13080084 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: I0268 CRESTON DR CONTRACTOR:CHAMBERLAIN PERMIT NO: 13080084
CATHERINE
OWNER'S NAME: CHAMBERLAIN CATHERINE 10266 CRESTON DR DATE ISSUED:08/12/2013
OWNER'S PHONE: 4087393040 CUPERTINO CA,CA 95014-1014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lie.4 40 SQ FT ADDITION TO FRONT OF SFDWL,KITCHEN
AND
Contractor Date DINING ROOM REMODEL 200 SQ FT
I hereby affirm that I ant licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my lieense is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
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. Sq.Ft Floor Area: Valuation:$10513
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 APN Number:32637038.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this eity to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY OM LAST CALLED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this pcnnit. Additionally,the applicant understands and will comply Issued by: Date:
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with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
(h".Cby
OWNER-HUILDER DECLARATION
affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
M., as owner of 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)
1,as owner of the property;am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under pcualty of perjury oue of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Seetion 25532(a)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as definedby't rea Air Quality Management District I
performance of the work for which this permit is issued. will maintain eompliance will he upe mo Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S cti 50 ,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Z r
Owner or authorized agent; am=r Datc
permit is issued. F x.� ;., _=re;�.:rr:t- -r. ti. •....-.x r-ti
1 certify that in the perfordtance of the work for which this permit is issued,l shall Vvi
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CON TRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked, work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
1 eertify 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 Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of it,Additionally,the applicant understands and will comply
with all n-po t so ce regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18. ++r �y y /• 1
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777=3333• bu1IdingQcupert1no.DTq
❑NEW CONSTRUCTION A ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#!
PROJECT ADDRESS 102401b G ��`� APN# 61�p 24 _31 —O 36
OWNER NAME PHD EMAIL h� 0 3 o ALA GG cow+
STREET ADDRESS CITY, STATE,ZIP FAX
t7 2CP£� a C)9-- , 4-0 �Tl1440 SG I
CONTACT NAME CC-` Z PHO N - O IrMAn.
V —
STREETADDRESS CITY,STATE.ZIP FAX
W Ja CA cWt119o . *7-9149.47.!+
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTORNAME LICENSENUMBER LICENSETYPE BUS.LIC 0
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHTTECT/ENGINEERNAME LICENSENUMBER BUS.LICK
li� AA cW G- S4 2
COMPANY NAMEE-MAIL FAX
SddTr
STREET ADDRESS Q o CITY,STATE.ZIP PHON -Z9 .��6 0
DESCRIPTION OF WORK
d T w V31 AMM6034
EXISTINGUSE PROPOSED USE CONSTRTYPE 9STORIES
5AWA� USE TYPE OCC, SQ.FT. VALUATION($}
R•glk ��At� l
EXISTG NEW FLOOR DEMO TOTAL q
AREA ri-0�I' AREA 4o S-r AREA NET AREA Z I
,44
BATHROhOOM!! `� KTCHEN 1 OTHER
REMODEL AREA REMODELAREA ? RE:MODELAREA
PORCH AREA DECK AREA TOTAL DECKMORCH AREA I GARAGE ARE&- El DETACH
❑ATTACH
9 DWELLING UNIT& ISA SECOND UNIT ❑YES I SECONDSTORY OYES
BEING ADDED? ORNO ADDITION? ITIJO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OOF'' 6 THF.BLDG AN ❑YES RECE ED TOT`A VALU'A�}ON:
PLkWNG APPL0 0N PLANNING APPROVAL LETTER EICHLER HOME? ❑NO /� (�
By my signature below,I certify to each of the following: I am the property owner or autho 1 agent to act on the property owner's behalf. I ave read this
application and the infonnation I a•pr2idcd is correct, I have read the Description of Work and verify it is accurate, 1 agree to comply with all applicable local
ordinances and state laws relati ildln construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicantlAgent: - Date: 4,S. O!5 . 1q
SUPPLEMENTAL INFORMATION REQUIRED PAN gigtKTWE ROUTING SLIP
_NewSFD or Multifamily dwellings: Apply for demolition permit for OVERTHE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of buildi
permit for new building. ❑ ExPREss ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ElsTA"ARD ❑ PUBLIC WOR16
farm 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 ❑ MANOR ❑ SANITARY SAVER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 20l1.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10268 Creston dr DATE: 08/12/2013 REVIEWED BY: Sean
APN: BP#: 'VALUATION: 1$10,513
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1GFNRES
USE: PERMIT TYPE: A
WORK [40 s ft addition to front of sfdwl Kitchen and Dining room remodel 200 sq ft
SCOPE
Mech. Plan Check Phimb,Plan Check FT Elec,Plan Check
Xlech. Permil Fee: Plumb.Permit Fee: Flee.Perxrir Fee:
01her Alech.Insp, Other Pb+mh Insp. Li Ocher Elce.Insp. Ea
Allech.ASP.Fere: Plumb.Insp. Fee: Elec.Insp.Fee:
NOTE:This estintate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,ela). Thesefees are based on the prefitnina information available and are only an estimate. Contact the Df2t for addn'l info.
