B-2017-0342CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0342
10983 NORTHSKY SQ CUPERTINO, CA 95014 (316 40 042)
EKIM PAINTING -
NORTH INC
CUPERTINO, CA 95014
OWNER'S NAME: SMITH EVELYN K H AND ROBERT L ET AL
DATE ISSUED: 03/01/2017
OWNER'S PHONE: 408-529-2764
PHONE NO: (408) 996-3897
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lia #623665
Contractor SKIM PAINTING - NORTH INC Date 07/31/2017
X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RESIDENTIAL COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION: .
BALCONY REPAIR AND REBUILD GUARD RAIL TO CODE
I hereby affirm under penalty of perjury one of the following two declarations:
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.
W-2. I have and will maintain Worker's Compensation Insurance, asp rovided for by
r Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $2000.00
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 40 042
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.
`7r fjTIiIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source reguulationsper the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
J -d"
SignatureDate 03/01/2017
�4A)
Issued by: Kim Dunbar
}J
OWNER -BUDDER DECLARATION
Date: 03/01/2017
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: 03/01/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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 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, *ctions 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
'
be deemed revoked.
Owner or authorized agent;
APPLICANT CERTIFICATION
Date: 03/01/2017 9
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
CONSTRUCTION LENDING AGENCY
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,
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
ARCHITECT'S DECLARATION
Code, Section 9.18.
I understand my plans shall be usseded as public records.
Licensed
Signature Date 03/01/2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(G cupertino.org
Q NEW CONSTRUCTION Q ADDITION " Q ALTERATION / Ti Q REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10983 Northsky Square, Cupertino, CA
APN# 2)k(e (.10 ()QL
OWNERNAME
Evie Halvorsen Smith
PHONE
I (408) 529-2764
E-MAIL
eviekg@aol.com
STREET ADDRESS Same
CITY, STATE, ZIP Cupertino, CA 95014
FAX
CONTACT NAME Butch Brisbin
PHONE (408) 996-3897
E-MAIL ektmconstructlon@gmall.com
STREET ADDRESS 10200 Imperial Ave
CITY,STATE, ZIP Cupertino, CA 95014
FAX (408) 996-3897
0 OWNER 0 OWNER -BUILDER" I] OWNER AGENT a CONTRACTOR 13 CONTRACTOR AGENT 0 ARCHITECT ENGINEER 0 DEVELOPER TENANT
CONTRACTOR NAME Eklm Painting - North, Inc LICENSENUMBER 623665 LICENSE TYPE C33 B BUS. LIC # 6197
COMPANY NAME E-MAIL FAX
Eklm Painting - North, Inc ekimconstruction@gmail.com (408) 253-9527
STRBETADDRESS10200 Imperial Ave cITY,sTATE,zIP Cupertino, CA 95014 PHONE (408) 996-3897
ARCHITECTIENGINEER NAME LICENSE Nut IBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF }YORK Like for like exterior construction repairs; to include balcony repairs and complete rebuild of
balcony rail to bring up to current building codes.
EXISTINGUSE - PROPOSED USE CONSTR. TYPE
'"STORIES
residence same 2 USE TYPE 'OCC. SQ.FT. VALUATIO144(S)
EXISTG NEW FLOOR DEMO ! TOTAL
AREA AREA n/a AREA NET AREA
BATHROOM KITCHEN OTHER _
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA, TOTALDECKIPORCHAREA I GARAGE AREA:DETACH
ATTACH
DWELLING UNITS, IS A SECOND UNIT, DYES SECOYDSTORY "DYES
BEING ADDED? ®NO ADDITION? ®NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN E] YES ' RECEIVED BYI TO AL VALUATION:
.PLANNNGAPPL# ONO PLANNING APPROVAL LETTER EICHLERHOME? ®NO
By my signature below, I certify to each of the following: la m "the property owner or authorized agent to a t on the property oivner's behalf. 'I have read this
application and the informations 1� a 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 relati' g to nilding co n. I a ho ize representatives of Cupertino to enter the `ab9v-identified®property for inspection putposes.
