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B-2016-1444CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS- CONTRACTOR; PERMIT NO., B-2016-1444 21968 OAKDELLPL CUPERTINO, CA 95014-1161 (32618 046) (H'Sac BROTHEP, CO SAN JOSE, CA 95121 OWNER'S NAME. SCHUETZ CHARLES W AND WINIFRED W TRUSTEE DATE ISSUED: 02/2912016 OWNER'S PHONE PHONE NO: 4086443112 LICENSED CONTRACTOR'S DECLARATION BUILDING PEit T INFO; License Class E[ Lie. #92J_M I Contractor (A.S.B.C, BRO-THER-CO ) Date 2/29/201X -BLDG _ ELL, qT _ PLUMB MECH X RES17ENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — — with Section 7000) ot'Division 3 of the Business & Professions Code and that my license is in roll force and effect. JOB DESCRIPTION: REMODEL HALL AY BATHROOM (40 SX.) I hereby affirm under penalty of perjury one of the following two declarations: i. I have and will maintain a certificate of consent to solf-insure for Workers Compensation, as provided for by Section 3700 of the Labor Code, for the performance, of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the ilcrromiancu of the work for which Sq. Ft Floor Area: Valuation: SI0000.00 this permit is issued. APPLICANT CURTIELCASION I certify that I have read this application and state that the above APN Number. occupancy Type: information is correct. I agree to comply with all city and county 326 18046 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 PERMIT EMPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the 1810 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and willWITHIN comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALL-ED INSPECTION. Code, Section 9.18. Issued by: PAUL O$ULLIVAN Signature Date 2L2912= Date: 2/_ 29120 k OWNER-BUILDER DECLARATION RE-ROOFS: All roots shall be insiected prior to any roofing material being installed. If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of the installed without first �btaining all inspection, I agree to remove all new Materials for following two-reasons: inspection. 2. 1, as owner ofthe property, or my employees with wages as their sole compensation, wilt do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature ofAppliLcalit:1 2. 1, as owner ofthe property, am exclusively contracting with licensed Date: 2aw-a-0 contractors to construct the. project (Sco.7044, Business & Professions Code). "Al- OR BETTER I hereby affirm under penalty of perjury one of the following three declarations; ALL R00�4 COVERINGS TO BE CLASS L I have and will maintain a Certificate of Consent to self-insure for Worker's l Compensation, as provided for by Section 3700 of the Labor Code, for the HAZARDOU5 MATERIALS DISCLOSURE performance of the work for which this permit is issued. insurance, for I have read the hazardous materials requirements under Chapter 6.95 of the California flealth I& Saicty Code, Sections 25505, 25533, and 25534, 1 will 2. 1 have and will maintain Worker's Compensation as provided maintain compliant l with the Cupertino Municipal Code, Chapter 9.12 and the by Section 3700 of the Libor Code, for the performance of the work for which Health & Safety Code, Section 25532(a) should I store or handle hazardous permit nit is issued. 3. 1 certify that in tile performance of the work for which this penuit is issued, I material. Aciaitionia I y, should I use equipment or devices which emit hazardous air ____ _ �1`eflned by the Bay Area Air Quality Management District I shall not employ any person in any manner sous to become subject to the will Maintain cfflllpli�uice with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California, If, after making this Certificate of .he Halth i Safety Code, Sections 25505, 25533, and 25534. 