B-2016-2350 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2350
10351 N PORTALAVE CUPERTINO,CA 95014-2324(316 31 020) HOMEOWNER
BUILDER
OWNER'S NAME: MCMANUS MARCELLA M TRUSTEE DATE ISSUED:07/20/2016
OWNER'S PHONE:408-255-1034 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor HOMEOWNER BUILDER Date X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MEECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: MASTER BEDROOM BATHROOM REMODEL-(64 S.F.);REPLACE
WINDOWS(10)-LIKE FOR LIKE.TO MEET EGRESS'
1. 1 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. Sq.Ft Floor Area: Valuation:$12000.00
APPLICANT CERTIFICATION
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 "N Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 316 31 020
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 all
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.
Signature Date 7/2012016 Issued by:Abby Ayende
Date:07/20/2016
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)
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:7/20/2016
I reby,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
j performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
C,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 t Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with th pertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co' , ections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION Date:7/20/2016
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 I hereby affirm that there is kconstrqction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permi ' i ed(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,cosK,and expenses which may accrue against said City in Lender's Address
consequence o granting of this permit. Additionally,the applicant understands
and will comply h II non-point source regulations per the Cupertino Municipal AR HIT . T' DECLARATION
Code,Section 9.1 1 understand my plans shall be used as public records.
Signature Date 7 2 1 Licensed
G i Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333•building(a)cupertino.org
$-ZoVp
❑NEW
CONSTRUCTION
ONSTRUCTION ❑ ADDITION ALTERATION/TNIE— REVISION/DEFERRED ORIGINAL PER
MIT#
kPROJb�J
OVVNERNAME OE-MAIL
16A 6C- 1zr % 2- —1®3 1\CG c.Ma M
S w L
ET DRESS C STATE,ZIP FAX
CONTACT NAME PHONE ' E-MAIL
5arne A-5 A5AVe -
STREET ADDRESS CITY,STATE,ZIP FAX
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR El CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CAL
CONT A CTOR N 'T 6 n t s& � LICENSE®ERP 0 LICENSE TYPE BUS.LIC
COMPANYNAME N i` FAX
STREETADDRESS:R � e2 & A�i Ia , PHONE
tQ ARCHITECT/BNGI NEER NAME LICENSE NUMBER 1� BUS.LIC#
COMPANY NAME E-MAIL
FAX
STREET ADDRESS q„ CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
S A
tZ t L GI✓ - ` s LV00iwel r>ae,A--°-S AMS S J-L- a i e-V'&ria 7cl:>o L-ill � i �,..
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
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
FBEINGADDED? ❑NO ADDTFIOI, ❑NO
PRE—APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REOEIV D BY A/L VALUATION
[:] :
PLANNING APPL# NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO l e .
JA 14
By my signature below,I certi each of the following: I am the property owner or authorized agent to act on the roperty owner's behalf. I have read this
application and the information h-v,ph,,
r vided 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 relatin t b g construction. I authorize representatives of Cupertino to enter the above-identified property for inspection-purposes.
Signature of Applicant/Agent: A Date: 1 KJ
SUPPLE M INFORMATION REQUIRED
r
PLAN CHECK TYPE ROUTING SLIP:
New SFD or Multifami dw pings: Apply for demolition permit for � ,
existingbuilding(s). Demol do i3vER THlrCUUNTEIt ❑ suuDIiyrLAN RFv
permit Is required prior to Issuance of building
XVIk
permit for new building. Ll EKPRESS ! ❑ PI SNNING PLaNRE1 IEYY
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTArmARD ❑ PUBLi��VoRxs
To—nn if any Hazardous Materials are being used as part of this project.
„ z *
LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAaOR ` ❑ SANrrARYSE0RbISTRICT
'" a i ❑ ENtIRONMENTAtAhALTH
BIdgApp_2011.doc revised 06/21/11
'
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
CUPERTIN0 (408)777-3228•FAX(408)777-3333•building(acupertino.ora
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS (8
p , P ` �� ' * y BP# P_
ff) 5) f ltJdLl w 1t6'i�tJ APN f�
OWN4R NAME OWNER ADDRESEL
to 7,0
DESCRIPTION OF WORK: tvtwopuiS 4 Do
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed,and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIR TIONS:Please read and initial each statement below to signify you understand or verify this information.)
I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner-
ilder"building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. 1, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
rovide coverage for those injuries.. I am willfully acting as an Owner-Builder and am aware of the limits of my
`i surance coverage for injuries to workers on my property.
I understand building permits are not required to be signed by property owners unless they are responsible for
construction and are not hiring a licensed Contractor to assume this responsibility.
understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may
r tett myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
e instead of my own.
I understand Contractors are required by law to be licensed and bonded in California and to list their license
u ers on permits and contracts.
5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors,and the
al value of my construction is at least five hundred dollars($500), including labor and materials, I may be
onsidered an "employer"under state and federal law.
