B-2017-0341CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0341
10937 NORTHSEAL SQ CUPERTINO, CA 95014 (316 40 024) EKIM PAINTING -
NORTH INC
CUPERTINO, CA 95014
OWNER'S NAME: JAKOB MARY K TRUSTEE
OWNER'S PHONE: 408-378-3887
LICENSED CONTRACTOR'S DECLARATION
License Class B: C-33 Lic. #1723665
Contractor SKIM PAINTING - NORTH INC Date 07/31/2017
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:
1. I have and will maintain a certificate of consent to self -insure for Worker's
ACompensation, as provided for by Section 3700 of the Labor Code, for the
S� performance of the work for which this permit is issued.
•,gam/2' ) 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 reg..platbTi .per thelpup'ertino Municipal Code, Section 9.18.
Date 3/1/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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).
I hereby affirm under penalty of perjury one of the following three 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.
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 `
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 ISSUED: 03/01/2017
PHONE NO: (408) 996-3897
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPAIR BALCONY & REBUILD GUARDRAIL TO CODE
Sq. Ft Floor Area: I Valuation: $2000.00
"N Number: Occupancy Type:
316 40 024
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Abby Ayende
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 3/1/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 Co e, Syns 25505253, and 25534.
Owner or authorized agent:
Date: 311/2017
CONSTRUCTION LENDING AGENCY
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
Date 3/1/2912 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 • building cc),cupertino.orq
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DNEWCONSTRUCTION n ADDITION f ALTERATION ITT L F RF.VTSTnNInFFFRRFn nRT(;TNAT.P1:PWTld
PROJECT -ADDRESS 10937 Northseal Square, Cupertino, CAT"N#316.
—.o
OWNERNAME Marvin Jakobs, Jakobs Rentals I PHONE (408) 378-3887
` E-MAIL marvjakob@gmail.com
STREET ADDRESS same
CITY, STATE, ZIP Cupertino, CA 95014
FAX,
CONTACT NAME Butch Brisbin
PHONE (408) 996-3897
E-MAIL ekimconstruction@gmail.com
STREET ADDRESS 10200 Imperial Ave
CITY, STATE, ZIP Cupertino, CA 95014
FAX (408) 996-3897
❑- OWNER ❑ OWNER -BUILDER ID OWNER AGENT % CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT D ENGINEER 1:. DEVELOPER 13 TENANT
CONTRACTOR NAME Ekim Painting - North, Inc
ENSENUMBER 623665
F
LICENSE TYPE C33 B
- BUS LIC # 6197
COMPANY NAME Ekim Painting - North, Inc
E-MAIL ekimeonstruction@ginail.com
FAX (408) 253-9527
STREET ADDRESS 10200 Imperial Ave
cITY;STATE,zIP Cupertino, CA 95014
PHONE (408) 996-3897
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK Like for like exterior construction repairs; to include balcony repairs and rebuild of existing railing
to bring railing up to current building codes.
EXISTING USE
PROPOSED USE I C_ONSTR
TYPE
n STORIES
residence
same
2
.USE
TYPE
OCC.
SQ:FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
-
AREA
AREA n/a.
AREA
NET AREA
BATHROOM
KrrGHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA TOTAL DECKIPORCH AREA
- GARAGE AREA:
BDETACH
ATTACH
rDWELLINGUN[TSi
1SASECONDUYIT ❑YES
SECONDSTORY .❑YES
BEING ADDED? NO
ADDITION? ®NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES.
CEI D BY
TOTAL VALUATION:
,PLANNING APPL C 1� NO PLANNING APPROVAL LETTER
EICHLERHONIE? ®NO
rlau&A,i —
V fie
By my signature below, I certify to each of the folloWving: I am the property owner or authorized agent to act obi the property owner's behalf. I have read this
application and the information I have Wed' 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 uildi constructio IthoYize repre entatives of Cupertino to enter tine above-ide—ntijfied p inspection purposes.
/roperty'for
Signature.ofApplicant/Agent: Date:.
SUPPLEMENT FORMATION REQUIRED
PLANCFiecKTYPE.
ciouTi,'GSLIP
17-1 OVER -TM -COUNTER'
1771. BUH DLNG PLANREVIEN
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s), Demolition permit is required prior to issuance of building
pen -nit for new building.
❑ EXPREMS
❑PLA\21WG'PrLkN REV"[Ew
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Q STANDARD :
❑PUBLIC %VORTCS
fOlm if any Hazardous' Materials are being used as part of this project.
❑ Lt►RCE
11 FIREDEPT
_ Copy of Plaruiiitg Approval Letter or Meeting with Planning prior to
❑ MAJOR
11 SANITARY SEwERDISTRICT
submittal GfBuilding Permit application.
-
❑ ENVIRONMENTAL HEALTH
BldggAApp 201 Ldoc revised 06121/11
SMOKE I CARBON MONOXIDE ALARMS w- n m2a E
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENTOEPARTMENT -BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
tPERTINO
(408)777-3228 - FAX (408) 777-33$3 w buildingcupertino.org
Permit No.
