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B-2016-1836CITY OF (i UPERTINO BUILDING PERMIT urTrr airNG ADDRESS: CONTRACTOR: PERMIT NO:13- 2�o (6 -- It 3,C --- OWNER'S NAME: �� �II �)e®( (��e(I Vinke—' DATE ISSUED: RX -F -1,2-C) OWNER'S PHONE: ' I PHONE NO: 6 _�V _ ._ b 3;. 2 - LICENSED CONTRACTOR'S DECLARATION LICENSED BUILDING PERMIT INFO: License Class. 5 .ic. #_ 62S 113 / Contractor Date (,22,/ 1t PY-UM tyvl COviSiyUC'V0h ` X BLDG —ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that in license is in full force and effect. I hereby of one of the following two declarations: JOB DESCRIPTION: Crx p � � © Ci V1 1 / affirm under penalty perjury I have and will maintain a certificate of consent to self -ins e for Worker's `l_eCV_CL/60 SQ, FT) c I 1 S SQ• 1. ( N) v �(1 Compensation, as provided for by Section 3700 of the La or Code, for the I p ke- N OT CH ( O performance of the work for which this permit is issued. CN) PC- LAVV1 1l 'S /l I have and will maintain Worker's Compensation Insuran as provided for by k Section 3700 of the Labor Code, for the performance ofe work for which this -- Sq. Ft Floor Area: Valuation: Z 00 0.0 o permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the abo e 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 5 2-2-70", representatives of this city to enter upon the above mentioned roperty 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 on -point � source regulations p r the Cup eg4yu*unicipal Code, Section 18. 180 DAYS FROM LAST CALLF-4- NSPECTION. Sign ailrl Date 6/ 2/2016 Issued by: �a ✓/ Date: 06/22/2016 OWNER -BUILDER DECLtWai tuiy RF ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the 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 s 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 wil h licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 6/22/2016 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 -in sure 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 ofthe 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 s. I certify that in the performance of the work for which thi 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 becorl a subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after maki ig 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, SecAmA 2 505, 25533, and 25534. Labor Code, I must forthwith comply with such provision; or this permit shall be deemed revoked. Owner or authorized a nt: APPLICANT CERTIFICATION Date: 6/22/2016 1 certify that I have read this application and state that the above information is C 'STRUC PION DriNVIN q AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that. ere is a constru tion len g agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issue c. 3097, Civ C.) to enter upon the above mentioned property for inspection pur oses. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino ag inst liabilities, Lender's Address judgments, costs, and expenses which may accrue against sai City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the C pertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 2 Licensed Professional o� CUPERTINO 71 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ( (4088)) 777-3228 - FAX(y4!T—A—Ti- 8) 777-3333 • building G0cuDertino.orn �0« �� FYI ♦rn.mr it 1 I M nnT 0—t InaCIIDDATI n"OTCJTATAT D17DMTTH I=] PIT ADDRESS 10890 Wunderlich Drive AMM 375-22-006 OWNERNAMB George Campbell PIONE (408)746-9731 E-MAIL abersnaze@gmail.com BTRBBT"D1" 10890 Wunderlich Drive CITY, STATE, ZIP Cupertino, CA 95014 FAX CONTACT NAME Bill McIntosh(660)861-131 wmcintosharchitect@yahoo.com 11 A111 520 Laverne Ave CITY, STATE, ZIP Aptos, CA 95003 FAx ❑ OwNER ❑ OWNER -BUILDER ❑ OwNERAGENT ❑ CI N7RACfOR L7 CONTRACTOR AGENT ISI ARCHITECT ❑ ENGINEER ❑ DBVEIDPBR ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LTC# COMPANYNAME E-MAIL FAX STREBTADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME William McIntosh LTCENSENUMBER C-28419 BUS. LIC# COMPANYNAME William McIntosh, Architect B -MAIL wmcintosharchitect@yahoo.com FAX STREBTADDRESS 520 Laverne Ave C`TY,STATE,Z[P Aptos, CA 95003 PHONE (650)861-1319 DESCRIPT`0NOFWORK Addition and remodel of SFR: Added Bedroom, Bath, Laundry, Garage, Deck Addition; Remodel Kitchen, Dining Room EXISTING USB SFR PROPOSED USE SFR CONSTR B V- # STORIES 1 USE TYPE OCC. SQ.Fr. VALUATION ($� AREA 1,732 AXIM REA ARBA 432 NET ARE 2,367 BATHROOM KG.,r.,,.. OTHER REMODELAREA NIA ABMODBLAREA 140 REMOfMAREA 178 PORCH/A DECKARBA 70TAL13WWORCH AREA G QE ARBA; DETACH NIA 400 400 500 ATTACH #DWELUNG UNITS: IB A SECOND UNIT ❑YES SEC NDSTORY YES 1 BEINGADDED2 NO ADD riON7 ®NO PRE.APPLICATION ®YBS IF YES, PROVIDE COPY OF 19 TIER BLDC AN ❑ YES }, 5 4 ": TOTAL VALUATION: PLANNINGAPPL# ❑NO RESPONSE ATTACHED BICILERHOME7 ® NO 2-i �� By my signature below, I certify to each of the following: I am I'the property owner or authorized ager to ac on the property owner's behalf. I halve read this application and the information I have provided is correct. I hale read the Description of Work and verify it is acmimte. I agree to comply with all applicable local ordinances and state laws relating to b •' construction. utylorize re ntatives of Cupertino to enter the above identifed for inspection purposes. 1roperty C Signature of ApplicantlAgent: Date: SUPPLEMENTAL INFORMATION E UIRED °; +C7�l6elc`raIRE "� _ New SFD or Multifamily dwellings: Apply for dem lition permit for existing building(s). Demolition permit is required prior o issuance of buildin permit for new building Commercial Bldgs: Provide a completed Hazardous Materials Disclosure CQ ffrANI/ARp t7sLTewpxr#s .. _ form Tony Hazardous Materials are being used as part o this project. o >� _ Copy of Planning Approval Letter or Meeting with anning prior to „moo$ ` submittal Of Building Permit application. -c ;.Gi91INt7XS pl•: I" CD ENvmtiiv�afi.It:>t�AT.� Rldadnn 7nt7,i--i—dli/7wi SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777•-3333 a building(a)cupertino.ora Address j 0 )o P J PURPOSE # of PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIU= AND R`F LENED TO THE BUILDING DIVISION This affidavit is.a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 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 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 vidnibj of the, X X bedroom(s) Signature. Lic.# Date: On every level of a dwelling unit including basements 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 907.2.11 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 in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below I have read and agree to comply with the terms and conditions of this statamant Owner (or Owner Agent's) Name: 61"ir �G� Si nature. . ,.. .. , . . Date: Contractor me: Signature. Lic.# Date: Smoke and C'O fonn.doc revised 03118114 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (40 28 • F (408) 777-3333 buildina(a)cupertino.org Owner Name.feo�d,e. �`I LS777-32P PermitNo. E� Address 16 Wv�jer 1 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. X No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible?, 11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? 11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. N No Go to Question'4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancyafter January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4.` On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). 0 My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101,5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the followine naee. s Owner or Owner Agent's Signature: �! _�-1 //l Date: P2/ 1117 --i Upon completing and signing this Certificate, please return it to the Building Division in order to final vour buildinLOnermi t. SB407 2015. doe revised 08/26/15