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B-2017-0731CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0731 20875 FARGO DR CUPERTINO, CA 95014-1805 (326 30 134) AMERICAN KITCHEN & BATH INC SAN JOSE, CA 95112 OWNER'S NAME: MITCHELL TIMOTHY AND KATHLEEN P TRUSTEE DATE ISSUED: 05/08/2017 OWNER'S PHONE: 408-529-4529 PHONE NO: (408) 436-8151 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class EJ Lic. #513838 Contractor AMERICAN KITCHEN & BATH INC Date 04/30/2019 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: KITCHEN REMODEL (121 S.F.) 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. C2. 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: $48300.00 permit is issued. APPLICANT CERTIFICATION 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 ordinances 326 30 134 326 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 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 Date 5/8/2017 Issued by: AblZyAygnde 171- DECLARATION Date: 05/08/2017 OWNER -BUILDER I hereby affirm that I am exempt from the Contractor's License Law for one of the RF -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 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: 5/8/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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. 2. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. 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. l7gJtler or authorized agent: APPLICANT CERTIFICATION Date: 5/8/2017 1 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 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 a DECLARATION ARCHITECT'S be used I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 5/8/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-333-1, building(n-)— —tinn Drg CUPERTINO I - 91_ � L���_ 0q51 PROJECT CONSTRUCTION [:1 ADDITION ALTERATION / TI [:1 REVISION /DEFERRED ORIGINAL PERMIT # J PROJECT ADDRESS ` , ^ APN # �(! CJ � � `t 11L OWNER NAME r PHONE ' E STREET ADDRESS CITY STATE, ZIP ` f�1 J[� ` FAX CONTACT NAME PHONE E-MAIL 1 S STREET ADDRESS CITY, STATE, ZIP �J'c1 sSi/ F u ati r ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LI NSE LICE E TYPE BUS. C # . c rice.,, , �,� t z —NUM -BE / :516 COMPANY NAME E-MAIL d Fg ; `�� 3��—Z`� Qceme�icctu+tc�te>7cr STREET ADDRESS ` CITY, ST TE, ZIP I 'Z PHO Lid �F36T i S i --T& � % �r i116< -A ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK / / )e, / de' l r --s, >> /� P ;o EXISTING USE PROPOSED USE ONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA// ) 40 -1 - REMODEL AREA PORCH PORCH AREA DECK AREA TOTAL AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: ISA SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RECEIVED BY: TOTgkL VALUATION. Iii WA V By my signature below, I certify to each of the following: I am the property owner or authorized agent tb act on thl 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 build' n onstruction/.�,I authorize rrese ves of Cupertino to enter the above-ide 'fie property for inspection purposes. Signature of Applicant/Agent: /�`/ Date: % SUPPLEMENTAL INFORMATION REQ RED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN 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 ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 115 CUPERTINO PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED, SIGNED, AND RETURNED TO THE BUILDING DIVISION This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314, R315,2016 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, 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: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door) X X On every level of a dwelling unit including basements and habitable attics X X Within each sleeping 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 Fire 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 R314 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 specified below have been tested and are operational, as of the date signed below.Z Address: �d9Z SfXW �4 C4(Permit Nob 'eb I Specify Number of Alarms: # Smoke Alarms # Carbon Monoxide Detectors: t have read and agree to co4ly with t_4e ter s and conditions of this statement Owner (or Owner Agent's) Name: Tf /% MSi nature ........ . .. . . ................................................................. Date:................... Contractor Name.-�f 7�� ry~tel �`y"'V�" Signature.................................................................... Lic.#........................................ Date:................... Smoke and COform.doc revised 01/10/2017 CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin4(5cupertino.org () .. � I _ ,, s Yi-J 1-1 Address 2091 TAP& 9R' Cg,0-7z01)0 A 95P 10 FIL llqtm�llja 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1.101.8 do not apply. Skip the rest of the form and sign bottom of form. ;K 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? ❑ 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 form and sign bottom of form. L No 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. gNo 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 fonn. tK 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 fon-n., Please check ONE of the following: A 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 nnprovements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or irnprovernents 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 c0717777ercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvernents shall require non- compliant plumbing fixtures to be replaced Nvith 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). 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 1101.1 through 1101.8, the current California Plumbing Code Ad California Green Building Standards Code, and manufacturer's installation requirements, and that the�a ate Conserv' plumbing fixtures comply with the requirements as indicated in the table on the following nage. Owner or Owner Agent's Signature: �/�//�///Y/,(/( Date: 1-1/' 14_ I Upon completing and signing this Certifrc please return it to the Building Division in order to final your building permit. SB40 7 2015. doc remised 01/05117 MITCHELL EXISTING 20875 FARG O DR. CUPERTINO, CA 95014 2 �4�3 2W3636� 2 &i Pe -L N m U F1. DB15 2B36RT 3DB) 1. ASSS 3 �- .. W c>------------------------------------------------------------------------- �m N r •- W N Lam' E>_c. ,. a4 N sf =t N- D ;3zON CdPERTNO m � W (� \ APPROVED 0 6 cat-- _ EY i� �. - 1 N Ir 'i �T.. = . v _________ _________ GJ ! m j 4-144-F N e - ��lt S 3DM All dimensions size designations MITCHELL This is an original design and must Designed: 5/8/2017 given are to verification on not be released or copied unless Printed: 5/8/2017 job site antm" j ` applicable fee has been paid or job conditions \ uisding Department order placed. Permit EXi TIl?i, r�kit All Drawing #: 1 No Scale. MITCHELL PROPOSED 20875 FARGO DR. CUPERTINO, CA 95014 All dimensions _size designations given areto veri{'ic_ation on job site an tm conditions \ ui'ding Department t Permit.kit. LIKE FOR LIKE KITCHEN REMODEL CABIN ETS/COUNTERS/FLOORI NG ALL LIGHTING WILL BE HIGH EFFICIENT ALL PLUMBING WILL BE CODE COMPLIANT HOOD WILL BE ON REQUIRED 6" DUCT ' NO WALLS/WINDOWS/DOORS RELOCATED/REMOVED MITCHELL This is an original design and must not be released or copied unless applicable fee has been paid or job order placed. All Designed: 5/8/2017 Printed: 5/8/2017 #: 1 I No Scale.