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B-2017-1405CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1405 10223 PARISH PL CUPERTINO, CA 95014-2205 (316 44 006) FARBEX CONSTRUCTION SERVICES INC. SUNNYVALE, CA 94086 OWNER'S NAME: `- OWNER'S PHONE: 917-375-6566 LICENSED CONTRACTOR'S DECLARATION License Class H Lic. #882824 Contractor FARBEX CONSTRUCTION SERVICES INC. Date 11/30/2018 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: t. I have and will maintain .acertificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the *,e,rfomumce of the work for,which thispermitisissued. ve and will maintain.Woiker's Compensation Insurance, as provided for by Stion 3700 ofthe Labor Code, for the perfomumce of the work for which this pmit 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,Ctipertino against liabilities, -judgments, costs, and expenses which may accrue against said City m consequence of the granting of this permit. Additionally, the applicanf understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 8/22/2017 I hereby affirm that am exempt from the Contractor's License Law for one of the following two reasons: t. "1,, as owner'df the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm underpdnaliy of perjury one of the following three declarations: 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. I certify that in the petfohnance 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 Califoma. If, after making this certificate of exemption, I1 become subject'to the Worker's Compensation provisions of the Labor Code,,I miistIforthwith comply with such provisions or this permit shall be deemed revoked: I 1 APPLICANT CERTIFICATION I certify that I have read thin application and state that the above information is correct. Ilagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to,ent'er upon the above mentioned'property for inspection purposes. (We) agree to save indemnify and keeplharmless the City of Cupertino against liabilities, judgments; -costs, and expensew s hich may accrue against said City in consequence of the grantin- of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 8/22/2017 DATE ISSUED: 08/22/2017 PHONE NO: (408) 590-5410 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BATHROOM REMODEL (3) - (246 S.F.) Sq. Ft Floor Area: Valuation: $60000.00 APN Number: Occupancy Type: 31644 006 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Jasmine Archbold Date: 08/22/2017 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 8/22/2017 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 maintaincompliance 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,-9rctwnq5505, 255 , and 25534. 900111, r authors en 8 22/20 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • building@cupertino.org PEMIT #B - - CtlP RTINO REV# DEF# F1 NEW CONSTRUCTION 7ADDITION-4AT.TF,RATTON n T T n MF.P n RE -ROOF n SWIMMING POOL/SPA PROJECT ADDRESS r� ,Q 5 A 9 S TPC-. O}GF— APN # OWNER NAME & ' M CIV YAN �0S-15- "�S �&,.,� E-MAIL � r STREET ADDRESS ���,a�/ �n �� 2 Qf!s STATE, ZIP t=IcApgge",>U2 ® 1F'% ❑ CONTRACTOR NAME ❑OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE F (Zia 4EX eeow..52 r ' r0--heJ5E,)-r Co vsiuc STREET ADDRESS CITY, STATE, ZIP 5' O G• 4r 2 �.v F kl }- 5 v� iV �} C. c . iy �d'S E-MAIL I PHONE ` BUS. LIC # 1�C a� 110 �f h6 2S'"aZS 4f vbe,�rseVNc co.�,.., SII❑ ARCHITECT ❑ OVINER ❑ OWNER AGENT ❑ CONTRACTOR AGENT El ENGINEER ❑ DEVELOPER ❑ TENANT CONTACT NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE DECRIPTON 7, L 2 N:VINGLE=FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL []COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) EXISTING USE EXISTING SF NEW FLOOR SF I PORCH SF DECK SF DEMO SF STORIES # TOTAL NET SF REMODEL I BATHROOM' 24 Jp REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED , SF SF SF ❑ DETACHED EXLSING j[ ❑ YES EICHLER ❑ YES SECOND STORY ADDITION OYES 'FIRE SPRINKLERS, NO u, [I11, NO NO DWELLING 'SECOND DWELLING ❑ YES ❑ ATTACHED ❑ DETACHED OTHER UNITS # i UNIT ADDITON: ❑ NO S F POOLS YI;❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE [:]PREFABRICATED in A 'POOL - SF I! ! '..SPA - SF I SPA ATTACHED ❑ YES N NO TOTA_ L - SF Commercial or Multi-FamiIu Buildincs with Public Swimming Pools requires Department o{EnvironmentaI Heath approval E ED 1 TOTAL VALUATION „1 1. RB -ROOF ! EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑ i. WOOD