B-2017-1812 • CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2017-1812
1107 KENTWOODAVE CUPERTINO,CA 95014-5807(359 31 003) BAYSIDE BUILDERS
INC
BURBANK,CA 91506
OWNER'S NAME: Aravind Ramachandran And Smite Das DATE ISSUED:10/23/2017
OWNER'S PRONE:951-334-9136 PHONE NO:(323)575-7238
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Uc.#1007839 •
ContractorBAYSIDEBUILDERS INC Date 10/31/2019 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:
(2)BATHROOM REMODEI(99 SF)-LIKE FOR LIKE;REPLACE
I hereby affirm under penalty of perjury one of the following two declarations: WINDOWS(11)AND(1)SLIDING DOORS-LIKE FOR LIKE;
1. 1 have end will maintain a certificate of consent to self-insure for Worker's UPGRADE PANEL(200 AMP)-SAME LOCATION
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#1 CHANGE LAYOUT TO HALLWAY BATH(54 SQ)SEE
performance of the work for which this permit is issued. REVISED PLANS;REDUCE WINDOWS TO(9)-ISSUED 11/6/2017
k2..1 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:$20000.00 '
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 359 31 003
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 per the din, Municipal Code,Section 9.18. 180 DAYS FROM LAST.CALLED INSPECTION.
e'
k Signature 9 Date 11/6/2017 Issued by:,Tasmine Archbold
Date:10/23/2017
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. . 1,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.
1 sale(Sec.7044,Business&Professions Code)
' z 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: —_
contractors to construct the project(Seo.7044,Business&Professions Code). Date:11/612017
hhereby affirm under penalty of perjury one of the following three declarations:• ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
z. I have and wilt 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. J certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 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 Arca Air Quality Management District I
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 Ilcnith&Safety Code,Sections 2 0533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent: t ��
APPLICANT CERTIFICATION Date:11/6/2017
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.
Signature Date 11/6/2017 Licensed
•
Professional
CONSTRUCTION PERMIT APPLICATION
,,\rbCOMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 •
w !,. r,- (408) 777-3228 • buil ding@cupertino,org PEMITr;B-tol-- - 11j412
CUPERTINO REV a ,DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION LI T.1. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROjECTADDRESS APN I .
I 1 ""? IC- -Tu 'oO9
OWNER NAME PHONE E-MAIL
' SM rr, . .7 1 .5 C1S-I -1,2,' .91113 la
STREET ADDRESS CITY,STATE,ZIP
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CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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STREET ADDRESS CITY,STATE,ZIP
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0 ARCHITECT 0 OWNER 0 OWNER AGENT CONTRACTOR AGENT❑ENGINEER❑DEVELOPER❑TENANT
e
CONTACT NAME E-MAIL
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, STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
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INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
XISTING USE EXISTING SF NEW FLOOR SF PORCH SF f DECK SF DEMOSF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. ,VALUATION($)
REMODEL REMODEL KITCHEN REMODEL0THR. GARAGE 0 ATTACHED - '
BATHROOM SF SF SF SF
[]DETACHED
FIRESC ❑YES EICHLER 0 YES SECOND STORY ADDITION D O
IRE SPRINKLERS❑NO 0 NO
DWELLING .I SECOND DWELLING ❑YES ❑ATTACHED❑DETACHED OTHER
UNirs4 'UNITADDITON: 0 NO SF
POOLSI -❑FIBERGLASS 0 VINYL-LINED ❑GUNITE ❑PREFABRICATED
POOL-SF SPA•SF I SPA ATTACHED DYES 0 NO I TOTAL-SF 11
0EIVED BY:
TOTAL VALUATION:
Commercial ar.MOH-Family Buildings with Piddle Swimming Pools requires Department of Environmental Heaffi manual ^
'�T� v
RE-RO OF EXISTING ROOF TYPE: D BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES fl WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACED NO( IF NO PLYWOOD ❑1" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
DYES I OF LAYERS THICKNESS❑Eta" OTHER ❑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 Pot 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 inspection pur as s. I acknowledge and authorize all Information contained on this application form
to be made available for public record. / J "2---e___
Signature of Applicant/Agent: ��Li' /` --"""'--- Date: III ISUPPLEMENTAL 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.