6. 1 understand if I am considered an"employer"under state and federal law, I must register with the state and
f eral government,withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
a employment compensation for each "employee." I also understand my failure to abide by these laws may subject
me serious financial risk.
7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family
idential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
icensed subcontractors and the number of structures does not exceedfour within any calendar year,or all of the work
i ,performed under contract with a licensed general building Contractor.
I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
inancial or personal injuries sustained by any subsequent owner(s)that result from any latent construction
cts in the workmanship or materials.
OWnerBuilderFonnn 2010.doc revised 04114110
9. 1 understand I may obtain more information regarding my obligations as an"employer"from the Internal
Revenue Service,the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State
License Board (CSLB)at 1-800-321-CSLB(2752)or www.cslb.ca.gov for more information about licensed
contractors.
10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner-Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license,the Contractors'State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers'compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued,this form must be completed and signed by the property owner and
returned to the agency respo ibl for issuing the permit. Note:A copy of the property owner's driver's license,
form notarization, or other verific "on cceptable to the city may.be required to be presented when the permit is issued
to verifythe property owner's sin ur .
Property Owner's Signature: Date: 711-72-0-) IL
p
(NOTE. The following Authorizat Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWN'ER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
OwnelBuilderFonn 2010.doc revised 04/14110- -
Assessor's Parcel Number:
Name of Owner: c,!(- M!L !l 15
Contact Person: %JQ+;k- � / Phone;
Project Address: f 5- I
Scope of Work: "i �� �t f 2we1d
VL
Code Editions: 2013 California Residential Code
2013 California Plumbing Code
2013 California Mechanical Code
2013 California Electrical Code
2013 California Energy Code
Mechanical Notes:
I. Bathroom vents shall terminate not fess than 3 feet from openings and property lines.(CMG 504.1)
"Energy Code MandatoLy Measures:
1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy luminaires(150(k)(7))
2. Permanently Installed luminaires In bathrooms shall be high efficacy luminaires OR are controlled by an.occupantsensors(s)certified to comply with Section 119 that
does not turn on automatically or have an always on option.(150(k)(10))
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EXISTING R 'qww
Plumbing.Notes:
I. Water closets shall have an average water consumption of not more than 1.28 gallons per effective flush.(CPC 403.2)
2. Shower heads shallhave a water flow not exceed 2.0 gallons per minutes @ 80 psi.(CPG 408.2)
3. Faucets in lavatories shall'have a water flow not exceed 1.5 gallons per minutes @ 60 psi and shall not be less than:8 gallons per minutes at 20 psi.(CPC-403.6)
4. Shower 5talls shall have a clear inferior finish area of 7.1 sq fL and be able to accommodate a minimum 30 Inch circle at the threshold level.These clearances shaltbe
maintained up to a height of 70 inches able the shower drain.(CPC 408.6)
6, Shower compartments and walls above bathtubs with Installed shower heads shall be finished with a smooth,nonabsorbent surface to a height not less than 72 inches
(6ft).(CRC R307.2)
6. The maximum hot water temperature discharging from the bathtub,shower and whirlpool bathtub filler shall be limited to 120 degrees Fahrenheit.The water heater
thermostat shall not be considered a control for meeting this provision.(CPC 409.4&408.3)
7. Water closet shall be set minimum 15 inches from Its center to a side wail or obstruction and 24 inch clearance in front of water closet.(CPC 402.5)
Electrical Notes.-
1.
otes:1. The Installation of smoke alarms in all of the following areas shall be provided; (R314.3)
a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms.
b. In each room used for sleeping purposes.
c. In each story within a dwelling unit,including basements but not including crawl spaces and uninhabitable attics.
2. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area In the Immediate vicinity of the bedrooms and on every level including `
basements in dwelling units that have fuel-fired appliances or allached garages.(CRC R315.1) t
3. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets.such circuits shall have no other outlets.(CEC 210.11(CH3))
4. All receptacles in bathrooms,garages,accessory buildings,outdoors,crawl spaces,unfinished basements,kitchens(where receptacles serve counter top surfaces), x
laundry,utility,wet bar sinks(within 6 feet of the edge of the sink),shall have ground-fault circuit interrupter(GFCI)protection. (CEC 210.8)
5. in all areas specified in 210.52,ali 125-volt,15-and 20-ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.11)
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BUILDING DIVISION - L,, PERTINO
APPROVEDi
IMUST be kept at the
`e o�f.plaecitiL scr�s,,,�•
^'1 site during c0i(struction It is Lll.ia'v�'ful t 7 make zany
Ch nges or it gyrations on sante, or to de iate
{h` the &,'-o 1,L' o olu approval from the BL,'ilding Official :
Ti S,arri ing of this plait and specifications SHALL NOT
b held.to peri,t or to be af; arproval of thb violation
of any pr visors f ar.y CityJrdinara or State Law.i
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