SHINGLES ❑ TILE ' OTHER (SPECIFY) REMOVE /REPLACE ❑ NO, IF NO PLYWOOD ❑'A" E13/8- PLYWOOD TYPE: PITCH: ROOF CLASS j; ❑ YES' # OF LAYERS THICKNESS ❑ 5/8" OTHER ❑OSB ❑ CDX OTHER 12 A PROPOSED ROOFTYTF: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER *Provide a signed copy of the Cupertino's Tear -Off Policy SF #of SQUARES B,y 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 Nave 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 ins a oses. I owle and authorize all information contained on tM application form t0 be made,available for public rec Signature of Applicant/Agent: Date: 22 SUPPLEMENTAL INFORMATION R UIRED t *New SFD/Secbnd Dwelling Units/Multifamily 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.doc revised 08101117 , SMOKE / CARBON MONOXIDE ALARMS n -' • OWNER CERTIFICATE OF COMPLIANCE �� 44, meg. COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTIN© 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333• buildinq@cupertino.orq i- ,. PERMIT C 1\OT'B m AL -14s71.1; ':......:.. :.. ..._._.-,. ; ..._ HIS CERTIFICA'U.HAS BEEl�- ' AI EEI3,st6NEN Ant Pikft-IINEilI9 T'iIE BU i V G:DI SION 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 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-referended 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. I49.2 2 3 P'T1 J Permit No.B-kt 7 1 Lt' Specify Number of Alarms. #Smoke Alarms MN #Carbon Monoxide Detectors EMI I have read and agree to comp1 with the terms and conditions of this statement Owner(or Owner Agent's)Name: '/ 'ar Signature �. . / 21/1-.7 Date: �s Ks Contractor Name: �Y Sign- s--1 .._..... 1. Lic.# 624:720 Q0 41( D e: l . . �� S' 1r 2GGCfC�/(/ Smoke and CO fonn.doc revised 12/15/16 '`' WATER-CONSERVING PLUMBING FIXTURES , (6:* ...C9 OWNER CERTIFICATE OF COMPLIANCE 1,,, COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION r CU P E RT I NO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ~C (408)777-3228 •FAX(408)777-3333 •building@cupertino.org Owner Name: �,_ l �j� I (,�,� A�` Permit No: v l �t-� Address: t10Z2 'A C ? c....F. CODE REFERENCE(S): Senate Bill 407(2009)/California Civil Code Sections 1101.1 through 1101.8 2016 California Green Building Standards Code(CALGreen)Section 301 BACKGROUND: As of January 1, 2014, SB 407 requires non-compliant plumbing fixtures to be replaced with water conserving plumbing fixtures when a property is undergoing additions, alterations or improvements. Applicants seeking to obtain permits for any of these types of work will be required to replace noncompliant fixtures prior to final permit approval or issuance of a certificate of occupancy by the local building department. This law applies only to properties built on or before January 1, 1994. Per Civil Code Section 1101.4, for any single-family residential real property, on and after January 1, 2014,building addition, alteration or improvement will require all non-compliant plumbing fixtures to be replaced with water- conserving plumbing fixtures. See list on the following page for scopes of work that are exempt from these standards. Per Civil Code Section 1101.5, for any multifamily residential real property and any commercial real property, on and after January 1, 2014, specified building addition, alteration or improvement will 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 (regardless of whether property undergoes alterations or improvements). Type of Property(choose one): II-Single-Family 0 Multi-Family 0 Commercial Property Information: YES NO 1. Is your real property a registered historical site?If YES,skip the rest of the form and sign bottom of form. 0 N- 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? If YES,skip the rest of the form and sign bottom of form. 3. Is water service permanently disconnected for your building? If YES,skip the rest of the form and sign bottom of form. 4. Is your real property built and available for use or occupancy on or before January 1,1994? If NO,skip the rest of the form and sign bottom of form. I/we, as the owner(s) 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 re :r-.. e indicated '. the table on the following page. Owner or Owner Agent's Signa', e: ---!. Date: 1 / 3 1 *Upon completing and signing this Certi"icate,please return it to the Building Inspector at final inspection in order to final your building permit.* SB407 2015.doc revised 08/16/17