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B-2017-0214CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0214 21063 CHRISTENSEN DR CUPERTINO, CA 95014-1652 (326 54 005) NOLASCO CONSTRUCTION GROUP MENLO PARK, CA 94025 OWNER'S NAME: PEARLMAN DALE L AND DARA B TRUSTEE ISSUED: 02/06/2017 OWNER'S PHONE: 408-996-1459 I I PHONE NO: (650) 289-6421 License Class 5 Lic. #626338 Contractor NOLASCO CONSTRUCTION GROUP Date 07/31/2018 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. I hereby affirm under penalty of perjury one of the following two declarations: t. 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 rfonnance of the work for which this permit is issued. 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. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Code, S ction 9.18. Signature_ �� Date 5/8/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). BUILDING PERMIT INFO: BLDG X ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: INSTALL (6) LIGHT FIXTURES - LIVING ROOM REV #1 - ADD 5 LIGHT FIXTURES - ISSUED 5/8/2017 Sq. Ft Floor Area: I Valuation: $1800.00 APN Number: Occupancy Type: 326 54 005 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende Date: 02/06/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 5/8/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" r. 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. 2. 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. s. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 5/8/2017 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code coons 2550 , and 25534. Owner or authorized agent Date: 5/8/2017 I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO 13 z0 i�--o2iy CONSTRUCTION PERMIT APPLICCATIs ��((�� ' COMMUNITY DEVELOPMENT DEPARTMENT • BUIBE I LOO ##.....ww.w.r 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building631cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESSrl I o (S /� C e h 7 J APN # %) �_ - / (1 VL�J iE OWNER NAME / PHONE �j (�i� � j�/�--UI k4-1 , _l -MAI Q (� Via''✓- Lc�:r ; h `"•v lV J i STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME 45OLM� �S �..I.n _ L `, J V' r PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME - �' LICENSE NUMBER LICENSE TYPE BUS. LIC # 62 O6- COMPANY NAMEE-MAIL. �/-�� 1O�'? [ j �oP7_ �> FAX �, .YdG �✓�'/.O ('9✓.�0� v��I�1i STREET ADDRESSCITY, 5 ;3 si'� riz (iYnve STATE, ZIP Ifo PH 2 - 6-12( ARCHITECT/ENGINEER NAME LICENSE NUMBER 2��33 BUS. LIC # 2 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE / DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED,DY:S. TOTAL VALUATION: C]PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 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. ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t g copstriictio_ . authorize representatives of Cupertino to enter the above -identified property for inspection purposes. ' " Date: 5- Signature of Applicant/Agent: _ SUPPLEMENTAL NTORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ; ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ r"REss ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ I= DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0214 21063 CHRISTENSEN DR CUPERTINO, CA 95014-1652 (326 54 005) NOLASCO CONSTRUCTION GROUP MENLO PARK, CA 94025 OWNER'S NAME: PEARLMAN DALE L AND DARA B TRUSTEE DATE ISSUED: 02/06/2017 OWNER'S PHONE: 408-996-1457 PHONE NO: (650) 289-6421 LICENSED CONTRACTOR'S DECLARATION BUILDING PEI T INFO: License Class j Lic. #626336 I Contractor NOLASCO CONSTRUCTION GROUP Date 07/31/2018 X BLDG X ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RES H)ENTLAL ) ENTIAL COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: INSTALL (6) LICjH2 FIXTURES - LIVINGROOM 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 'performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by {J Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $1800.00 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 326 54 005 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 F,XPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 1,80 DAYS OF "PERMIT ISSUANCE OR Additionally, the applicant understands.andwill comply with all non -point u source regulatio per the Cupertino Municipal Code, Section 9.18. 