B-2017-1446 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1446
23500 CRISTO REY DR UNIT 412F CUPERTINO,CA 95014-6532(342 53 176) BAY AREA
ENTERPRISE •
SAN JOSE,CA 95148
OWNER'S NAME: SUNDERBRUCH RUTH TRUSTEE - DATE ISSUED:08/31/2017
OWNER'S PHONE:650-537-5043 PHONE NO:(408)238-5043
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#817817
Contractor J3AY AREA ENTERPRISE Date 03/31/2019 X BLDG X ELECT X PLUMB
. X 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:
UPGRADE(5)RECESSED LIGHTS;UPGRADE OUTLETS(15);
I hereby affirm under penalty of perjury one of the following two declarations: UPGRADE LIGHT SWITCHES(8);UPGRADE BATHROOM FAN(1);
1. I have and will maintain a certificate of consent to self-insure for Worker's UPGRADE SHOWER PAN AND SHOWER VALVE
C.a pensation,as provided for by Section 3700 of the Labor Code,for the
rerformance 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. Sq.Ft Floor Area: Valuation:$6500.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 342 53 176
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 upertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Sign re to 8/31/2017 Issued by:Jasmine Archbold
Date:08/31/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-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 Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:8/31/2017
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
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 anyperson in anymanner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
p y 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 •ertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health& • Code,-Se .. 25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Ow a or authorized agent.
APPLICANT CERTIFICATION 1.131:,v`.8/31/2017
I 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,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. I understand my plans.shall be used as public records.
Licensed
Signature ' Date 8/31/2017 Professional
\\ I / CONSTRUCTION PERMIT APPLICATION
f„„/ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
01.19r, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(a)cupertino.orq
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 2 3 5.-00 / y!;b p4
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OWNER NAME S
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CONTACT NAME /"�1,..,e_�! / e C. J
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OWNER 0 OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAMElig / l Sf
HEN
SE NUMBER I LICENSE T PE BUS.LIC#
COMPANYNAMEv �Q L ,4(/IQC E-MAIL, r-4,9 ILe�C6'1ti[CI,Y Ye FAX
STREET ADDRESS CITY,STATE,ZIP nuONE
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ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK (.,t l _
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EXISTTIIkrG USE PROPOSED SE 1 CONSTR.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 REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA i GARAGE AREA: ❑DETACH
0 ATTACH ,
#DWELLING UNITS: IS A SECOND UNIT DYES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? LINO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE B]' x M a , TOT_ VALUATION:...
PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO , f ---
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pI perty owner's behalf. I have read this
,application and the information I have provided is rrect. 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 buildin c ctron. I authorize representatives of Cupertino to enter the abo..' -identified property for inspe tion'purposes.
a}
Signature of Applicant/Agent Date: U
1/, ' v '
SUPPLEMENTAL INF RMATION REQUIRED `
.: PLAN,CHECKTYPE +_ � x .RODTINGSLIP<_'7 Fy
New SFD or Multifamily dwellings: Apply for demolition permit for ,t '
▪❑ OVER THE COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building r _, a fi i
permit for new building. h❑ EXPRESS `❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 0 ❑ 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 `' ` _ ,' 3.
❑ MAJOR.l . ❑ SANLTARYSEwERDIbTRICT
submittal of Building Permit application. i, w , s x
• .F,„M,.., .4 t.;;:f. ' ,,❑M ENVIRONMENTAL,HEA.TH �>,
BldgApp 2011.doe revised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
4.494., COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildinq(a cupertino.orq
PERMIT CANNOT":W.FINALED UNTIL.TRIS CERTIFICATE HAS.BEEN
COMPLETED,SIGN ID,AND TURNED 'O 11iE BUILD3INGII,IVISION
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 907.2.114 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. Z3 ).--(;"° 'jib ti P, z''/Arci/vi Permit No '/
Specify Number of Alarms: #Smoke Alarms. ' #Carbon Monoxide Detectors. ,,
l have read and agree to comply wit erms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature /y' DatG—
Contractor Name:
Signature Lic.# Date.
Smoke and CO fonn.doc revised 12/15/16