15070090CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10165 ADRIANA AVE
CONTRACTOR: AVA CONSTRUCTION
PERMIT NO: 15020150
OWNER'S NAME: PICCHETTI NITA L TRUSTEE & ET AL
21060 HOMESTEAD RD APT 216
DATE ISSUED: 02/26/2015
OWNER'S PHONE:
CUPERTINO, CA 95014
PHONE NO: (408) 387-0999
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
TO CLEAR CODE ENFORCEMENT CASE: KITCHEN
�7
License ClassLic. # �y 3
REMODEL
` I
Contractor /1 Cnv� w C t��ot� Date �� �_�
(132 SQ FT); REMODEL (2) BATHROOMS (145 SQ FT);
REMOVE/REPLACE (12) LIGHTS; REMOVE/REPLACE (12)
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:
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
Sq. Ft Floor Area:
Valuation: $20000
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
APN Number: 32620024.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 D F PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS 17aST CALLED INSP TION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
tTv -
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point ource regulations per the Cupertino Municipal Code, Section
9.18.
�/2� j� ��
RE -ROOFS:
Signature Date
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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
1 hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the
declarations:
Health & Safety Code, Section 25532(x) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectionsgf505,25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this�Z(
Owner or authorized agent: Date:
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, 1
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
1 hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building oDcuperbno.onq
❑ NEW CONSTRUCTION ❑ ADDITION LTERATION / Tl ❑ REVISION / DEFERRED ORIGINAL PERMIT #
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PROJECT ADDRESS to% / _1 ri r i�a
APN k �O o Z__1 l (b
OWNER NAME �W\I`r
PHONE �jG
E-MAILr
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STREET ADDRESS
CITY, STATE, ZIP I FAX
CONTACT NA',4E „�
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PHONE u �"
E-MAIL 1q� ^�C lir
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STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OWNTER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ^ � ,+ r � �� �r-J Ek ���
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LICENSENUMBER C1� 47-
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LICENSE TYPE �
BUS, LIC 4
COMPANY NAME /��{
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STREET ADDRESS !� �a ! CITY, STATE, ZIP ` ��
PHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC 4
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
�C"�
E ' TING USE PROPOSED USE CONSTR. TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (5)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM /•
REMODEL AREA
`
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
f DWELLING UNITS:
IS A SECOND UNIT ❑ YES
E] YES
�SFCONDSTORY
BEING ADDED? ElNO
ADDITION? NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIV Y, k -- -
TOTAL VALUATION:
PLANNING APPL k NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
r f
a (�
9 -r
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have ided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
v'
ordinances and state laws relating to b construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
PL uv cHEcicYPE
IiovTllvc SLIP,
❑ ovER TxE eouNrER
❑ slt\G 7?La,N RE«Ew
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
o
�7 PLAh^VIiiG PLAN REVIEW ,
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
sTAND.itD
x
❑ PUBLIcwoRxs =._
form if any Hazardous Materials are being used as part ofthis project.
`
�
❑
Copy of Planning Approval Letter or Meeting with Planning prior to
LARGE � k
FIRE DEPT x
_
submittal of Building Permit application.
0dO�R
❑SANITARY sEVI EitnrsTRlcr
-" 'r
❑��:ENYIRONi\`IENTAL' I3EALTH ..
BldgApp_2011.doc revised 06/21/11
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I,7
CITY OF CUPERTINO
Fm_� FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10165 Adriana Ave
FEE
DATE: 02/26/2015
REVIEWED BY: Sean
APN:
BP#: J` j a ���U
'VALUATION: 1$20,000
PERMIT TYPE: Building Permit
Elea Insp. 0.0 hrs $48.00
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Duplex
USE:
$0.00
PENTAMATION 1 R3SFDREM
I PERMIT TYPE:
WORK
To Clear Code Enforcement Case: Kitchen remodel 132 sq ft); Remodel 2 bathrooms 145 sq ft);
SCOPE
Remove/replace (12) lights; Remove/replace (12) windows.
Permit Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Di.ctrirt_ etc). These fees are haled on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef" 7/1/13)
FEE
QTY/FEE
Elec. Plan Check 0.0 1 hrs $0.00
. t.