180 DAYSFROM LAST CALLED INSPECTION. Signature ''? Date 2/6/2017 Issued by: Abby Avende OWNER -BUILDER DECLARATION Date: 02/06/20170, I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected RE -ROOFS: prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without first Dbtaining 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 ofApplicanta contractors to construct the project (Sec.7044, Business & Professions Code). Date: 2/6/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF, COVERINGS TO BE CLASS "A" OR BETTER 1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's i Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE I have read the 4azardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Healthi& 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 this permit is issued, I Health &ection 25532(a) should I store or handle hazardous Safety t7ode, SH Additioi: d I devices hazardous shall not employ any person in any manner so as to become subject to the material. , shouluse equipment or which emit 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 t Health &Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. O,waer`-irr` horkze agent: APPLICANT CERTIFICATION (,Date: 2/6/2017 ld I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY C, I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Signature Date/2 6/2017 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(a)cupertino.I zoos ION m L to ❑ PLUMBING I I NLECHANTCAT- n FT Ff'TR Tr A T n ra7cr IT T A rrcnT TC m1bC PROJECT ADDRESS AP1,r r t u✓ OWNER NAME r PHOA pp f Yrs f'rz� [ 2 c C Q12 STREET ADDRESS CITY, STATE ZIP F , �y G 1 /jam t zr' ! �l CONTACT NAME �z PHONE ' !" -Ifs t `T EMAIL �j J d STREET ADDRESS CITY, STATE, ZIP FAX ❑ OIAWER ❑ OMIER-BUILDER ❑ OVNTTERAGENT . ❑ COATRACTUR ❑ CONTRACTORAGEI\T ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORTAA4E FZ c/ ( LICENSE NUMBER �Z �r � / L14 ENSETIPE �,� (� (� BUS. LIC r 40( ( 2 - lJ L COMPANY NAME f)5 a� cd o a-�� E -Aye M . ��/ n Gam% s I c sl��.c ��: FAX STREET ADDRESS CITY, STATE, ZIP /' PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER I i BUS, LIC f COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONB USE OF ❑ SFD or DLYLEX ❑ I,RTLTI-FAMILY PROJECT IN R'II.DLAND ❑ YES PROJECT IN BUJI-DLNG: ❑CON34ERCLAL URBANA'TERFACEAREA ❑. NO FLOOD ZdNE ❑ YES ❑ NO ,. IS THE BLDG AN ❑ YES EICHLERHOME? ❑ NU DESCRIPTION OF WORK _ Z Cl -;6,, /_174 �S i / s E? hq h I TOTAL VALUATION: g [� / ,D D� � RECEI��EDBY« �" ;>- _ :.:..,..:,_.:;. By my signature below, I certify to each ofthe following: I am the property owner or authorized agent to actllion the property o ner's beh If. 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- J.authcErize representatives of Cupertino to enter theabove-identifiedd property for inspection purposes. Signature of Applicant/Agent: Date: 0:6r /7 SUPPLEMEa, ,TAL INFORMATION REQUIRED '. ©\ ER,THE-COL''sTER- < fl LARGE AIEPAIiscApp_2011.doc revised 06121111 CUPEFiTINO PURPOSE SMOKE/ CARBON MONOXIDE ALARMS OWNER.CERT[FICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildinaCalcupertino.ora This affidavit is a self -certification for the installation of all required Smoke and Carbononoxide Alarms for compliance with 2016 CRC Section R314, R315, 2016 CBC Sections 420.6 and 907.2.11.2 w Iere 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 dwelluig 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 I SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door) X X 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. La 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 firdshes 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 specified below have been tested and are operational, as of the date sighed below. } ff Address: ;10. C'�.� ��- �c��� A Permit No. F ° Specify Number of Alarms: to 4 Smoke Alarms: # Carbon Monoxide Detectors: F7 1 l have read and acree to comply with the.,terms and conditions of this statement C(..eC i Signature .... ... ................... ....i° -s ....................... ... ....................... Dater/ ctor Name: nature.. ........................... i .................................... Lic.# ......................................Date:................. S777oke and COfbiwi. doe revised 01/1012017 CUPERTINO Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 8) 777-3228 . FAX (408) 777-3333 • building(Dcupertino.orq 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. ZYNo 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? ❑+ 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. Cl/No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. N-lNo 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 occupancy after 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. M"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. Ple e 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). ❑ 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 properly, 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'plurnbing fixtures comply with the requirements as indicated in the table on the following vane. A I Owner or Owner Agent's Signature: / -•/otx� Date: �/fl /1 i Upon,completmg and signing this c:ertrtrcate, please return it to the Building Division in order to trnal your building permit. SB407 2015. do revised 08126/15