Signature of Applicant/Agent. - Date:
6
suPPLEmWTAL INFORMATION REQUIRED PLAN CHECICTYPE ROUTPNGSLiP "
_New SFD or Multifamily dwellings: ,Apply for demolition permitfor ❑ OVER -THE COUNTER ❑" BUILDLVGPLAN ]REVIEW "
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS . - PLAN "i GPLAPIR.EViE�v
_ Connnercial Bldgs: Provide a completed Hazardous Materials Disclosure. ❑ STANDARD ❑ PUBLICWORKS
form if any Hazardous Materials are being used as part of this pioiect, ❑ LARGE 0 FIRE DEP! .
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR SANITARY SEwERDISTRICT
submittal of Building Pennit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 201 Ldoc revised 06121/11
I WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMIUNITY DEVELOPMENT DEPAI?TI:'ENT • BUILDING DIVISION
CUPERTINO 1.)300 TORRE AVENUE -CUP ER-11NO, C;; 55C1a-3255
(408) 777-3228 • FAX 77-3333 r i�r!c tae w gar<_�
Q�� Pt nritio.N/y
Address I o I D 1 V L�(`T f1 (/1 ��t l_ATr?� 1 'L4 rV l (l,0 1:
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.
0(i 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?
D 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 four and sign bottom of form.
IS No Go to Question 3.
3. 1s water service permanently disconnected for your buildint*?
❑ 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?
C] NNO My real property is built and available for use w occupancy after January 1, 1994.
Civii Code Sections 1101.1 through 1101.8 do not apply. Skip the test of the form and sign bottom of'fornn.
X Yes My real property is built and available fen use or oCi:upancy on or before January 1, 1994.
Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
Please check ONE of the following:
My property is a single-family residential real property. See Civil Code Section 1101.4.
On ar;d after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing Fixtures
to be replaced Nwith 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).
I l My property is a multifamily residential real property. See Civil Code Section 1101.5
Cin and after January 1, 2014, specified building alterations or improvements shall require non- compliant.
plumbing fixtures to be replaced with .eater -conserving plumbing fixtures.
On or before January 1, 2019, all non-counpliant plumbing fixtures shall be replaced with %vater-
conserving plumbing fixtures throughout the buildint; (regardless of w}ncther property undergoes alterations or
improvements).
❑ 'Ay 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
plurnbirig fixtures to be replaced with water -conserving plumbing fixtures.
Cin or before January 1. 2019, all non-compiiant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures tluoughout the building (regardless of vwhether property undergoes alterations or irnproveincnts).
1, as the owner or owner's agent of this property, certify under penalty of perjure that non-compliant plumbing fixtures Nvi11 be
replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1 101.1
through 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fxtt es comply with the requirements as indicated in the
table on the following page_
Owner or Owner Agent's Signature: 11 "V-547 -- _L Date: _-J /,-)- (
r_ pon completing and signinthis Certificate, please return it to the Building Division in order to tinal your building permit.
S'Rw(17 X11 S.�roc re�i red U� _'G/15
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
1 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building(dcupertino.org
Permit No.'�®��
Address
PERMIT CANNOT BE FAA—LED AND COMPLETED UNTIL THIS CERT]
HAS BEEN SIGNEftAND RETURNED TO THE BVILDIN,C DIVISI(
PURPOSE
This affidavit is a self -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
$1000.00, 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 in-cmediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each slee ing 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 Dire 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 8314 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 have been tested and are operational, as of the date signed
below.
1 have read and agree to comply with the terms and conditions of this statement
�1eweer (ar Ow er Agent'ss) NNanmec�,�'
,........................
......... Date:
Contractor Name:
Sinature........_....................................................Licl._........._..........._............Date:...................
Smoke and COjorvn.doc revised 03/18/14