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B-2017-1688
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1688 10504 DEMPSTER AVE CUPERTINO,CA 95014-1226(326 48 030) SHERMAN ELECTRIC SUNNYVALE,CA 94086 OWNER'S NAME: SINGH MAHESH AND JIGNASA DATE ISSUED:09/28/2017 OWNER'S PHONE:408-761-2238 PHONE NO:(408)438-1078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#872944 Contractor SHERMAN ELECTRIC Date 02/28/2018 X BLDG X 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: PROVIDE POWER FOR HOT TUB;INSTALL(2)OUTLETS 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 `.a= .formance of the work for which this permit is issued. .I' 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 permit is issued. Sq.Ft Floor Area: Valuation:$2100.00 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 326 48 030 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 sourceregulations per the e ' Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Si ture - Date 9/28/2017 Issued by:Abby Avende Date:09/28/2017 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) z. ;'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:9/28/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1.' I 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 az 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 Munici.al Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 255 tom"'5533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. • mer or authorized agent: r}• APPLICANT CERTIFICATION Date:9/28/2017 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 comp) 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 9/28/2017 Professional CONSTRUCTION PERMIT APPLICATION \ I /^k/ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ( 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 ,/,'gt.tss. 4. s , (408) 777-3228 • building@cupertino.org PEMIT#B-O-1. - "'`v CUPERTINO REV# DEF# • ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF •N. WIMMING POOL/SPA PROJECT ADDRESS {� �t,, APN#,5t2 DE,4p5-1 4 TvaENvE- `"[�� ©W �r OWNER NAME PHONE E-MAIL vv Nr4-/t/EtiF( $/rt)(F( 4106 --76f- acZ3V' Mivits}i51t.)4,,: 6,tup4iL., Conk STREET ADDRESS CITY, STATE,ZIP /0 5-b`1 GE"IPsT�2 ,4v1EA/v.� LV PkS/27 1A/C1 664 93-79/q CONTRACTOR NAME 0'OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE Ieta/14/2 I) 57--/e',044 ) 5Heitm4/0 1r...,6erTZIC Li 87g ly4 C-I v STREET ADDRESS CITY,STATE, ZIP /goo? K r FES e_0,-4-0 S/iv/v✓vi2csI GA 9/v86 E-MAIL PHONE BUS.MC# e lm'i a seig,,em AA) c iL l c r iv lET W0' -3/11- Aig0Z(% 0 ARCHITECT 0 OWNER,❑OWNERAGENT 0 CONTRACTOR AGENT El ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME E-MAIL STREET ADDRESS CITY,STATE,ZIP PHONE DECIUPTON peovr0G Pow Ci i eR- POT V/1' 1*,.ip `ru'o &I t 0vti-y4T' SI GLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) ' 1t�gd REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED BATHROOM SF • SF SF SF ❑DETACHED EXISING 0 YES EICHLER ❑YES SECOND STORY ADDITION 0 YES FIRE SPRINKLERS ElNO 0 NO 0 NO DWELLING SECOND DWELLING' 0 YES ❑ATTACHED❑DETACHED OTHER UNITS# UNIT ADDITON: ❑NO S F POOLS" ❑FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED POOL-SF SPA-SF J SPA ATTACHED❑YES 0 NO I TOTAL-SF REC ED BY: TOTAL VALUATION: Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval tA, ., V*Z`I 17'9 RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF E ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGL S❑TIL OTHER(SPECIFY) REMOVE/REPLACE 0 NO IF NO PLYWOOD 1=11/2" 1=13/8" PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES I#'OFLAYERS THICKNESS❑5/8" OTHER III OSB ❑CDX OTHER .12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES 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 ordinanc-- and . ate laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for insp= tio. .urposes. I acknowledge and authorize all information contained on this application form to be made available for,,public record,/ 9/2e/P/7 of Applicant/Agent: i // Date: SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second 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 08/01/17 • SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION � � 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255C . (408)777-3228•FAX(408)777-3333•buildincq(a�cupertino.org PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED,SIGNED.AND RETURNED TO THE BUILDING DIVISION PURPOSE This affidavit isa 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 X X bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door) On every level of a dwelling unit including basements and habitable attics 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;hot 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 accordancewith 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: 1051),A D E - yam, Avg Nu,c Permit No.t3-otov1 (4,86 C c.®s4J/Nw,11 RDx' Specify Number of Alarms #Smoke Alarms. I ( #Carbon Monoxide Detectors 8 I I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: r . IU KI4eSti- 4,- Signature ..:_-:. .. .. Date: Contractor Name: 0.107tao.ea9 Skt°0-askA16.10 Signature . ffi6 Lic.# eyy Date: 7dk.11:07 Smoke and CO form.doc revised 01/10/2017