B-2017-1112CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-1112
20729 GARDEN CREST CT CUPERTINO, CA 95014-5056 (362 30 057)
DONE RIGHT HOME
REMODELING INC
SANTA CLARA, CA
95050
OWNER'S NAME: NELSON ATSUKO T TRUSTEE & ET AL
DATE ISSUED: 07/11/2017
OWNER'S PHONE: 408-504-3773
PHONE NO: (800) 816-0000
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class $ Lic. #1002689
Contractor DONE RIGHT HOME REMODELING 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 (200 SF)
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.
�2.
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: $8000.00
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
and state laws relating to building construction, and hereby authorize
36230 057
362
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.
Signatur Date 07-11-2017
Issued by: Kim Dunbar
OWNER DECLARATION
Date: 07/ 11 /2017
-BUILDER
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:
1. I, as owner of the property, or my employees with wages as their sole
installed without fust 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: 07-11-2017
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
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
s. 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,ons 2550 , 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPL.ICANT CERTIFICATION
Date: 07-11-2017
f�L[NG
I certify that I have read this application and state that the above information is
AGENCY
CON TRUCTION
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.
Licensed
Signature Date 07-11-2017
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO I (408) 777-3228 • FAX (408) 777-3333 • building cu ertino.OM 11
❑ NEW CONSTRUCTION ❑ ADDITION E ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS ao a P r�e Y -,C r -e S�
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR It `CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANI
CONTRACTOR NAME
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ARCHITECT/ENGINEER NAME
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BUS. LIC #
COMPANY NAME
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CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK /1
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
I # STORIES
USE
TYPE
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VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA�00
REMODEL AREA
PORCH AREA
DECK AREAJTOTALDECK/PORCH
AREA
GARAGE AEA -DETACH
EA: DTAC
❑ ATTACH
#DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? []NO
ADDITION? ❑ NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
D
ION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER
EICHLER HOME? 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 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 construe ion. 1 authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFO ON REQUIRED
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
El MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06/21/11
\ F L
SMOKE / CARBON MONOXIDE ALARMSAu-05
OWNER CERTIFICATE OF COMPLIANCE
01.1, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPEiiTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinqAcupertino.orq
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED,SIGNED,AND RETURNED TO THE BUILDING DIVISION
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 immediate vicinity of X X
the bedroom(s)
On every level of a dwelling unit including basements 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 �,, �j�
Address: Os . ,2 ��� �,� ��`�" " / ° Permit No.
Specify Number of Alarms: #Smoke Alarms. I CEO I #Carbon Monoxide Detectors. I r
I have read and agree to comp! with the terms and conditions of this statement
Owner(or Owner Agent's)Name: tri
Signature . !u/.. :; C-1-4
7` Date:��p7./.
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 09/27/16
WATER-CONSERVING PLUMBING FIXTURES3 (4LO3 $jt0-
OWNER CERTIFICATE OF COMPLIANCE
4,1.64 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinci cuoertino.orq
•Owner Name � v."v ptE�V Permit No. V4-'*—
I i-
Address Xi2-91G ✓c(e Ores _ C , (ti fl'vi D , eA
PERMIT CANNOT BE FINALED AND''`COMPLETED UNTIL THIS CEl;2`TJFICATE
HAS B E.1*3 JGNED ANp RF tiiINED.; 'O`TH_ E,BUILDINGaDLVI xoN
Please refer to the attached California Civil Code Sections 1101 1—1101 8 which are part of this Certification form.
1 Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101 1 through 1101.8 do not apply Sign below and skip the rest of the form.
Owner' Signature: Date.
Ve-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.
Sign below and skip the rest of the form.
Owner' Signature: Date:
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 Sign below and skip the rest of the form.
Owner' Signature: Date.
�No Go to Question 4
� I
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 Sign below and skip the rest of the fonn.
Owner' Signature: Date:
Gr.-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 Refer to the attached.
g 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-
conserving 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
plumbmg fixtures to be replaced with water-conserving plumbing fixtures.
SB407 2014.doc revised 03/18/14