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B-2017-1383CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1383 11873 SHASTA SPRING CT CUPERTINO, CA 95014-5107 (366 55 027) HIB M CONSTRUCTION SAN JOSE, CA 95136 OWNER'S NAME: KONG SAMUEL KYANSAN AND SARAH AYE TRUSTEE DATE ISSUED: 08/18/2017 OWNER'S PHONE: 408-750-6526 PHONE NO: (408) 315-4663 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class j3 Lic. #642852 Contractor H I B M CONSTRUCTION Date 04/30/2018 X BLDG —ELECT -PLUMB MECH Y 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: REPLACE SIDING (1800 S.F.) - LIKE FOR LIKE 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 Laboi Code, for the r� rmance of the work for which this permit is issued. 2. 01 ave 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: $20000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application'and state that the abovei APN Number: Occupancy Type: information is correct. I agree to comply with all city and county, ordinances 366 55 027 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. Additionally, the applicant understands and will comply with all non=point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Pgnat Date 8/18/201 Issued by: Abby Ayende OWNER-BUILDER DECLARATION Date: 08/18/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the followingtwo reasons: RE-ROOFS.- E-ROOFS:following 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 Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 8/18/2017 I hereby affirmunder penalty of perjury one of the following three, declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. I have and will mabitaina 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; las,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 themork 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 ' ' 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, ager making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9:12 and exemptton,1I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code; I must fortjiwith comply with such provisions) or this permit shall _ be deemed revoked., , ! ner or authorized age I i APPLICANT CERTIFICATION at 8/18/2017 1 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 1 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 6HH less the City of Cupertino against'liabilities, judgments, costs;, aril expenses;wlich 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, Section9.18. 1 understand my plans shall be used as public records. Signature Date 8/18/2097 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-325512 f (408) 777-3228 • building@cupertino.or PEMIT #B -©� 1� CUPERTINO REV# DEF# F-1 NEW CONSTRUCTTON n ADDITION n ALTF.RATTON n T T n MF.P n RE -ROOF n SWIMMING POOL/SPA PROJECT ADDRESS �S C_ APN # Z:4-- OWNER AMS A t!t/-01R- \ / STREET ADDRESSY S CITY, STATE, ZIP fwd- � rr � ❑ CO NAME ❑OWN - ER CO LICENSE NUMBER LICENSE TYPE X41 �7 STREET ADDRESS CITY–STATE, ZIP E- JL LPHONE BUSS.. LIC# ❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CO OR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NA_W AIL STREET ADDRESS CITY, STATE, ZIP PHONE DECRIPTON Uv INGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED ` BATHROOM SF SF SF SF ❑ DETACHED EXISING ❑ YES EICHLER ❑ YES SECOND STORY ADDITION 11 YES FIRE SPRINKLERS El NO .NO ONO DWELLING SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER UNITS # UNU ADDITON: []NO S F POOLS1. ❑ FIBERGLASS ❑ VINYL -LINED [I GUNTTE ❑ PREFABRICATED POOL-' SF SPA - SF SPA:ATTACHED ❑ YES N NO TOTA_ L - SF RECFrWED BY: T AL VALUATION: Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP''ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGL S ❑ TT EW OTHER (SPECIFY) REMOVE /REPLACE ❑, NQ IF NO PLYWOOD ❑ lh " ❑ 3/8" PLYWOOD TYPE> PITCH: ROOF CLASS i YES I#OF LAYERS THICKNESS ❑ 5/8" OTHER ❑OSB '❑ CDX OTHER .12 A PROPOSEDROOFTYPE: ❑BUILT-UP ROOF: ❑ASPHALTSHINGLES❑WOOD SHAKES ❑WOODSHINGLES ❑OTHER *Provide a signed copy of the Cupertino•s Tear -Off Policy SF #iof SQUARES By my 'signature below l 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 cal.; ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified,,propertyi for inspection purposes. I acknowledge and authorize all information ontail;ed on this application form to be made available for public reco/ Signature of Applicant/Ag9�9 Date: SUPPLEMENTAL INFORMATIC&IEQUIRED *New SFD/Second Dwelling! Units/Mi ltifairily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter• or,Meeting with Planning prior to submittal of Building Permit application. *HOA -Provide a letter of approval from the Home Owner's Association BldgApp_2017.doe revised 08101117 6 r"l 7.12.16 cat C Seven Springs Owners Association Application for Approval of Architectural Change/Addition CATEGORY C Category C - Modifications that are exterior modifications with no changes to the original building stmcntre•or floor plan. All roofing, siding, window material change, exterior paint color change, addition of.a roof attic fan, or garage door, fall into this category. Date: hJ Request for Approval of Proposed Change I PLEASE.PRINT THE'FOLLOWING ING INFORMATION -Name: SFTiv�='(— I N �� Address: Home I'hone:,j - S 1Work Phone: email: i "A �a=L%GI `l t" fi� M �d a ,14 C? -la- ,. C 04 4 l� Description of Proposed Change: 1) Paint Color Change: Please choose from "approved list" Net E-cierirr Sitlirg Color & G<rajze doorts.i `ir=u• co<3r, Specified body color 1� . , -' Trim color: SIA ; i SS:1+F Front door color: 2);RoofingMaterial.hange(please;ch'ec on 120 a. Ligh*eight Concrete Tile from MonierLifetile - style "Cedarlite 5780', color "Muirwood" b. GAF Laminated Fiberglass Asphalt - style "Grand Canyon", color ",Mission Brown" AF Laminated Fiberglass Asphalt -style "Grand Canyon", color""Stonewood" d: Dzcra Stone Coated Steel Rood System- style "Decca Shake"; color "Shadowood" e. Class "A" Fire Retardant Roofing System using pressured treated cedar wood.shingles with fire "retardant fiberglass cap sheet underlay: Need to have a City of Cupertino Permit accompanying this application for all wood shingle roofs. 3) Siding,Material Change (Please check one choice) Siding Material: Hardtplatik._Cedarmill (wood grain finish) or Hardiplank Smooth Finish. Which iides are you changing material! (.front ✓back left right V) 4) Window ;Material and:Design change: (Please check this box): Vinyl Windows - color White *Must include manufacture also Include cut sheet for type and style of windows:. Retrofit _ New Constr. 5) Adding a Roof Attic Fan. , Tubular or Skylight , Satellite Dish Air Cotiditioner (location of Condenser), Please attach. infotmatiori regarding the .proposed change Application must include dimension, color of the proposed fan and its location'lon the roof. Please -include detailed drawings, specifications, and product brochures if available. Tubular'skylight up to 14" diameter, one roof attic fan up to 26" in width & height - paint to match roof 6) Garage,doors: a. Recessed wood panel, not raised in center same style for windows ("PLAIN" - non decorative) Style 84 (8 panels across,;64 (6 panels across), 44 (4 panels across). Style _ with windows or Style _ no windows b. Insulated wood; insulated metal wl wood facing or "Carriage House" style 303C windows — 303 no window _ 7) Solar System: Adding solar panels to the roof of home. (Requires drawing indicating placement of panels and photo for type of panel to be installed) _ 8) Any additional exterior modification (please specify) Homeowner's Signature: �34,t _, The request is in tori pliance uith Seven Springs HOA Architectural,Control CommitteeBoard: Approvedl Denied pending. Guidelines: littp:rise,.•en-springs;orgtfU uarchitectual-,6�pidelines.pdf Architectural _Control Committee Board: Signa tu�� '�1� ! Date: e .� z SMOKE / CARBON MONOXIDE-ALARMS '111Ir OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildings cupertino.orq M �,,; ��" a �?A.�YM k�,��'"-r�'�*�' ..� � is,s �sc z" '" .tea W A f s s-0 M�� '� a`'3 4W. 4 ' (S :; ;.,:� s3 {'4i MY* i il.'FLAT CA11 1[�OT E-IIYALED �I*18,LeERrIIFICA,TE B S�BEEI H C�NI�PLETED,SIL NE i,ANDS i,mb)'TO a E `�t'DI SIO � PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 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 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 areain 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. Address: /i f3 .5:pr j Permit 1\Tol, per—/ice Specify Number of Alarms: #Smoke Alarms: WM #Carbon Monoxide Detectors: Q I 1 have read and agree to comply with the terms andditions of this statement Owner(or Owner Agents)Name: conC}f Signature 1.. . .. Date: G!� 7 Contractor Name: �- • —r-- signature Lic.# ... . Date:1'41/7 /&iv 6.s�1 d., Smoke and CO form.doc revised 12/15/16