO
ADDITION? ONO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN YES
RE -
TOTAALU ION:
_PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER H ❑ NO
2 Q
By my signature below, I certify to each of the following: I am the prope owner or auth..iz ag o act on property owner's e —Ihave read this
application and the information I have provided is corse . I cad th escription of Work an er accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil � co n. au rizeye resentatives of Cupe A -o enter the above-identifiedproperty for inspection purposes.
�t7 4
Signature Apph—t/Agent Date: 16 / a ' i
of _
SUPPLEMENTAL INT377710N REQUIRED
PLANGHECKTYPE
ROUTING SUP
❑ ovER-TRE-couN TER
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑EXPRESS
❑ PI,ANNINGYLANREVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Els2AND M-
❑ PUBMC WORKS
rm if any Hazardous Materials are being used as part of this project.
fo—
❑ LARGE
❑ FIRE DEPT.:
_ Copy of Planning Approval Letter or Meeting With Planning prior to
El nlAsoR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONAwNTAL.HEALTH
B1dg,4pp_2011.doc revises' 06/21/11
/17
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CtJPEitTiNO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building @cupertino.om
PURPOSE
Tlus affidavit is a self -certification for the installation of all required Smoke and CarboniMonoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.1.1.2 where no interior access for
inspections are required.
GENERAL INFORMA'T'ION
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 Alarins be installed in the following locations:
AREA
SMOKE ALAR! l
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
X
X
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 contah fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarixis 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) maybe 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 alarin(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 specified below have been tested and are' operational, as of the
date signed below.
Address: -� tf� ik `-'1o. 9 r, .l a g mit No
�% Per
Specify Number of Alarms:
1 have read and aqree to comply with the terms and conditions of this
Owner (or Owner Agent's) Name:
Signatu Date: I//
5u 0
._........ ... ......... ..... ...................I...
Contractor Name:
Signature............................... .......................... ......... Lic.# ................... .................... Date:
Smoke and COforrn.doc revised 09,127116
1
A
-r.
OWNER CERTIFICATE OF COMPLIAN
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION"
Ul'1 a'C.INt 10300 TORRE AVENUE - CUPERTINO, DA 95014-3255
u 01 -
(408) 717713228 m 1= �4fl8j 777-3333 buildinsaiakoaoeai no. rtnit ; 6 '
' Owner Name Oro 6�
No,
Address Al fib C,4
I. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 11+01.8 do not apply. Skip the .rest of the form and sign ;bottom of form.
1WNo Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of theprop e
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?El p rt3' or -its
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?
-11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
10 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.
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:
_ FR Myproperty 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 no'n-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 (r(regardless of whether property undergoes alterations orimprovements).
❑ 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).
1, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant pluinbing 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 followin page.
Owner or Owner Agent's Signature f';
Upon completing, and signing this Certificate; ase return it to the Building Division in order to final your building permit.
SB40 7 2015. doc revised 018126115
Assessor's Parcel Number: L T y
Name of owner: SU
Contact Person: i�f VVe i3/C,66-9Phone: S/6 - -5-7 - 4�
Project Address: d j 6 V- S d
scope ofworl: I;,A cv#0-, 6
l� rest i.t'�' J ✓i c c i3�iJ
Code Editions: 2013 California Residential Cade
2013 CaVornla Plumbing Code
2013 California Mechanical Code
2013 California Electrical Code
2013 California Energy Code
M-frou cal Notes
Bathroom vents shall terminate not less than 3 feet from openings and property lines, (CLIC 504.1)
Enerov Code Mendalory Measures
1. All permanently Installed high efficacy luminaires shall be switched separately from low efficacy luminaires (150(k)(7))
2, Permanency Installed luminaires In bathrooms shall be high efficacy luminaires OR are controlled by an. Occupantsensors(s) certified to comply with section 119 that
does not turn on automatically or have an always on option. (150(k)(10))
COMM! JNITY DE1/FLDPny.=NT PFPARTMENT
BUILDING DIVISION - CUPRTINO
This srrst of Finn, and eprn: ;p ; 4,n . P,nl!ST he lo�pt at the
Jab o•.rr'..: n `Onclii ,_ It i. t.r. :d tc m -.any
: no, or r+N
th if..,rn,v 0-Its>rcr,imatho CI+: C,.o,,Ial-
TI nirra �)f i , r,4,n r nk7T
.+n
C 13 L -v.
EXISTING BATHROOM FLOOR PLAN
plumbing Notes:
1. water closets shall have an average water consumption of not more fnan 1.28 gallons par effective flush. (CPC 403.2)
2. Shower heads shall have a water flow not exceed 2.0 gallons per minutes @ 80 psi. (CPC 408.2)
3. Faucet8.ln lav atorlea shall have a waterflow not exceed L5 gallons per minutes @ 60 psi and shall not be less than .8 gallons per minutes at 20 psi. (CPC 403.6)
4. Shower stalls shall have 8 clear interior finish area of 7.1 sq.ft, and be able to accommodate a minimum 30 Inch circle at the threshold level. Thane clearances shalrbe
maintained up to a height of 70 Inches able the shower droln. (CPC 408.0)
5. Showeroempartments and walls above bathtubs with Installed shower heads shall be finished with a smooth, nonsbeerbent surface to a height not less than 72 Inches
(611). (CRC R307.2)
6, The maximum holwater temperature discharging from the bathtub, shower and whirlpool bathtub filler shat be limited to 120 degrees Fahrenheit. The water heater
thermostat shall not be considered a control for meeting this provision. (CPC 40M & 408.3)
7, water closet shall be set minimum 15 Inches from Its center to a sidewall or obstruction and 24 Inch clearance In front of water closes. (CPC 402.5)
Electrical Notes:
1. The Installation of smoke alarms In all of the following areas shall be provided; (R314.3)
a, On the ceiling or wall outside of each separate sleeping area In the Immediate vicinity of bedrooms.
b. In each room used for sleeping purposes.
o. In each story within a dwelling unit, Including basements but not Including crawl spaces and uninhabitable attics.
2. Approved carbon monoxide alarms shall be Installed outside of each separate sleeping area In the Immediate vicinity of the bedrooms and on every Ievel Including
basements in dwelling units that have fuel -orad appliances or sh-h el garages. (CRC R315.1)
3. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such circults shall have no other outlets. (CEO 210.11(C)(3))
4. All receptacles In bathrooms, garages, accessory buleings, outdoors, crawl spaces, unfinished basements, kitchens (where receptacles serve countertop surtaces),
laundry, utility, wet bar sinks (within 6 feet of the edge births, sink), shall have grcund-fault circuit interrupter (GFCI) protection. (CEC 210.8)
5. In all areas specified In 210.62, ell 125 -volt, 15 -end 20 -ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.11)
6 + �
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Toll,
4— 6 1 I L
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CUPER`1•INO
Building Department
OCT 12 2016
REVIEWED FOR CODE COMPLIANCE
Reviewed 6y. -4— —
j ACT 12 2010
M-12 'L '-1�0 im