B-2017-1036CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1036
22724 MAJESTIC OAK WAY CUPERTINO, CA 95014-5614 (342 32 124) BUMBLEBEE HOME
SERVICES GROUP INC
SAN JOSE, CA 95132
OWNER'S NAME: FURUSHO JOAN K
OWNER'S PHONE: 650-969-1049
1111 Lai _31911104 IXGLIM111 I J"Me"IMM11314
t; Il
License Class 5 Lic. #1022093
Contractor BUMBLEBEE HOME SERVICES GROUP INC Date 12/31/2018
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.
9 t� 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 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 upertino Municipal Code, Section 9.18.
Signature Date 6/29/2017
OWNER-BLI7LDER DECLARATION
DATE ISSUED: 06/29/2017
PHONE NO: (408) 726-2115
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
MASTER BEDROOM AND HALLWAY BATHROOM REMODEL (90
S.F.); REPLACE WINDOW (6) - LIKE FOR LIKE TO MEET EGRESS
Sq. Ft Floor Area: I Valuation: $18000.00
APN Number: Occupancy Type:
34232 124
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby Avende
Date: 06/29/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF -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
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.
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.
1 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 6/29/2017
Signature of Applicant:
Date: 6/29/2017
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 the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Section 05, 25533, and 25534.
Owner or authorized agent:
Date: 6/29/2017
CONSTRUCTION LENDING 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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
T) -2o r� - vn3
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinoacupertino.oro
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT
PROJECT ADDRESS 2 21 ,2 -Lf qJe_ C_ o ftv W " APN #
OWNER NAME
PHONE LE -
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STREET ADDr4SCI STATE ZIP FAX
COhTACs PHONE
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STREET ADDRESSCITY, STATE, ZIP FAX
D I &UC-Erl COGSS / �( fes- Q_— JF CA Cl �
❑ OWNER ❑ OV,'NER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CO�UA� 1 LIC EJt�ER^n LICE E TYPE HUS. LIC # Zo 3� �.
COMPANY NAME' N / E LULU FAX
U
STREET AD RESS CIThY �ST� TE, ZIP PHONE
VCR d�Sl ►.1 D12— U "bg:F CA . cJ S 13 2- 0;11 12(-- 211
ARCHITECT/ENGHN'EER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK
add c f VJ VV6(-0 W S
EXISTING USE PROPOSED USE CONSTR TYPE I # STORIES
USE TYPE OCC. SQ.FT. VALUATION (S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODEL AREA REMODEL AREA
PORCH AREA ECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS IS A SECOND UNU ❑ YES SECOND STORY ❑ YES
BEING ADDED? NO ADDITION? NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESCEIVED BY TOTAL VALUATION:
PLANNLNG APPL # [:]NO PLANNING APPROVAL LETTER EICHLER HOME? El NO
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 providpddscorrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relate ilding ons ction. I authorize representatives of Cupertino to enter the above -identified prperty for inspection purposes.
Signature of Applicant/Aeent: Date: `(
SUPPLEMENTt Ilv ION REQUIRED
PLANCHECKTYPE -. r ROUTINGSLIP -
New SFD or Multifamily dwellings: Apply for demolition permit for 0 OVER-THE-COUNTER _ ❑ BuirDL�GPLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑. EREss ❑ PLAh'NINGPLANRE�TEw
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAA'DARD" : , ❑' PI BLIc,RORt
form if any Hazardous Materials are being used as part of this project. L4RGE ❑ FIRE
DEPT,
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
�❑ MAJOR ❑''S4hITARISE�6ERDISTRICT
❑:. ENVIRONMENtA IltALTE
BldgApp_2011.doc revised 06/21/11
IsEq-211111111
PURPOSE
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
I 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.
Address: Z Lf ti{i L O W4L hK_6 Permit No. 02-00— RC13 C.
Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: 7
7771
I have read and aaree to comoly with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature............................................................................................................ Date:...................
Contractor
)Name: j
Signatur��... .................................................. Lic.# ........... Date: 7.6 ..
11
Smoke and COfortn.doc revised 0111012017
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPER'TINO, CA 95014-3255
408) 777-3228 • FAX (408) 777-3333 -; building(a.cupertino.org
Owner Name ��SIfTJ Permit No. i;,2 -c n — U
Address �`Z�%`Z� F f"� t'� �'tC oak ..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.
P 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.
El The licensed plumber's certification has been provided to the Building Division.
Skip the rest of,the form and sign bottom of form.
?-No Go to Question 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.
i� No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
El 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 forin and sign bottom of form.
�F 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. Please check ONE of the following:
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 improvements).
❑ My property is a multifamily 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-
conseiving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
❑ My 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
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 iunprovements).
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 and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the following pate. i l
IOwner or Owner Agent's Signature:' I LLz ( & X-)__
Upon completing and signing this Certi Cate; pease r&11
jn it to the Building Division in order to final your building permit.
SB407 2015. doe revised 01105117