B-2016-3099CITY OF CUPERTINO BUILDING PERMIT
10144
BUILDING ADDRESS:
CONTRACTOR: PERMIT NO: B-2016-3099
10144 CAMINO VISTA DR CUPERTINO, CA 95014-2608 (342 14 061) HOMEOWNER
BUILDER
OWNER'S NAME: WONG ALVIN KAND CHERYL R TRUSTEE .
OWNER'S PHONE: 408-517-0718
LICENSED CONTRACTOR'S DEC . R ....;CON
ivi
License Class Lic. #
Contractor HOMEOWNER B I DER pate
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:
s. 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.
APPL.ICrANT 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 non -point
source regulations per the Cupertino Municipal Code, Section 9.18,
Signature Date 11/10/2016
OWNER-BUt7 DER DECLAR TION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
i. 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).
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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
�perrfo'rmance of the work for which this permit is issued.
%'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 pemrit 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
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,.
ISSUED: 11/10/2016
NO:
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
M ECH X RESIDENTLAL _ COMMERCIAL
JOB DESCRIPTION: 90GAVZM"
1 ST FLOOR MASTER BEDROOM�REMODEL (200 S.F.)
Sq. Ft Floor Area:
Valuation: $40000.00
APN Number: Occupancy Type:
34214 061
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Ayende
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection..
Signature ofAppl
Date: 11/10/2016
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Dvaner or authorized agent:
Date: 11/1012016
CONST RUCTION
I hereby affirm that there is a construi4 ion tnggency or the performance
of work's for which this permit is issued ec
Lender's Name
Lender's Address
ARCHITECT'S DFCLARATION
I understand my plans shall be used as public records..
Licensed
Date 11/10/2016 (
Prnfaccin
CONSTRUCTION PERMIT APPLICATION &ZO
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COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
CUPER INN (408) 777-3228 • FAX (408) 777-3333 •building ,cuperlino.org
NEW CONSTRUCTiO1V ❑ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
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OWNER NAME j a r\ PHONE E
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CONTACT NAME
USE I TYPE I OCC_ I SQ.FT. I VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA I NET AREA
BATHROOM- KITCHEN - OTHER
REMODEL AREA 0-o REMODEL AREA REMODEL AREA
/
ATTACH
#DWELLINGUN7.TS: ISA SECOND UNIT YES SECOND STORY ❑YES - - - - -
BEINGADDED? [3NO ADDITION? ❑NO
❑ PROVIDE COPYOF L4 THE BLDG AN Q YES irE y' T AL VALUATION:
PLANNI G APPON ❑ YES IF ANN G APPROVAL LETTER EICHLER HOME? ❑ NO
4® PLANNING APPL # NO PLANNING
By my signature below, I certify to each of the following: I am the property owner or authorized agent to ct on th properly 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 to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Appiicant/Agent: /� Date: It— ID ®1 to
_ New SFD or Multifamily dwellings: A'pr molitio permit for
existing building(s). Demolition permit is required prior issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
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❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER 11 TENANT
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USE I TYPE I OCC_ I SQ.FT. I VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA I NET AREA
BATHROOM- KITCHEN - OTHER
REMODEL AREA 0-o REMODEL AREA REMODEL AREA
/
ATTACH
#DWELLINGUN7.TS: ISA SECOND UNIT YES SECOND STORY ❑YES - - - - -
BEINGADDED? [3NO ADDITION? ❑NO
❑ PROVIDE COPYOF L4 THE BLDG AN Q YES irE y' T AL VALUATION:
PLANNI G APPON ❑ YES IF ANN G APPROVAL LETTER EICHLER HOME? ❑ NO
4® PLANNING APPL # NO PLANNING
By my signature below, I certify to each of the following: I am the property owner or authorized agent to ct on th properly 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 to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Appiicant/Agent: /� Date: It— ID ®1 to
_ New SFD or Multifamily dwellings: A'pr molitio permit for
existing building(s). Demolition permit is required prior issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp 2011. doe revised 06121111
UPERTINC7
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building65.cupertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS
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OWNER NAMEL,,,,,,
DESCRIPTION OF WORKS,.}
.OWNER ADDRESS ii �) /� f
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We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of -
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read', initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval.of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
64A-11. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
64622. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name) instead of my own.