Elec. Permit Fee: IEPERMIT
F-1-457 s.f.
$645.00
LiOther
Elea Insp. 0.0 hrs $48.00
Ii_.
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>>"
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Di.ctrirt_ etc). These fees are haled on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef" 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F-1-457 s.f.
$645.00
Remodel, Bath (<=300 sf)
IREMRESBAT 1.
Suppl. PC Fee: 0 Reg. OT
FO.07
hrs
$0.00
PME Plan Check:
$0.00
132 1 s.f.
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Permit Fee:
$0.00
Suppl. Insp. Fee.e Reg. Q OT
0.0
hrs
$0.00
12 # Window / Sliding Glass Door
$574.00 I WINREP Replacement
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
=# Electrical
$48.00 IBREMRECEP Recep/Switch/Outlets
?t
Administrative Fee: ]ADMIN
$45.00
E)
Work Without Permit? E) Yes 0 No
$1,960.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$2.60
Select an Administrative Item
Bldy, Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2,104.601$1,912.00
TOTAL FEE:
$4, 016.60
Revised: 02/14/2015
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 10 IA Avc
PERMIT # 1jrC ZO 1
OWNER'S NAME: MSC
PHONE # p —'� ®® C1M\
GENERAL CONTRACTOR: NIR CT 0 A/
BUSINESS LICENSE # �
ADDRESS: I060cyt/j ,S"% /a -214 wetlgri,,
CITY/ZIPCODE: CUl eJ-,A els
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU ONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. _
4 I am not using any subcontractors.
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
-
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
N'
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date
ADDITIONAL CODE REQUIRMENTS
Energy code mandatory lighting measures:.
1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy
luminaires. (150(k)(7))
2. Permanently installed lighting in Kitchens shall be high efficacy luminaires, Up to 50% of the
wattage of permanently installed lighting in kitchens may be in lights that are not high efficacy.
(150(k)(8))
3. Permanently installed luminaires in bathrooms, garages, laundry rooms and utility rooms shall be
high efficacy luminaires OR are controlled by an occupant sensor(s) certified to comply with Section
119 that does not turn on automatically or have an always on option.. (150(k)(10))
Plumbing elan notes:
4. Water closets shall have an average water consumption of not more than 1.28 gallons per flush. (CPC
403.2)
5. Shower heads shall have a water flow not to exceed 2.0 gallons per minute @ 80 psi. (CPC 408.2)
6. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 1.8
gallons per minute @ 60 psi. (CPC 403.6)
7. Shower stalls shall have a clear interior finish area of 7.1 sq. ft. 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 above shower drain. (CPC 408.6)
8. Shower compartments and walls above bathtubs with installed shower heads shall be finished with a
smooth, nonabsorbent surface to a height not less than 72 inches (6 ft). (CRC R3Q7
9. The maximum hot water temperature discharging from the bathtub, shower 1 thtub
filler shall be limited to 120 degrees Fahrenheit. i
e #M.,
t s 1 be c nsidered
a control for meeting this provision. (CPC 409.4
10. A 30 -inch clear width for water closet compartme in front of water closet.
(CPC 402.5)
Electrical Plan Notes:
11. The installation of smoke alarms in all of the following areas shall be provided: (CRC 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.
12. The installation of carbon monoxide alarms in the following areas shall be provided: (CRC R315.1)
a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in
the immediate vicinity of the bedrooms and on every level including basements in dwelling
units that have fuel -fired appliances or attached garages.
13. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets
in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1))
14. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such
circuits shall have no other outlets. (CEC 210.11(C)(3))
15. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines,
dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units, built-in heaters or
any other fixed appliance with a motor of/4 h.p. or larger shall be on a separate 20 amp. branch
circuit.
16. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished
basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar sinks
(within 6 feet of the edge of the sink), shall have ground -fault circuit interrupter (GFCI) protection.
(CEC 210.8(A))
17. In all areas specified in 210.52, all non-locking type 125 -volt, 15- and 20- ampere receptacles shall be
listed tamper-resistant receptacles. (CEC 406.12)
ResKitBathPolicy_2014.doc revised 01/15/14
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