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 owner or authorized agent: be deemed revoked. Date; 2/291201 i -1 AkPIAC IFICATIO-N LLEND11Nf�_A(3Kn_Y kN C)ASTRUCUO I hereby affirm that th�re Is a construction lending agency for the performance I certify that I have read this application and state that the above information Is of work's for which this permit Is issued (Sec. 3097, Civ C.) correct. I agree to comply with all city and 6 county ordinances and state laws ' relating to building construction, and hereby authorize representatives of this city Lenders Name to enter upon the above mentioned property for inspection purposes. (We) agree Lencler's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City In I ARCHIT W­TIJ DECLARATI consequence of the granting of this permit, Additionally, the applicant I understand my plan# shall be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 212212016 CONSTRUCTION'PERMIT APPL[CAT ON COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING [VISION 10300 TORRE AVENUE • CUPERTINO, CA 96914-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertinG.cig i ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION J TI REVISION J D FERRED ORIGINAL PERMIT # PROJECT ADDRESS J � � APN � 3R- BOW. QWNCRNAME �f E^fl { / ��"�_�.Iilsr % PHONE ..✓ �✓ � s.✓pppp�L.r LJ r'� J�" E-MAIL STREET ADDRESS q t(9 0 DO CITY, STATE, ZIP p��/ { p� CA 95t*AX CONTACT NAME PHONE ^ E-MAIL STREET ADDRESS CITY, STATE, ZIP ws C !! FAX ® OWNER ID OWNER -BUILDER ❑ OWNER AGENT eONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 13 DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUME tt� 66 L CENSE TYPE � Bus. LIC # COMPANYNAME ! _ E-MAIL FAX STREET ADDRESSt�f, CITY, STATE, ZIP " PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK] a l MISTING USE PROPOSED USE COMM TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION($) ExISTG AREA JI - NEW FLOOR REA DEMO AREA TOTAL NETAREA BATHROOM KITCHEN REMODEL AREA REMODELAREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: DFTACH ❑ATTACH # DWELLING UNITS: IS A SECOND UNIT L1 YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? L]NO PRH-APPLICA•IION ❑ YES IF YES, PROVIDE COPY OF PLAA*NINGAPPL# QNO PLANNING APPROVALLF-TTER IS THE BLDG AN YES ❑ EICHLERHOME? ©NO '�.,-=M: D`BY : _ - - �--� �:=--'=-= -=- ==---- -+:=:� =:;= ; ,,;,jA__ TOTAL VALUATION: r.p� By my signature. below, I certify to each of the following: I am the property owner or authorized agent to act n the property owner's behalf. I have read this application and the information I have provided is correct. 1 have read the Description of Work and Yerify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui in straction. I authorize representatives of Cupertino to nterthbabove-idenligadpropei for inspection purposes. Signature of Applieaut/Agent:Al Date: SUPPLEMENTAL INFORMATION RE UIRBD - ;'�-�•::.: =:::. .PL.AMCH _ CK_JYPE New SFD or Mul 'amly ure1lings. Apply for demolition errnit far existing building(s). Delnolition permit is required prior to issuance of buildirrgpenni OVERTHE QU\1ER -__ - - -- - - - - - ❑ •BIJILDINGPLAJvRElIE16 ^' t for new building. Commercial B1dgs•PIovrdeacoInplet ed Hazardous isclosure -, :. 51'A-1'DARD ,-; m-:�`���"�'_- ❑ PUBLIC 1'VORKS _ fans if any Hazardous.Materials are being used as part of this project. _ _' .... : :❑ �iliE.nErr„: : =:-= :: - : _= CoApproval- py 1? a ztnng Letter or Meeting with Planning nor to _ - - - - - _ . -_ - -- submittal of Building Permit application. .- .:- ._-_:. ❑ sA eITARxs«ErtDlsrRlcr ::.. - - — BldgApp_201 Ldoe revised 06121111 21 VV;Vate, OFFICE COPY I V 1; V:1 Ver - -, ,4-- f 6'T6 -L I. PPMEINTD). ARTMENT :;L CUP$ Thki •--t of phIs and rprcli I cati on r. M. U ST b e lm. pt at th a v 11 Zi�,-Mfa, or to dcmj- A, IV2!!:II0LIif!p"".!,-IV,-A from tha Building cifficial. n a n cl Digi;' IC?1,-L. N", )T ;al W ..Lt.,f:jjI of C 6 i lice ur L,:?.w. 14, �ff oa� p/ricce .