'64. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
C�,5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
""`�'6, 1 understand if I am considered an "employer' under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
1
7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
V8, 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuildeYFonn 2010.doc revised 04114110
W-9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors` State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed
contractors.
0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
amthe party legally and financially responsible for proposed construction activity at the site address listedabove.
& 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity,I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers.
2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name:
Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form'notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verify the pr9perty owner's s ,n ture.
Property Owner's Signature: �( ,� Date: I (-10-10
--------------------------------------------------
(NOTE: The following Authorization Form Is requ�(ed to e completed by the property owner only when designating an
agent of the property owner to apply for a constructfen ermit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which l understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized_ Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature:
Date:
OwnerBuilderFonn 2010.doc revised 04114110
Assessor's Parcel Number:
Narne of Owner: �,-
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Contact Person: (--1 [ 1 y Phone. I ✓" l I f
Project Address:�[�
Scope of Work: f �'A '] 6j:' 1 :_7"' r/
Code Editions: 2013 California Residential Code
2013 California Plumbing Code
2013 California Mechanical Code
2013 California Electrical Code
2013 California Energy Code
Mechanical Notes,
1. Bathroom vents shall terminate not less than 3 feet from openings and property lines. (CMC 504.1)
Enemy Code Mandatory Measures:
1. All permanently installed high efficacy lumfnafras shall be switched separately from low efficacy luminaires (150(kX7))
2. Permanently installed luminaires In bathrooms shall be high ehloacy luminaires OR are controlled by an occupantsensors(s) certified to comply with Secton 119 that
does not turn on automatically or have an always on option. (150(k)(10))
I
r.J
Ptumbina Notes:
1. Water closets shall have an average water consumption of not more than 1.28 gallons per effectNe 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. Faucets. in lavatories shall have a water flow not exceed 1.5 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 a clear interior finish area of 7.1 sq.fl. and be able to accommodate a minimum 30 Inch circle at the threshold level. These clearances shall be
maintained up to a height of 70 inches able the shower drain. (CPC 408.6)
5. Shower compartments and walls above bathtubs with Installed shower heads shall be finished with a smooth, nonabsorbent surface to height not less than 72 inches
(611). (CRC R307.2)
6. The maximum hot water temperature discharging from the bathtub, shower and whirlpool hatitub filler shalt be limited to 120 degrees Fahrenheit. The water heater
thermostat shall not be considered a control for meeting this provision. (CPC 409.4 & 408.3)
7. Water closet shall be set minimum 15 Inches from Its center to a side wall or obstruction and 24 Inch clearance in front of water closet. (CPC 402.5)
Electrical Notes:
1. The Instalallon of smoke alarms in all of the following areas shall be provided: (R314.3)
On the ceiling or wall outside of each separate sleeping area In the Immedlate vicinity of bedrooms.
b. In each room used for sleeping purposes.
c. In each story within a dwelling unit, including basements but not including crawl spaces and uninhabitable since.
2. Approved carbon murexide alarms "it be installed outside of each separate sleeping area In the Immediate vicinity of the bedrooms and on every level including
basements In dwelling wits that have fuel4lred appilances or attached garages. (CRC R315.1)
3. Al least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such circuits shall have no other outlets. (CEC 210.1l(CX3))
4. An receptacles In bathrooms, garages, accessory bulldings, outdoors, ora vl spaces, un nnlshed basements, kitchens (where receptacles serve counter top surfaces),
laundry, utility, wet bar sinks (within a feet of the edge of the sink), shall have ground -fault cimult interrupter (GFCI) protection. (CEG 210.8)
5. In all areas specified in 210.52, all 125-voll, 15 -and 20-- ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.11)
1 '
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO
t
APPROVED
` This set of plans and specifications MUST be kept at the job
1 \ site during construction. It is unlawful to make any changes or
IS 1 alterations on same, or to deviate therefrom, without approval
from the Building Official.
.I The stamping of this plan and specifications SHALL NOT be
held to permit or to be an approval of the violation of any
•� provision of any City Ordinance or State Law.
1
BY AbbyAAyende
._._DATE - 11/14/16
MIT NO B-2016-3099
flI I I(
if CUPERTINO 1 I
I Building DpplartmentFM
!
,^ FOR CODE(CSM lIARLE-
EXISTING BATHROOM FLOOR PLAN Reviewed By: Abby Ayende PROPOSED BATHROO FLQPLAN(
Date: 11/14/16