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B-2016-2928 • CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:13-2016-2928 20129 PACIFICA DR CUPERTINO,CA 95014-3112(369 29 006) TERRACOTTA CONSTRUCTION INC SAN JOSE,CA 95132 OWNER'S NAME: CHENEY JOHN P AND LYNNE A TRUSTEE DATE ISSUED:10/17/2016 OWNER'S PHONE:408-736-5900 PHONE NO:(408)431-6889 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#920167 Contractor TERRACOTTA CONSTRUCTION INC Date 10/31/2016 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(144 S.F.);HALL&MASTER BATH REMODEL I hereby affirm under penalty of perjury one of the following two declarations: (100 S.F.) 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. it 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:$18000.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 29 006 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 arid will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALL_. $ L PECTION. Signature ) uci ...t1043 Date 10117/2016 Issued i . �":*!'S Date: 10/17/2016 - 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 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:10/17/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALLROOF 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 permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous 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,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 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: k„)‘..1C1 APPLICANT CERTIFICATION Date:10/17/2016 I certify that I have read this application and state that the above Information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit 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, 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 ARCHITECT'S and will comply with all non-point source regulations per the Cupertino Municipal I understand myplans shall be used asDECLARATION Code,Section 9.18. public records. Licensed Signature Data 10/17/2016 Professional N-4%---- -, CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 "" CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(c?cunerfino.orq • 6— `6 F Z-9 1 2 El NEW CONSTRUCTION El ADDITION ❑ ALTERATION/TI 11 REVISION/DEFERRED ORIGINAL PERMIT Y 7 PROJECT ADDRESS /2.1 Z.%.ic� Pr .. I APN R �, _ o 04 OWNER NA 4E "` CAe4Y/tee P TE_ E-I ZAIL STREET ADDRESS 5„1, / ,i sy,./ ?.3`:4,7 Ii ZI ti7'.` cipzaek • ! vs-74, Fax CONTACT NAESE .��}`it} �V P NSE MAIL A k it 61,1,-513 4St-688A Ctt'UL L 4e_gC�.tO� STREET ADD SS FAX ,V1 , Gk.. ci53x'Nel KV1 �L l VA J ©OWNER. 0 OWNTR-BUILDER. 0 ovari RAGENt RP CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGA'EER 0 DEVELOPER 0 TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE,TYPE BUS.LICn JUL() »P. 461- l w44151 COMPANY NAMEE-MJJL FAX "C�V-W4WtT CUt�SNE1)C.r1C 14 '�leAr+rltttsk,wv e t?'k.Cbr \ STRE -3EPI Kro[ VIAC byilio f { lll/k TE r r �5 i3`- ilk-61i941ARCHITECT/ENGINEER NAME J. LICENSE NUMBER BUS.LIC 45 �� COMPANY NAME E-MAIL 1 FAX STREET ADDRESS CITY,STATE,ZIP I PHONE • DESCR TION OF WORK cant A 1 dolt hark say.n 4 aAte.r- ‘crAtAkccorel krEAma c' -. ' t 'T ‘ • EXISTA.G USE PROPOSED USE CONSTR.TYPE r STORIES USE TYPE OCC, SQ.FT. VALUATION(5) EXISTG NEW FLOOR ` DEMO TOTAL - AREA AREA AREA NET AREA MIMI BATHROOM KITCHEN OTHER RI:MODELARE.A REMODEL AREA /L/ REMODEL AREA PORCH AREA DECK_AREA TOTALDECK•POf/RCH AREA GARAGE AREA: I DETACH ❑ATTACH If DWELLLNG UNITS: ISA SECOND UNIT ❑YES SECOND STORY DYES - BEING ADDED? ONO .ADDITION? DNO :---- PRE APPLICATION ❑YES IF YES,PROVIDE COPY OF 1 IS TH£BLDG AN 0 YES C,EIVE i s - `aTAL VALUATION: PLANNLNOAPP1.