- badrmn< h4, -Z Alot 64"m, /Ocvoz, ( . or RECEIVED BY ppo I c t va`71 CUPeRTINO Building Department EVIEWED FOR C()r) _ (;OMPLiANCE Reviewed Sy: TE WWW -)- (q 6 �-, "r MNO ,,martment FEE'r 2 9 2016 REVIEWED FOR CODE COMPLIANCE Reviewed By: T OWNEK GERERCATE OF COMANCE COMMUNITY DEVELOPMENT DEPARTMENT'- BUJLDINO� DIVISION 10300 TORRE AVENUE 1, CUPERTINO, CA 95044-3255 (408) 777-3228 - FAX (408) 777x3333 a bujildlnqAcupefflm�omr VIA( FEUM CANNOT Dt VINALP.D AND GO*U HA 0 SDVEN, 0mg, PURPOSE This affidavit is a self -certification for the installation of all required Smoke �nd Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.x.1.2 where no interior access for inspections are required. GV -N" MA t INTORMATION Existing single-family and multi -family dwellings shah be provided with Smoke Alarms and Carbon Monoxide alarms, When the valuation of additions, alterations, or repairs tq existing dwelling units exceeds, $1000.09, 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: I ARIA I_ SMOKE ALARM CO AIAAM_�,. Outside of ear -h separate sleeping area in the immediate vicinity of the X X On, every level of dwelling unit including basernents- X Wiflun, each sleeping, room X Carbo Mar aide alarmis are not required in dwell- M—gs which, do not contain fuel bu i -egappliances and, that do not have an, attached garage. Carbon monoxide alarms coi4ined- with 6m,- oke alarms shall comply with CBC Secdon 429,61 and, shall be approved by the Office of the State Fire Mar I I Flo,wer S In dweffing wivit s with no commer 0, i d power sup=ply, al ar mi, mm ay be s ol ely batter: y ope r ate- d, In, exy&fihg, d,,w, e2hmg, umd1si alar. zns ar e per nrifted to be s allely battery operate[[ d W1,11e r e repairs- or after altiom do, not r e saft k, # die, r� em, -ovall, of w A at, d, Ce fim 1 sli, e 9 or th, e-; e is, no access) by i- n eLarts- of alti q, ba s ev. L, ent or, C r, aw 1, s pace,. R! ef a toy CRC S e -c & n,, A314 and CK, Sect ons, 9:87.2-11.41 and 42016-2. 4m, elect r 1 c al p e r m, It is r e quke d for aijan , w, , wIt dich mit b & em am dedl to, the Build m, g w k Ing A5- twRer, of the above -referenced proper, V,, Yhereby eeT fify do Hite alarm(&) referee—teed above hasArm'beeim instafle& n, m amwda%Lve with the mmmvfactalri ei(s in&hmfiewa m-0 in eowq)11m e w5lih the Cafifwiftlo, and Codes. The allm-ms have teem, tes#ed amid axe op�raft� as, of the date sicced .9 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE Ell COMMUNITY DEVELOPMENT DEPARTMENT - BUILDINd DIVISION T_ 10300 TORRE AVENUE - CUPERTINO, CA 95014-3Z55 CUPERINO (408) 777-3228 - FAX (408) 777-3333 - building0—cunerfind.org Owner Nam Permit Nor Addres_s_- A 44 /,-r e&A607 d Se 14 1. Is your real property a registered historical site? n X0 Civil Code Sections 1101.1 through 1101.8 do not apply, Skip the rest of the form and sign bottom of form. 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? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. 0 The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. 2-1 ro­ 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 restofthe form and sign bottom of form. Ej6,��o Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? 0 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. E] 2 Yes My real property is built and available for use or occupancy on.or before January 1, 1994. Civil Code Sections - 1101.1through l,101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Plte check ONE of the following: My 0 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 multitamity residential real property. See Civil Code Section 1J101.5. 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 erty -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). Las the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced priortodate specified above with water-conservingplumbingfixtures 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 p1junlying fixtures comply with -the req*einents as indicated in the table on the following page. Owner or Owner Agent's Signaturell Upon completing and signing this Certificate, please return ' to the Building Divisi6n in order to final your building ermit. i 533907 2015 doe revised 08126115