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B-2017-0042CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0042 10354 DENISON AVE CUPERTINO, CA 95014-2429 (316 29 067) JOHN SCALMANINI SAN JOSE, CA 95126 OWNER'S NAME: ROELLIG THOMAS LAND BETH G DTE ISSUED: 01/06/2017 OWNER'S PHONE: 408-239-7320 P ONE NO: (408) 295-3200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT O: License Class B Lic. #560601 Contractor JOHN SCALMANINI Date 08/31/2018 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENT [AL -- COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE (8) WINDOW AND (1) DOOR LIKE FOR LIKE. I hereby affirm under penalty of perjury one of the following two declarations: i. 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. 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 i permit is issued. Sq. Ft Floor Area: Valuation: $12800.00 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 316 29 067 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. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FRO LAST CALLED INSPECTION. SignatureDate 1/6/17 Issued by: SEAN HAT Date: 01/06/2017 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 i. 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 ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 1ZEU I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COV 1KRINGS TO BE CLASS "A" OR BETTER t. 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. HAZARDOUS MATFRIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardou 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 & Sal Ay Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with he Cupertino Municipal Cade, 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, S ction 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, air contaminants as definene Ad I use equipment or devices which emit hazardous by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance 'th 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 age t: - APPLICANT CERTIFICATION Date: 1/6117 I certify that I have read this application and state that the above information is 0&6RUCTION LE 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 per it 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, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal AMMITECTIS 1 understand my plans sha I be used as public records. Code, Section 9.18. Licensed Signature Date 1/6/17 Professional CUPERTINC3 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVIS 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • build ing(c-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION L- I ALTERATION / TI F RF.VTSTnN / T)RFRRR ORT(3TMAT PFRUfTTII PROTECT ADDRESS /� � � CVL /J APN # OWNER NAME ag MAIL E-MAIL 1V l fl J !�+PHONE —71 STREET ADbRESS� CITY, STATE, ZAP (`� FAX , CONTACT NAMES� { �C (� �� PH NEO � � �� MAIL � � � STREET ADDRESS /'j� 1 6 2 er�/I s' CITY, STATE, ZIP FAX SE .%ase Qzl ❑ OWNER ❑ OWNER-BUH.DER ' ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME J G j c 4 % f rl (poe LICENSE NUMBER,5�0 (0 ( 9 LICENSETYPE �p (J BUS. LIC # °'1 7 6 �L f COMPANY NAME (,, fov E-MAIL FAX , p� E r 1' I! &,, �,j 00 STREET ADDRESS 1, (�2. CITY, STATE, ZIP l �Ot, Mrd ems+' V 0 !� IS ti Gs2 �As-3ICA ARCED T/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY N E-MAIL FAX STREET ADDRESS CITY, STATE, zip PHONE DESCRIPTION OF WORK EXISTING USE - PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO 'TOTAL AREA AREA AREA NET AREA BATHROOM 1 KITCHEN OTHER REMODEL AREA 1 REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA:DETACH []ATTACH r DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY E] YES BEING ADDED? NO ADDITION? ❑NO PR.E-APPLICATION E] YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECIVED.'Y;Y:'.;£a ..;..:- ;__- --- TOTAL VALUATIONT: PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NOlei _ By my signature below, I certify to each of the.following: I am the property owner or authorized agent to act on the pi operty 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 build vconstruction. I authorize representatives of Cupertino to enter the above identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE4ENTAL INFORMATION REQUIRED PI,A V CHECK TYP R0' T1NG SLIP New SFD or Multifamily dwellings: Apply for demolition permit for 9VER-THE-6oUNTE LA-� BUILDING PLAN REVIEW existing building s). Demolition permit is required prior to issuance of building f permit for new building. ciEXPRESS' PLANNINGPLAN REVIFW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD l] -PUBLIC WORKS. form if any Hazardous Materials are being used as part of this project. [] LARGE. ❑ FH2E DEPT _ Copy of Planning Approval Letter or Meeting With Planning prior to fl IMAJOR. - sAI�ITARY submittal of Building Permit application. , SERER➢isTRICT:' . -�ENVIRONkENTAL HEALTH BldgApp 2011.doc revised 06/21/11 juPERTINO Owner Name —7-4 a A WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE ;,.. r` COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION f '7 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (4%) 777-3333 • building-cuoertino org Q�f, 13e t, Roeah'q Permit No 0'-� Ot 7_ o�y� Address0 33,4 Oe- h /s e%,t A. f/ -tr 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. 11, o 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. Go to Question 3. r. 1 Y 3. Is water service permanently disconnected for your building? 0 Yos Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 19 No Go to Question 4. 4. Is yogr real property built and available for use or occupancy on or before January 1, 19949 ❑ Nb 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 -I-,--1 994; — - -- -- -- 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: My property is a single-family residential real property. See Civil Code Section 1101.4. Or} and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures tote 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- co'.iserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ M,I property is a commercial real property_ See Civil Code Section 1101.5. Or. 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 replagled prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 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. 14 ,.e a 4, Owner or Owner Agent's Signature: - Date: / /-* /7 Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit SB40 7 2015. doc revised 08126115 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 4 i,. 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 - FAX (408) 777-3333 - buildinaft-cupertino.org i3 -o1, 004a, inspections are required. Jarrns for cress for GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon i Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000 00, CRC Section 8314 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 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 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 i I as not result in the removal of wall and ceiling finishes or there is ' no access by means of attic, basement or crawl Refer space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for i 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 lifornia Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. Address: —Permit No. Specify Number of Alarms: Smoke Alarms: # Carbon Monoxide Detectors: !_._-J ___j _4 --ty—ifh fh= forme ant rnnditinns of this statement i I flavu luau alio abp - —gggr if- -, __ — . O (or Owner Agents) Name: Signature ................ Dat6� _;Z.7115101 ei.ffe ....... ____ ... .... .... . . ..... 1 400// 7 ..................... . ................. ................................... .............. .............. Contractor Name: Signature..........__ ............... - ............ ....... .............. Lic.# ..........._............---...........Date: .................... ............ ...... __ .............................. Smoke and CO form. doc i-evised 09/27116