B-2017-1832 CITY OF CUPERTINO BUILDING PERMIT
•
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1832
•
10140 N BLANEY AVE CUPERTINO,CA 95014-2330(316 21 074) MB K T CORP
SAN JOSE,CA 95131
OWNER'S NAME: MC AFEE JIMMY J AND PATRICIA A TRUSTEE DATE ISSUED: 10/26/2017
OWNER'S PHONE:408-307-1263 PHONE NO:(408)675-5674
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#863274 X BLDG X ELECT _PLUMB
Contractor M B K T CORP Date 03/31/2019
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:
REPLACE PANEL(125 AMP)SAME LOCATION
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
OF) .
performance of the work for which this permit isr issued.
n. 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:$2500.00
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 316 21 074
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 regulationsti /per the CupertinoMunicipalCode,Section 9.18. 180 DAYS FROM LAST CALLED-INSPECTION.
Signatur /t,...-!i C9- 24 _ Date 10-26-2017 Issued by:Kim Dunbar
Date: 10/26/2017
O R-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
t. 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: 10-26-2017
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
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the 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 fi e,Sect' 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall II be deemed revoked. Owner or authorized age t
APPLICANT CERTIFICATION Date: 10-26-2017
I certify that I have read this application and state that the above information is i .'Et 4► ►t I► •
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 10-26-2017 Professional.
CONSTRUCTION PERMIT APPLICATION
\- -rb:,, • COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONB .
t 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ,
.,,:,'',:a;'1,.
(408) g r b 777-3228 • buildin @cu ertino.org PEMIT#B o,3,
( - /
CUPERTINO REvt✓ DEFS
•
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. K 4 MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS /®/,f „/ 4/o1 rM 8h1*f'E y 4v1- APN a 2 c .22 _o? .A
OWNER NAME Tm A4 'A pe /`� P NE E-MAIL /
�J, �I'� G08J 30 ~/26 3
STREET ADDRESS ' �/ 0 N0 R TH t9L A/&V �E STATE,ZIP •
`
� � cup��e7/Alo, cep{- 9rm1I •
,CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
P4ct F1 C .Coifs 7 4'Iu4N,s $63 a C - 1(6
STREET ADDRESS CITY,STATE, ZIP •
3'9-2-/ Qv/no D,QIv� £4," JoSe, 04,- 95131 _ , I
E-MAIL PHONE BUS.LIC
1osr+Ge Pe IF!CCo%ts-rk2Ec?R1CI s.eon foto 9 -2,./q- 4113 ---8L1 `f C 93 ✓2)
0 ARCHITECT 0 OWNER.❑OWNER AGENT `CONTRACTOR AGENT':ENGINEER 12 DEVELOPER 0 TENANT
CONTACT NAME , E-MAIL
kibSi+ c'14 ve-R .T0 S 1-1-4 G PAC,F i c(Le itS r E`k cT trz'i'C I AVCS .: C 0,1*1
STREET ADDRESS CITY,STATE,ZIP ' PHONE
a3'7-g-i4 ' 0 Uoll; PAwe 5/47pq 1/4TOSl , GA- 4 5131 '.60-ayc/-V/3
D ECRIPTON' ,
/ A/))P i►`-«/ M;A/ L l 1 =. t2,40. / k 1PL11-cE pn wit- r--- Afr-e- ()Lb ',f
•
INGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING,SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES S TOTAL NET SF USE TYPE OCC SQ.FT.' VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE 0 ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
EFIRESPRINKLERS
G 0 YES EICHLER ❑ YES SECOND STORY ADDITION ONO
FI • RE PRIN KLERS.❑NO 0 NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER
UNITS A UNIT ADDITON:. ❑NO S F
POOLS I❑FIBERGLASS 0 VINYL-LINED ❑GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF 1 '
RECEI BY•ITIOEITAL VALUATION:
Commercial or Multi-Familq Buildings with Public Swinuviug Pools requires Department of Environmental Heath approvallik �, 00'2P
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES E TILE OTHER(SPECIFY)
REMOVE/REPLACE I]NO IF NO PLYWOOD 01" ❑3/8" PLYWOOD TYPE: PITCH:. , ROOF CLASS
❑yEs F OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER •1A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES OWOOD SHINGLES 0 OTHER
*Provide,a signed copy of the Cupertino's Tear-Off Policy , SF got 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 authorizerepresentatives of Cupertino to
enter the above-identified property for inspection purposes. I acknowledge and authorize all information contained;on this application form
to be made available for public rec rd
Signature of Applicant/Agent: cQ Date: /6 v2 er -
SUPPLEMENTAL INFORMATION REQUIRED 1,
•
*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 ,
•
B1dgApp_2017.doc revised 08/01/17
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTfNO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinQ Cupertino oro
PERMIT CAl\iNOT,BE FINALE))UNTIL THIS CERTIFICATE HAS.BEEN
S 4a �
CQMPLETED,SI NED AND RE TURIID T�3 I HE B PURPOSE ,:�. . x I 'GD
x Sit
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide
compliance with 2016 CRC Section R314,R315,2016 CBC Sections 420 6 and 907.2.11.2 where no in erio access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alalias. 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
Outside of each separate sleeping area in the immediate vicinity of the CO ALARM
bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door) X X
On every level of a dwelling unit includin:basements and habitable attics
Within each slee.in7 room X X
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 907.2.11 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 accordance with the manufacturer's instructions and m compliance with the Cahforiii.a Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below
Address % , � d
, • 1 7fA � �/'< ri 9 Permit No 7 - `
Specify Number of Alarms #Smoke Alarms
nal #Carbon Monoxide Detectors.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
JiAA.
c �L� Signature . ....... ...
.Date:
Contractor Name:
7
Signature
Lic.# . Date:
Smoke and COform.doc revised 01/10/2017
OWNER ER CERRBO ATE OF COMP, SMOKE / MONOXIDELUANCE gm
At C
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 1(_7���
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinci cupertino.orq
PERMI`3'CAS jNOT`BE F 1ALEI)UNTIL.TIIIS CERTIFICATE:.HAS BEEN:
QOMPLETED,SW-NM A.1 1RETURNE fQ THE BI3ILDINTG DW1SION
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 Alaiins 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, alaiin(s) may be solely battery operated.
In existing dwelling units,alanns are permitted to be solely battery operated whererepairs 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 alami(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. / 0/ " 0(1 -gjz„,q-,Jf Avc adm_77,4 )6 cm 9(7)i' `f Permit No j7-- /
Specify Number of Alarms #Smoke Alarms 7 I #Carbon Monoxide Detectors I £ I
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:> t . j
t AA.AJ�-°� i��c�°d{--�G-� Signature ... .. .....� . / . Date:/4/./
Contractor Name:
Signature Lic.# Date:
Smoke and COfornz.doc revised 01/10/2017