*I-IOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1812
1107 KENTWOOD AVE CUPERTINO,CA 95014-5807(359 31 003) BAYSIDE BUILDERS
INC
BURBANK,CA 91506
OWNER'S NAME: Aravind Ramachandran And Smita Das DATE ISSUED:10/23/2017
OWNER'S PHONE:951-334-9136 PHONE NO:(323)578-7238
I Oa l t: I t' 1 I. BUILDING PERMIT INFO:
License Class B, Lic.#1007839
Contractor BAYSIDE BUILDERS INC Date 10/31/2019 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:
(2)BATHROOM REMODEL(99 SF)-LIKE FOR LIKE;REPLACE
I hereby affirm under penalty of perjury one of the following two declarations: WINDOWS(11)AND(1)SLIDING DOORS-LIKE FOR LIKE;
1. I have and will maintain a certificate of consent to self-insure for Worker's UPGRADE PANEL(200 AMP)-SAME LOCATION
Compensation,as provided for by Section 3700 of the Labor Code,for the REV#1 CHANGE LAYOUT TO HALLWAY BATH.(54 SQ)SEE
performance of the work for whichthis permit is issued._-i REVISED PLANS;REDUCE WINDOWS TO(9)-ISSUED 11/6/2017
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:$20000.00
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 359 31 003
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 per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
(ffnature Date 11/6/2017 Issued by:Jasmine Archbold
I'v . Date: 10/23/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the J1F-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:11/6/2017
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 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 Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
• r er or authorized agent:
APPLICANT CERTIFICATION !k e:11/6/2017
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 11/6/2017 Professional
•
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
rv, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
,as 'r
- •
(408) 777-3228 building@cupertino.org PEMIT#13-to11- - db1.Z
CUPERTINO REV'# l DEF#I
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.1. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS APN i
11 t .--/ TWCco1.) v
OWNER NAME PHONE . • E-MAIL
5ti4 t i n. pi .S 6151 _172,4.911. t.
STREET ADDRESS CITY, STATE,ZIP
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'CONTRACTOR NAME 0 OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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I STREET ADDRESS CITY,S1TA_TE, ZIP \�` ` I
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❑ARCHITECT ❑OWNER ❑OWNER AGENT'pp.CONTRACTOR.AGENT❑ENGINEER 0 DEVELOPER❑TENANT
CONTACT NAME E-MAIL
/s:k.-+ems S'4- -a( C.P akruart re 0 1 ,co.'.-,
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON . ,
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•
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LY DE❑INDUSTRI ❑COMMI I
XISTING XITIIN OF H SF CK SF DEMOAL 5F STORIES TOTAERCIALL NET USE TYPE OCC SQ.FT. VALUATION(5)
REMODEL REMODEL KITCHEN ' REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF ❑DETACHED
EXISiNG ❑YES EICHLER 0 YES SECOND STORY ADDITIONYES
0
FIRE SPRINKLERS 0 NO 0 NO NO
DWELLING SECOND DWELLING ❑YES. ❑ATTACHED DETACHED OTHER'
UNITS# UNIT ADDITON: ❑NO S F '
'POOLS' ❑FIBERGLASS D VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA.ATTACHED❑YES 0 NO I TOTAL-SF -
00
I ,,,P.F,cEIVED BY: TOTAL VALUATION: •
..........itti)
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath avvroval
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES I=1 WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACED NO IF NO PLYWOOD ❑'A" ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
D YES #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER .12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES D OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF Pot SQUARES
By my signature below I certify,to each bf 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 inspection pur - s. I acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: / Date: 1 I I I 11 -
6
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 approvl.from the Home Owner's Association
BldgApp_201.7.doc revised 08/01/17
• CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1812
1107 KENTWOOD AVE CUPERTINO,CA 95014-5807(359 31 003) BAYSIDE BUILDERS
INC
BURBANK,CA 91506
•
OWNER'S NAME: SMITADAS DATE ISSUED: 10/23/2017
OWNER'S PHONE:310-739-0214 PHONE NO:(323)578-7238
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
•
License Class B Lic.#1007839
Contractor BAYSIDE BUILDERS INC Date 10/31/2019 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:
(2)BATHROOM REMODEL(99 SF)-LIKE FOR LIKE;REPLACE
I hereby affirm under penalty of perjury one of the following two declarations: WINDOWS(11 )AND(1)SLIDING DOORS-LIKE FOR LIKE;
1. I have and will maintain a certificate ofconsent to self-insure for Worker's UPGRADE PANEL(200 AMP)-SAME LOCATION
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
4.7 Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$20000.00
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 359 31 003
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 accrueagainst 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 per the Cu ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
IetlI ne -e Date 10/23/2017 Issued by:Jasmine Archbold
Date: 10/23/2017
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 ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:10/23/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
a. 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 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 Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25 I ,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 'O e' l7• thorized agent: 4+ 11, rl
APPLICANT CERTIFICATION (I(5 ."0 23 I 7
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 .l 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 ekpenses 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 aspublic records.
