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B-2017-2036
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-2036 10890 NORTHSKY SQ CUPERTINO,CA 95014-0537(316 40 053) PENGUIN ELECTRIC SUNNYVALE,CA 94086 ' OWNER'S NAME: KRODEL GREGORY M TRUSTEE • DATE ISSUED: 11/28/2017 OWNER'S PHONE:408-248-9004 PHONE NO:(650)823-8388 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lie.#888482 Contractor PENGUIN ELECTRIC Date 12/31/2018 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: REPLACE PANEL(100 AMPS)-SAME LOCATION . I hereby affirm under penalty of perjury one of the following two declarations: 1. &have and will maintain a certificate of consent to self-insure for Worker's Co spensation,as provided for by Section 3700 of the Labor Code,for the , ' 'r1,--iformance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by if fr , Section 3700 of the Labor Code,for the performance of the work for which this ' permit is issued. Sq.Ft Floor Area: Valuation:$1500.00 , APPLICANT CERTIFICATION I certify that I have read this application and state that the above • information is correct.I agreeto comply with all city and county ordinances APN Number: Occupancy Type: • and state laws relating to building construction,and hereby authorize 316 40 053 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. igi nature .�__, 7— Date 11/28/2017 Issued by:AbbyAyende Date: 11/28/2017 . 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 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:11/28/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER '. 1. ; I 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. 0 ne or authorized agent:r/� Z------- APPLICANT CERTIFICATION i f©ate:11/28/2017 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 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 11/28/2017 Professional - CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT •• BUILDING DIVISION ,•...„,,r 4' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • • 11 _ 'o l�- - ?,off. :•.,.:..,,,..,;!..i.,,.„.. (408) 777-3228 • building@cupertino.org PEMIT rB- CUPERTINO REV>± _ DEFB • ' ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEP E RE-ROOF ❑SWIly MING POOL/SPA PROJECT ADDRESS ,Q oP� 5g-y • APN A �`4' 'O 5')) OWNER NAME C ��1(J OE L PHONL1 tO�2-'tS - Oo y I E-MAIL 1 oa�1 Q 0 1. .Ca'— STREET ADDRESS ,'-C CITY, STATE,ZIP g „-... ------4i,"%---a1/4"-"-4L.--AUF ------ ----_ _ S-t).4"0Yliikt..`✓— 1_ —i_` -_. _______________________ - _- eCONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE c oe-e`er p c��,,.► � � Bea(-161- C-.t0 ISTREET ADDRESS CITY,STATE, ZIP 6e63 lxwts Aryl' S3 uN;NiY Ili LA. �'�-IO��O E-MAIL PHONE BUS.LIC; 0 ARCHITECT ❑ INNER. OWNER AGENT ❑CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT ' CONTACT NAME / E-MAIL SP1, I 6. IXC - • rO•".".2y�a (e+'�VUI✓ .-a— �.- \C-.,Cm"—, STREET ADDRESS CITY,STATE,ZIP V i1 PHONE 3 L.4 .lic As-1/44-r 5vN4i-c' CA- 94,686 - ( 5-0-623 -838B DECRIPTON '�U. c CX-c�►� 100 AN\P �►tt.. �-�7 trll-� SAME • • ❑SINGLE-FAMILY/DUPLEX ' ❑MULTI-FAMILY 0 INDUSTRIAL ❑COMMERCIAL I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES; TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN REMODELOTHR ' GARAGE 0 ATTACHED BATHROOM SF , 5F SF SF 0 DETACHED EXISING ❑YES EICHLER ❑ YES SECOND STORY ADDITION OYES • FIRE SPRINKLERS❑NO 0 NO ❑NO DWELLING SECOND DWELLING ❑yEs 0 ATTACHED❑DETACHED OTHER UNITS; UNITADDITON: ❑NO 5F POOLS ❑FIBERGLASS 0 VINYL-LINED ❑GUNITE D PREFABRICATED POOL-SF SPA-SF I SPA ATTACHED DYES 0 NO I TOTAL-SF • EIVED BY:n TQQQ'J'AL VA DATION: Conmiereial or Multi-Familu Build/Pis with Public Swimmino Pools reaulres Department of Envirmvuenlal Heath approval I]_� p._ f , Ti,` RE-RO OFI EXISTING ROOF TYPE: E BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑ITILE OTHER(SPECIFY) REMOVE/REPLACE❑NO IF NO PLYWOOD D'h" D 3/B" ' PLYWOOD TYPE: PITCH: ROOF CLASS ❑YES Y.OF LAYERS THICKNESS❑5/B" OTHER 005B ❑CDX OTHER •12 A PROPOSED ROOF TYPE:DBUILT-UP ROOF DASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER ."Provide a signed copy of the Cupertino's Tear-Off Policy SF Cot 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 purposes. I acknowledge and authorize all information contained on this application form to be made available for public record. Signature of Applicant/Agent: '�..----- Date: Ii-a43-17 SUPPLEMENTAL INFORMATION RE UIRED ' I. • *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 beiiig'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 : % Bldg71pp_2017.doc revised 08/01/17 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE g COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinq(c�cupertino.orq .., . T CANNOT BE=HNALED UNTIL THIS CERTIFICATE S._:BEEI\` COMPLETED,;SLGNED,,AND i TT RNED TO THE B i t ING DOISION 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 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 alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and m 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 id o 70644aLiCe- Permit No. 2677- Z-036' Specify Number of Alarms #Smoke Alarms I I #Carbon Monoxide Detectors 7. I I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature . .. . . .. Date: Contractor Name: , Pc in�/5vq� (;c f i—i124, Signature //,--1, / Lic.# 4��1..1! Date: i2-16 17. Smoke and COform.doc revised 01/10/2017