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B-2017-1771
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1771 6021 SHADYGROVE DR CUPERTINO,CA 95014-4644(375 40 002) REBOZZI INC SAN JOSE,CA 95123 OWNER'S NAME: TARIQ MEHRAFROZE DATE ISSUED: 10/16/2017 ' OWNER'S PHONE:408-996-7049 PHONE NO:(408)229-9689 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: . License Class B Lic.#747473 Contractor REBOZZI INC Date 03/31/2018 X BLDG _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: BATHROOM REMODEL-(40 SF) I hereby affirm under penalty of perjury one of the following two declarations: 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. 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 i, Ce I/ permit is issued. Sq.Ft Floor Area: Valuation:$6200.00 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 375 40 002 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 applica t understar}rd a .will comply with all non-point source regulations pe• e Cupe Ino Mud `.al Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. � �Signature _ A/ v ,// Date 10-16-2017 Issued by:Kim Dunbar r.;„ / Date: 10/16/2017 . IAkE'-: - t tIL _.._•T_I\ 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 a. 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: 10-16-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 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. a. 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.1 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Secr ons 2551.,25 d 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. /, Owner or authorized agent;, ��._ ., ZEMIP Date:10-16-2017 APPLICANT CERTIFICATION - I certify that I have read this application and state that the above information is CONST'UCTION Or DING 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 10-16-2017 Professional CONSTRUCTION PERMIT APPLICATION \ i(:: vCOMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION B 4°. �' 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 (408)777-3228 • building@cupertino.org PEMTT#B- ( - I / I CUPERTINO REV# DEF# ❑ NEW CONSTRUCTION ADDITION ALTERATION 0 T.I. ❑MEP, ❑RE-ROOF 0 SWIMMING POOL/SPA PROJECT ADDRESS q)1 \ \V\ kot) I �t\``Q f ) I APN li 3. ..6--^ i/.0 0 0OWNER NAME tV1N\\l 11J{ (� U\V1 P 101/NE, E- !T(� IN(Vicw 1-OW 1 Pv , c1cil0 , 10k-'I°I MAn y 1+CkV i.� b\.(W i1.0 n STREET ADDRESS i,f\�1 a.,„6,1 ., ,Q O1 CITY,STATE, A(!` ® tA q '` iVONTRACTOR NAME ❑OWNER-BLIILLOMPANYPANAME'`l) LICEENySEI,NNUMBER `J{,- LICENSE TYPE boZ� Cons c nu'1�l b STREET ADDRESS `® �y/��fin` ye 1 sy�/�y/�1 CrrY,STATE, �1n'y�1 oose,E-MAIL 5�to5 \m\ 1��L iA1� 1�� V,1 ` BUCtv 13 0 ARCHITECT 0 OWNER ❑'OWNERPHONE .U'CONTRACPORAGENT❑ENGINEER 0 DEVELOPER❑TENANT CONTACT NAME (�po,„e etS a 9N V E-MAIL STREET ADDRESS CITY,STATE,ZIP PHONE DECRIPfON 930i%,p (Om tikyk INGLE-FAMILY/DUPLEX El MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES II TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) REMODEL REMODEL KITCHEN REMODELOTHR GARAGE 0 0 ATTACHED © a r+_ BATHROOM SF SF SF SFDETACHED �CbA\(/ EXISING YES EICHLER YES SECOND STORY ADDrriON ❑YES FIRE SPRINKLERS R,NO NO WO DWELLING SECOND DWELLING El YES 0 ATTACHED❑DETACHED OTHER uNrrs,} UNIT ADDIIDN: 0 NO S F POOLS! ❑FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED❑YES ❑NO TOTAL-SF / ,OP IgAyr7SN: Commercial or Multi-Family Ruildimts with Public Swimming PooLs requires Department of Environmental Heath approval113.1A (7, ` RE-ROOFI EXISTING' ROOF TYPE: I=1 BUILT-UP ROOF 1:1 ASPHALT SHINGLES WOOD SHAKES 0 WOOD SHINGLES 0 TILE/�OTTHERR((SPECIFY) REMOVE/REPLACE El NO IF NO PLYWOOD Cl t" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS El YES I U OF LAYERS THICKNESS 0 5/8" OTHER OMB 0 CDX OTHER :121 PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF aof 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 ordinances and state laws relating to,building construction. I authorize representatives of Cupertino to enter the above-identified property for in pection purposes. I ; owl•dge and authorize all information contained on this application form to be made available for public record. Signature of Applicant/Agent: _ _�',�� / _�% ' .%I//� Date: /o—/(a / • SUPPLEMENTAL INFORMATIO 1 S UIRE P *New SFD/Second Dwelling Units/Multifamil P wellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous MaterialsDisdosure 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 IIMir iF L7-: L OWNER CERTIFICATE OF COMPLIANCE A0 ta. , .,g COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinci(a�cupertino.org PERMIT CANNOT..BE FINALED UNTIL THIS CERTIFICATE HAS.BEEN COMPLETED,SIGNED,AND,RETURNED TO THE BUILDING DIVISION 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,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 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, alamm(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 9 Address. • 1 Permit No.NO Al 31 Specify Number of Alarms #Smoke Alarms ! t( J #Carbon Monoxide Detectors. I I I have read and agree to comply with the terms and conditions of this statement N Owner(or Owner Agent's)Name: elt rotzC.• `a r;ev Signature • `.00-4.CJ./ Date: :4.1Y..ltj.. Contractor Name: Signature Lic.# Date: Smoke and COform.doc revised 01/10/2017