FEE ITEMS (Fee Resofulion 11-053 EH: 7/1/121 FEE QTYIFEE MISC ITEMS
Plan Check Fee: Hourly Only? O Yes Q No $0.00 1 hours Plan Check,Hourly
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $139.00 ISTPLNCK
PME Plan Check: $0.00 = s.f Remodel,Kitchen(<=300 so
Permit Fee: Hourly Only? ()Yes Q No $0.00 $626.00 1REMRESKIT
Suppl. Insp.Feb-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conslr action Tax:
Administrative Fee: Q
Work Without Permit? Q Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Docinnentation Fees: Building or Structure
i
Strong Motion Fee: 1BSEIS3ffCR $1.05 E3.E hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $417.00 1STINSP Inspection,Hourly
SUBTOTALS: 1 $2.05 $1,182.001 TOTAL FEE: 1 $1,184.05
Revised: 0710112013
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OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildingiCa cunertino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SI
Iti&6�-#dAME .r. OWNER ADDRESS O�j
DESA MTF61 OFWORK: r
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS.Please read and initial each statement below to.signify you understand or verify this information.)
I-n
understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner-
Building permit that erroneously implies that the property owner is providing his or her own labor and material
0.
py. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an u&1`1 ensed person and his or her employees while working on my property. My homeowner's insurance may not
provde coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
r/ Z5,1
. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
AL3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit. 1 understand that I may
prokect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
na e�mstead of my own.
' . I understand Contractors are required by law to be licensed and bonded in California and to list their license
num 'e- rs on permits and contracts.
5'. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total-Value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
cons dared an"employer" under state and federal law.
I understand if I am considered an"employer"under state and federal law, I must register with the state and
feder"()'government, withhold payroll taxes, provide workers'compensation disability insurance, and contribute to
unempployment compensation for each"employee." I also understand my failure to abide by these laws may subject
me to�serious financial risk.
understand under California Contractors' State License Law, an Owner-Builder who builds single-family
reside t!aI structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
livens_d�subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is �rfded under contract with a licensed genera[ building Contractor.
nderstand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
defect lin the workmanship or materials.
OWnerBuilderForm 2010.doc revised 04/14/10
R
I L
I may obtain more information regarding my obligations as an "employer"from the Internal
R7en:g Service, the United States Small Business Administration, the California Department of Benefit Payments,
and t ''California Division of Industrial Accidents. I also understand I may contact the California Contractors'State
Licen2 oard (CSLB)at 1-800-321-CSLB (2752)or www.cs[b.ca.gov for more information about licensed
c�ontr�actors.
f/ 1�I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
am the�party legally and financially responsible for proposed construction activity at the site address listed above.
Z-401if l agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by plicable laws and requirements that govern Owner-Builders as well as employers.
4al)
1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
tion I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors,you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verify the property owner's signature.
ProEty,Owner's_i5ignafure --
-----------------------------------------------------------------------------------------------------------------------------•---------------
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
,�) Excluding the Notice to Property Owner, the execution of which l understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work): Clt�l►411
rolect Location or Address: I b Z[.0, max-t�I'L rJsz+J�
Name of Authorized Agent: GCO2t Tel No 24,
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Address of Authorized Agent: E1 � � _ �k�1.L S7Rf" S�q SO . SAS—Cs95113
.Xs 1 -
4l I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy.Note:A copy of the property owner's drivers license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
gnature. �
,- roperty Owner's Signature: f - Date:
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OWnerBuilderForm 2010.doc revised 04114110
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
CITY HALL
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
C U P E RT I ISI O (408)777-3228 • FAX(408) 777-3333
SCOPE OF WORK: Kitchen Remodel.
Project shall comply with the 2010 California Building (Base code 2009 IBC), 2010 Residential
(2009 IRC), Plumbing (2009 UPC), Mechanical (2009 UMC), Electrical (2008 NEC), Fire (2009 IFC)
and Energy Codes(2008 Building Energy Efficiency Standards)
Energy code mandatory lighting measures:
1. All permanently installed high efficacy luminaires shall be switched separately from low
efficacy luminaires. (150(k)(7))
2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of
the wattage of permanently installed lighting in kitchens may be in lights that are not high
efficacy. (150(k)(8))
Plumbing Alan notes:
3. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to
exceed 2.2 gallons per minute. (CPC 402.1.2)
Electrical Plan Notes:
4. The installation of smoke alarms in all of the following areas shall be provided: (R314.3)
a. On the ceiling or wall outside of each separate sleeping area in the immediate
vicinity of bedrooms.
b. In each room used for sleeping purposes.
5. The installation of carbon monoxide alarms in the following areas shall be provided:
(R315.1)
a. Approved carbon monoxide alarms shall be installed outside of each separate
sleeping area in the immediate vicinity of the bedrooms and on every level
including basements in dwelling units that have fuel-fired appliances or attached
garages.
6. A minimum of two 20 amp small appliance branch circuits shall be provided for all
receptacle outlets in the kitchen, dining room, pantry, or other similar areas. (CEC
210.11(C)(1))
7. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing
machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC
units, built-in heaters or any other fixed appliance with a motor of 114 h.p. or larger shall be
on a separate 20 amp. branch circuit.
8. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces,
unfinished basements, kitchens (where receptacles serve counter top surfaces), laundry,
utility, wet bar sinks (within 6 feet of the edge of the sink), shall have ground-fault circuit
interrupter(GFCI)protection. (CEC 210.8)
9. In all areas specified in 210.52, all 125-volt, 15-and 20-ampere receptacles shall be listed
tamper-resistant receptacles. (CEC 406.11)