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B-2017-0669I CITY OF CUPERTINO BUILDING PERMIT I :,DING ADDRESS: 7 CRAIG CT CUPERTINO, CA 95014-2912 (359 15 014) OWNER'S NAME: HAVILAND JOHN L AND MARILYNNE E TRUSTEE OWNER'S PHONE: 408-497-7521 LICENSED CONTRACTOR'S DECLARATION License Class _Q -M Lic. #390359 Contractor JONES MASONRY Date 05/31/2018 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: 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. 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. 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 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 td save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, th applicant understands and will comply with all non -point source regula o per the Cupertino Municipal Code, Section 9.18. YSignature Date 04/28/2017 ECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. z. 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. 3. 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, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 04/28/2017 CONTRACTOR: PERMIT NO: B-2017-0669 JONES MASONRY SAN JOSE, CA 95154 DATE ISSUED: 04/28/2017 PHONE NO: (408) 377-7512 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: CHIMNEY REPAIR FROM SHOULDERS Sq. Ft Floor Area: Valuation: $4200.00 APN Number: Occupancy Type: 359 15 014 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar RE -ROOFS: 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. Signature of Applicant: Date: 04/28/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with theupertino Municipal Code, Chapter 9.12 and the Health & Safety Co e, Sections 25505, 25533, and 25534. Owner or authorized agent:_ Date: 04/28/2017 CONS CTION LENiQG AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARC HITECT'S .CT'DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 •.buildina(a)cupertino.ora ❑NEW CONSTRUCTION n ADDITTnN 1 I AT TF ^ I I RFVTCThT.T I nTZrrDDVn nvir1TXTAT na—T— PROJECT ADDRESS OWNER NAME .�-- PHONE E Ma STREET ADDRESS CITY, STATE, ZIP FAX �a CONTACT NAME P O ,,!! E- 1f" T 'IVp4 t STREETADDRESS yO TATE, ZIP Irs FAX •� ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME C LIC 5 ER LICE SE TYPE BUS IC # COMPANY NAME E MAII F f W STREET ADDRESS CITYTE, ZIP A co O ARCHITECTIENGINEER NAMELICENSE NUMBER BUS. LIC # COMPANY NAME 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 (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? [:]NO ADDTTION? [:]NO PRE•APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RE D T VALUATION• 7 PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO ('J^� By my signature below, I certify to each of the following: I 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 prow}de ect. 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 }Suildin ons I authorize representatives of Cupertino to enter abo above -identified property for inspection purposes. Signature of Applicant/Agent:. -" Date SUPPLEMENTALINI(uUl IA11v✓ ;QiJIItED ROUTINGSLIP PLAN CHECK TYPE .: _ New SFD or Multifamily dwellings: Apply for demolition permit for L] ovER-rai COTrrizER BTJILDII+rGPLAN iiEVIEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. �, EXPxEss �. PLAN NINGPLANREVIEVP..' _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E STANDARD ElPUBLIC WORKS ' form if any Hazardous Materials are being used as part of this project. E LARGE FIRE DEPT ' _ Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR s iNITAItYBEwERDISTRICT - -- submittal of Building Permit application. © ENVIRONMENTALHEALTH BldgApp 2011.doc revised 06/21/11 SMOKE I CARBON MONOXIDN6PLI�AN CSOWNER CERTIFICAT E OF CO COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 0300 TORRE AVENUE. CUPERTINO, CA 95014-3255 cuQerij,no-019 - FAX 408) 777-333*3 u!Id!nq@ (408) 777-3228 FILE -1-: CabonmOOke andPURPOSE the installation Ofall required Sm -re no interioraccess This affidavit is a self-certificatiOn for 2016 CBC Sections 4�?0.6 and 90.2-whe compliance with 2016 CRC Section 8314; 8315' for inspections are required, GENERAL INFORMATION dwellings shall be provided with Spoke Alarms and Carbon dwellincr units exceeds must' amily S, or repairs existing 0 ,tin, single-family and m'-" alteration Smoke Alarms and/or Existing . When the valuation of additions, Monoxide alarms R31Called , and CBC Sections 907.2-11.5 and 420.6 require that $1000.00, CRC Section 8314, e Alarms be insin the followinot'locations'. Carbon MOr'Ox'd S oj:� 'M l�CO�AAI�," I A X AREA a area ill the immediate vicinity of the om door) Outside of `each separate sleep" t, not be located withiand 3 feet of bathro X X (smoke alarms shall n tab . le attics bedroom(s) - ,it includin',b aserrerls and hab' X 0-a every leve of a dwellincgT) ------- Within each -burnincy appliances and that Ln's W11: ch CIO not contain fuel -red in dwellings -1, Carbon Monoxide alarms are not required alarms combined with sn-Lo ce alarms Shan comply With an attached garage- Carbon 'Fire Marshal - do not have Z:) n d by the office of the State CBC Section 420.6 and shall be approve. _ - alarm(s) may be solely battery operated. �, units with no commercial power supply, alterations do Power Supply' in dwelling be solely battery operated where repairs Or alt permitted to 'basement Or claw' alarms are . no access by melm of attic, In existing dwelling Unl and celino. finishes or there is cal -peryrtit is required for removal of wall 0.6-2. Anectri not result in the r Sections 907.2-11.4 and 42 space. Refer to CRC Section F314 and,CBC alarms which must be connected to the building wiring• the alarm(s) ref erenced above hash been property, I hereby certify that compliance with the California Building As owner of the above -referenced pro facturer's instructions and in cOrnP ed and are ope"ratiolaal, as of the -,,7jth thenianti installed in accordance . ai codes. The alarms specified below have . been test -da Resident' V0 t .0. 2a ,d Calif orr Perm! v. date sioned below- -�oe r � 0- C- -t I !� -r-"- �—� # Caiboi, MO-1-10--i—d-Detectors: A,ddress'. —LIP -h " Smoke Alarms: with the terms and conditions of this st,temen Specify Number of Alarms: I have read and agree to pates f i Name: ........... oviner (of Owner Agent's) .......-*...................... .... Date* . ................. 4 Uc.# .................. I .......... Contracetorarne— Signature ........ * ............................. I ........................... — revised 01/1012 '0 1: Smoke and coforndoc CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUP.ERTINO, CA 95014-3255 (� (408) 777-3228 - FAX (408) 777-3333 - building(_ cupertino.ora r 2� r �1 66 - 6 ✓' i '1 -I (c o Permit No. CJ f Address ®6 c�G 2 50 C �� 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. 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? 11" s Civil Code Sections 110 1. 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. ❑ NTo Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ,,,ZNo Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ 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. PI se check ONE of the following:. My property is a single fmnily 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). 0 My property is a nxultifaMily 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). ❑ My property is a conunercial 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 plutmbing 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 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-coiAeiving plumbing fixtures comply with the requirements as indicated in the table on the following Uasze. Owner or Owner Agent's Signature: 114 Date: _-,.) f ( 4 114-- ' Upon completing and signing this Certific e, please r6fam it to the uilding Division in order to final your building permit. SB40 7 2015. doe revised 01/05117