- NO PLAN''L'iGAPPROVALLETTER EICHLE 1-3 OM 'a y By my signature below,I certify to each of the following: I am the property owner or authorized anent 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 to a ldine construc`io0. I authorize representatives of Cupertino to enter the above-identified roperty for inspection purposes. Signature of Applicant/Agent:, V uO \V__ Date; iQ�l l 20 lio SUPPLEMENTAL L FORM.ATI0 ON REQUIRED 4265, u _' ._ :: - - - Q ,��-,:s.: :�--CH£CK-T'1PE`:-„.::;.�.�' 4Ss"'`=cn„ -V4 PLA'c • ----- New SFD or 4vItlfanll) dwellings: Apply for demolition permit for ��:6t£RT'E-LO "TER��a3 = ;: �D:SLIII.DTi,C PLA. RNES? .--__ _ 5u existing building(s). Demolition permit Is required prior to issuance-of building ”:=?� 01V.P• _ ,; • , ernit for new building.. [7kxRs._ ai:Bi - '�] rLS§iropirtIfi - 4 � T _ - ^' rs _' Nvi� �i� — — — Commercial Bld_s. Provide a completed Hazardous Materials Disclosure " �_: .nR ::�� _ *> 's'B; CBL,z -tt s= — - _ _ - - -- - - - - - - - - ` - form if any Hazardous Materials�-ebeing used as thi-po'ect ':0 '_ G , _ -- - - :_- -- - FIRE D&PT - - = - - : -� :.:: � _ ; '� _Copy of PlanningApproval Letter or Meeting ith Planning priorto #_ �., -:- r_ :-- ^ %.n,❑•, - - -= - t:- _•:%y1AJH. - _-=cg "S T&PY•'.SE, ERI)ISTRJCT4;r subttai f Bulding Permit a3:4-, . .��max . _ - _ .V z, � :ul:�. ? =, ` `Eti1R ? :T4I:It-El-tiff-2:M ., BldgApp_201Ldac revised 06121111 r_ fc--1 SMOKE / CARBON MONOXIDE ALARMS , OWNER CERTIFICATE OF COMPLIANCE -Praz ( ,all ib ��s.r9ss COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPER fltsi7 (408)777-3228•FAX(408)777-3333•buiidinqcupertino.orq PERMIT CANNOT BE FINALED Ul�TIL THTC CE2TIFICATE HAS BEAN o CO 1 'TED;(-:a- ,.A: R> TTTRNF.D 07 sti ti=6 D k 1I174SIONPs; PURPOSE This affidavit is a sell-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 S1000.00,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 X X the 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 specified below have been tested and are operational, as of the date signed below. Address: Z®12°1 Pc(C Cck Permit No.7-Olin Z0128 Specify Number of Alarms: #Smoke Alarms: I '5 1 #Carbon Monoxide Detectors: 1 I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature Date: Contractor Name: Signature Lic.# c12.12.41Date:1 'j�0k) Smoke and CO form.doc revised 09/27/16 r: 7717 WATER-CONSERV1NG PLUMBING FIXTURES 3 •,=.72-J OWNER CERTIFICATE OF COMPLIANCE )-05-ta al lib COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ".r CUPERTINO 10300'TORRE AVENUE•CUPERTINO,CA 95014-3255 / r 08)777-3228•FAX(408)777-3333 buildi • • •..,..17rva.or. A)/: Owner Name AS 'Permit Ne4L-,(07/(le • e_ ? • Address Q . nA -C)r 1. Is your real property a registered historical site? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. t pi'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? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. El The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. AL" [a 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? El 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: Ea 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 builcfrig.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). El 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 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 co7ply with the requirements,as indicated in the table on the followin: a:e. Owner or Owner Agent's Signature: 7,111111) Dafe: °Far - Upon completing and signing this Certificatealeme return i.t to the Bui ng Division in order to final your building permit. Darnel Hernanaez,Agen SB407 2015.doc revised 08/26/15