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B-2017-0696
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0696 1061 NOVEMBER DR CUPERTINO, CA 95014-4129 (362 16 013) THE RIGHT ANGLE BUILDERS INC MORGAN HILL, CA 95037 OWNER'S NAME: RIDDLE RALPH W JR AND BEVERSTEIN ROXANNE C DATE ISSUED: 05/02/2017 OWNER'S PHONE: PHONE NO: (408) 393-3943 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #891849 Contractor THE RIGHT ANGLE BUILDERS INC Date 02/28/2019 X BLDG —ELECT —PLUMB MECH X RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: 1 ST FLOOR BATHROOM (2) REMODEL - (90 SF) I hereby affirm under penalty of perjury one of the following two declarations: REV#1 CHANGE FRONT DOOR TO ORIGINAL FACING - ISSUED 06- 1. I have and will maintain a certificate of consent to self -insure for Worker's 06-2017 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 Sq. Ft Floor Area: Valuation: $65000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 362 362 16 013 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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ( Signature "1 4 Date Issued by: Kim Dunbar OWN R ILLD DECLARATION Date: 05/02/2017 -B .R I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: r. 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) z. 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: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE z. 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 material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: A_ =- � . APPLICANT CERTIFICATION Date: I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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 ARCIRTECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date Professional tC CITY_ OF CU,PERTINO BUILDING PERMIT BUILDINGADDRESS: 1061 NOVEMBER DR CUPERTINO, CA 95014-4129 (362 16 013) CONTRACTOR: THE RIGHT ANGLE PERMIT NO: B-2017-0696 BUILDERS INC MORGAN HILL, CA 95037 OWNER'S NAME: RIDDLE RALPH W JR AND BEVERSTEIN ROXANNE C DATE ISSUED: 05/02/2017 OWNER'S PHONE: 408-2575939 PHONE NO: (408) 393-3943 LICENSED CONTRACIOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic. #891649 Contractor THE RIGHT ANGLE BUILDERS IN Date 02/28/2019 XBLDG —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: I hereby affirm under penalty of perjury one of the following two declarations: 1 ST FLOOR BATHROOM (2) REMODEL - (90 SF) 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. 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. Sq. Ft Floor Area: Valuation: $65000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above ATN Number::- Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 36216 013 " 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-pointint WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18., 180 DAYS FROM LAST CALLED INSPECTION. Signature,' :' Date 05/02/2017 Issued by: Kim Dunbar i Date: 05!02/2017 .4..:, OWNER -BUILDER DECLA ATION 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. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Scc.7044, Business & Professions Code). Date: 05/02/2017 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 1 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 Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I 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, Sections 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: 05/02/2017 ` I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 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. 1 understand my plans shall be used as public records. Signature Date 05/02/2017 Licensed Professional ❑ NEW CONSTRUCTTOW CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENTS DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUP�RTINO, CA 95014-3255 (40y8-)777-3228 • FAX ({408) 777-3333 • buiidincupertino.ara�, i I A}ITITTrfIAT IX 1 AT mc'n .w mrr�ar r mr 1� � /� �r) u icc vratviS r Tiri CttiCCll UMUINAL FERNIIT # PRO.IECT ADDRESS APN# } � `1 L t OVMRNAME PHONE E -DAA -IL STREET ADDRESSI ID N, Fll./-U U11 I) MIDIt l CITY STA ZIP A I TO L_ FAX CONTACT NANIE i ` i Cts 1 PHONE � EI 3 q � E_MAII r �t �- 'e' 0 1 cc k It%1!h STREET ADDRESS CITY, STATE ZIP t4LC FAX ❑ OWNER ❑ OWNER BUILDER ❑ OWNER AGENTI CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT R,NAME ALC' A t d v L LICENUIyIB LICENSE TYPE BUS. LIC # COMPANY NAME pp � E-�II� J FAX STREET ADDRESSE¢' VL^( �d Y, STATEZIP L�L( CA I �) L+' J PHO NE VI (Y 1� � 1 J 1 1 4 3 ARCHnECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE w PROPOSED USE CONSTR. 