Licensed
Signature Date 10/23/2017 Professional
•
. CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
9/ 10300 TORRE.AVENUE • CUPERTINO CA 95014-3255 . B
...„,..„,.,,, ..
(408) 777-3228 • bLlilding@cupertinO.org PEMIT#B-1-011. - CJ 1 !r
CUPERTINO REVS DEFE
' ❑ NEW CONSTRUCTION ❑ADDITION DA ALTERATION ❑T.I. ❑MEP DRE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS I i o7. t< v I
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OWNER NAME PHONE S5)1/4/1fes- E-MAIL
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STREET ADDRESS CITY, STATE,ZIP _
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CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
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ISTREET ADDRESS CITY,STATE, ZIP
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CONTACT NAME E-MAIL '
At.iCe S4eNl .•lice @ 1)6%1Si8.e_IDL.(1de CIS. .ca.,.\ •
STREET ADDRESS CITY,STATE,ZIP PHONE
DECRIPTON
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•
SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5)
z9
133p REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
I4-74:, 6_
, oaM` > 'q n SF SF SF ❑DETACHED •
EXISG ❑YES EICHLER ❑ YES SECOND STORY ADDITION ❑❑NO
FIRE S
FIRE SPRINKLERS❑ NO 0 NO
' DWELLING SECOND DWELLING ❑YES 0 ATTACHED❑DETACHED OTHER '
UNITS; UNITADDITON: ❑NO S F 1
IPOOLS' ❑ FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED ^
POOL-SF SPA-SF _ I SPA ATTACHED ❑YES 0 NO TOTAL-SF ! r % '('
EIVED BY: L%p0'T"?:L�)1 t`J'A ION I
Commerdal or Multi-Fmnilu Buildings with Public Swimming Pools re0uires Deportment of Environmental Heath ammo 1 x 2-0 �QO
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NO IF NO PLYWOOD ❑1- ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
DYE q OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER -12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF DASPHALT SHINGLES ❑WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF Sof 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 inspection p ose acknowledge and authorize all information contained on this application form
to be made available for public record.
Signature of Applicant/Agent: (' /L...--".1-----� Date: 1012;141-1
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
FE
s SMOKE / CARBON MONOXIDE ALARMS 1
OWNER CERTIFICATE OF COMPLIANCE ` 1249-11
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinp(a cupertino.orq
PERMIT CANNOT.BE FIN.ALED UNTIL TSS CERTIFICATE:.HAS BEEN:
COMPLETED SIGNED;AMIRITITRAti;TO THE 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
$1000 00,CRC Section R314,R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations.
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420 6 and shall be approved by the Office of the State Fire Marshal.
Power Supply- In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420.6.2.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below
Address- I.I ' -T,0cvD AcVe, Permit No. 6 ITh l 'I.--
Specify
eSpecify Number of Alarms #Smoke Alarms I S J #Carbon Monoxide Detectors J 2-
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name: }7 i
&t_(('? 64e-in Signature d-LYS Date:fZ�4 .l1
Contractor Name: ,1
m S (DE. ,L4 LDErLS Si nature G " 4 °°'..)$.74:1114.1q.11.
g � Lic.# Date:
Smoke and COform.doc revised 01/10/2017