00j�`tv' TYPE # STORIES i USE TYPE OCC. SQ.FT. VALUATION{$} EXISTG NEW FLOOR DEMO TOTAL, AREA AREA AREA NET AREA BATHROOM KI'T'CHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? IRNO ADDITION? OVO PRE APPLICATION OYES IF YES, PROVIDE COPY IS THE S RE E D Y, - --' T V TION: PLANNING APDL # []NO PLANNING APPROVAL LETTER E EICHI ER RHOME HOME? O PC By my signature below, I certify to each of the following: i am the property owner or orized agent to act on the property 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: A`t— Date: SUPPLEMENTAL INFORMATION REQUIRED; PLAN CHECK TYPE- RouTTivGslsr ❑ OVER-THE-COUNTER ❑ Bun nlNGrr AN REVIEW 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 Yi.ATVNuvG PLaKiu VIEW . _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure [] STANDARD ❑ PUBLIC WORIKS form if any Hazardous Materials are being used as part of this project. i ❑ LARGE. ❑ FHtE'DEPT Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. ❑ MAJOR ❑ SANITARY sY wER DISTRICT ❑ ENVIRONMENTA L MALTA BldgApp 2011.doc revised 06/21111 CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 • Fax (408) 253-5173 SANITARY DISTRICT PERMIT I FFER Cupertino Sanitary District has adopted Resolution No. 1263. Building Permit Request (Over -the -Counter) iU Single Family Project ❑' Multi -Family Project ❑ Commercial Project Project Address: �( (� l+ N 'QeA^,& Permit Number:co q Scope of Work:��©dam, Owner/Applicant Name: -A-16\(\ P lc&o--t Address:3*-� 1 Date: Prepared By: Phone: L-10 I 'v e� City Authorized Representative 1, as property owner or authorized agent,' acknowledge that all Cupertino Sanitary District requirements will be met and all required fees will be paid prior to the approval of final inspection for proposed project. Date: Signature: t -e— Owner / Authorized Anent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY Pre -inspection Required Final Inspection Required Date Scheduled: Date: Conditioqal Approval By: Authorized Representative Cupertino Sanitary District District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc City of Cupertino. Inspection Fee Paid Date Paid: _2 — 1—1 Inspe tion Fees: $250/unit - Single Family Residential already connected, but new cleanout is required $150/unit - Single Family Residential already connected with existing cleanout in working order D $350 Minimum — Commercial and Retail Actual Amount: L� $200/each — Disconnect and/or abandon lateral service Connection Permit Fees: $350/unit - Single Family Residential connecting to existing lateral C� $650/unit — Single Family Residential connecting with new lateral C� $100/unit — Multi, Hotel, Living Units, etc. Actual Amount: [� $500/connection - Commercial and Retail Actual Amount: Connection Use Fees (See Attached Calculation Sheet): D Area and Frontage Fees Amount: 0 Residential Excess Fees over 3.5 unit/acre Amount: C� Commercial and Retail Connectiori; Fees Amount: D Commercial and Retail Change in Use Fees Amount: Date: — 2 ! 1-7 Final Approval By: - 5;7' Authorized Repre tative Cupertino Sanitary District I i SMOKE / CARBON MONOXIDE ALARMS (IP OWNER CERTIFICATE OF COMPLIANCE { COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION •4_ ii 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 408 777-3333•buiidingCa�cupertino.org t CUPERTINO (408)777 3228 FM( } j _ PEtMT,S NOTBEF)T,ANED T--NQ--Er�- CEItI._.FICATEHAS BEEN= = L . '," 7f - - . Y p, 'LFEIgSG RtilOTH3 D' lIC ISO\ . k , ,. --4,1-- ''''''7,',4'44",74 ::',7': ,, : ,l de PURPOSE for the installation of all required Smoke and Carbon Whore xinintenor Alarms for access com Bance is a self ceRCiSectio comphan ce with 2016 CRC Section 8314.8315,2016 CBC Sections 420 6 and 907._ for inspections are required. GENERAL INFORMATION Misting single-family and dwellings shall be provided with Smoke oke Alarms and Carbon on Monoxide alarms. When the valuation of additions, alterations,or repairs existing dwelling s exceeds $1000.00,CRC Section R314,R315, 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' SMOKE ALARM CO ALARM ------------- AREA X X separate sleeping area in the immediate vicinity of the I Outside of each pX X �l bedroom(s)-(Smoke alarms shall not be locatewithin feetabitable attics door) X 1 b g unit including basements On every level e a dwelling Within each slee•in�room required 1111111111111 in dwellings which do not contain fuel-burning halllcomcesy that dor not have an Monoxide alarms are not an attached garage. Carbon monoxide ceaef the StateFire with Marshal. do not by the Of CBC Section 420 6 and shall be approvedalmay Power Supply' In dv"''elling units with no commercial power supply, arm(s) be solely battery operated. permitted to be solely battery operated where orf mattics or rOT alterations av�'1 do Intxisting dwelling oval alarms are - n �s 907.2.114 and 420 6.2.An electncal permit is required for spt result in the removal of wall and ceiling finishes or there is no access by means space.Refer to CRC bSe coion R314 and rinected to the buildli"tb'viring alarms�uhi ch must ave been s referenced above has/have I hereby certify that the alarm(s)p p� liana-with the California Building As oiled of the above-referenced r0 cty, arms specified below have been tested and are operational,as of the installed in accordance with the manufacturer's instructions and in coin and California Residential Codes.The al P Permit No �7 -2a`� � �o _y date signed below rd kit/address E Specify Number of Alarms _ #Carbon Monoxide Dztectors NO Smoke Alarms ` i have read and agree to comply with the terms and conditions of this statement pate:aOwner(or Owner Agents)Name; �-(� �/ Si.nature Data: Ill I 4 b� .. �}G� � t fi �1�(�� pa ,�f�� Lica _ Lea CT. Contractor Name: I� T I Signature f I j �'' �c die/6 -1 Smoke and CO.f°"mdOC revised 0I/10;201