CarbonMonoxide:
Address of Alarms Smoke:
PERMIT CANNOT BE FINALED AND COMPLETED UNTffi THIS CERTIFICATE
TO THE B UILDING DB719tbN
ETA
A
PURPOSE
This affidwdtis a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
4
comuliance with 2013 CRC Section 8314, 2013 CBC Sections 420.6 and 907.2.11-2 where no interior access for
inspections are re
GEN—tRAL. INFORMATION
Existing single-family and multi -family divellings shall be provided with Smoke Alarms and Carbon
Monoxide alarrog. 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 ACarbon and/or on
Monoxide Alarms be installed In the follo�ving locations:
SMOKE ALARM CO ALARM
Carbon Monoxide alarms are not required in dwellings which do not contain fuel burning appliances and that
alarms c 'alarms shall comply with
do not have an attached garage. Carbon monoxide a ombined with smoke
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
er p!yr; IrL dwelling units with no commercial y bi-en tery- operated,
be s batt
i.arrs 1h=ms -are permitted tobeSd7ejy_ vmeze-Tep=s_o- aitc i-rs.
do
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As owner of the above -referenced property, I hereby certify that the alarm(s) referenced abmze rps
installed in accordance Adth the manufacturer's instructions and in compliance with the California BuilL
alarms have been tested and are operational, as of the date signed
and California Residential Codes. The 0
below.
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Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On Eery 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
alarms c 'alarms shall comply with
do not have an attached garage. Carbon monoxide a ombined with smoke
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
er p!yr; IrL dwelling units with no commercial y bi-en tery- operated,
be s batt
i.arrs 1h=ms -are permitted tobeSd7ejy_ vmeze-Tep=s_o- aitc i-rs.
do
'_-'aaV
MY
-pegawfl5i" Aw
f ro —�,fV a- a zZI I—_ M A I a wAng, W YE M
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced abmze rps
installed in accordance Adth the manufacturer's instructions and in compliance with the California BuilL
alarms have been tested and are operational, as of the date signed
and California Residential Codes. The 0
below.
I ha vee fead and ag= to corn 1Y vAth th4- 61-7 Ns sta,'emen
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CUPERTITaiO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COivlMUNI TY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
±0300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408 7�f7•-3228 s FAX s r (408) 777-3338 • building0gleninc-orc
I, is your real property a registered historical site?
rl Yes Civil Code Sections 1101.1 through. 1101.8 do not apply. Skip the rest of the form and sign bottom of foral.
U NN o Go to Question 2.
2. roes your real property have a licensed plumber certifying that, due to the age or configuration of the prcgpery or its
plumbing, installation of Nvater-conserving plumbing fixtures is not technically feasible?
Yes Civil Cade Sections 1101.1 through 1I01.9 do not apply.
3= The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the fain and sig bottom of form.
Li
Ts -%eater service permanently disconnected for your building?
G{ Yes Civil Code Sections 1101.1 through 1141:8 do not apply. Skip the rest ofthe fore and si- 'ter m—
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 19942
Q No My real property is built and availably for use o> occupancy after januaiy
1.1994.
Civil Code Sections 110 1. 1 trop 10 1.8 do not apply, S Ldp the restofthe fog
XYes Iv4y real property is built and available for use oz occupar cy pq or bet'gre january
Civil Code Sections 1101.1 through I101.8 apply. Check one of the th-ree F611 d„
bottom of form..
5. Please check ONE of the following:
4' :property is a sin&b fdmil}j siile�ztirrL re l prc�pe See Civil Cade Sept= 1 1.
On and after:Jan 1, 2014, buiiding alt dads or inaprovements sliefisequire all €zon-eoinpiiarit pldnibing fixtures
- to be replaced -with N-vatcr-con erving ���b _��hri7 ube l,�ilding. Or or before Jar nary i, 2017., all non-
coir pl�art pli rnbin n,ures=shall replaced tvifa e Ing Ph3TihL11g fi re ..(leaardless of i�hether
�' ' ,propertj= undergoes altorafioi� o_ v�rpro�'e ��s = .- .. -
01 --m-'y pyor!` rty is a nmd iizrnio 'I F" #', zeal z. ri a
On 1�2014.
olrtb�n�=fxtnrs✓s to be realaced with water-conser�=trig dumbing fixtures.
On or before _January 1,'2019, all non-compliant plumbing fixtures shall be replaced -kAithwater- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements).
as the ovvner or oxNner's agent of this property, certify under penalty of perjury -that non-compliantplumbing fixtures will be
.replaced prior to date specified above with water -conserving plumbing fixtures in accordance with £iN-il .Cade Sections 1101 A
through 110 1.8, the current Cal=fornix Plumbing Code and California Green Building Standards Code, arf ' marpfac Tees
installation require:fients- and =flat the v ater-conservingpt Fl plwith he retuirem is as intdica)ed in the
taableon. the follo v,_'g tee:
F. _� nr C� rfer nx' r n tore. Date:
L.
{ ` ? iiip s33 V mid si airs this CeriiYicate, please Ie iii ii to lie I�tilld}Zla I?i3-i5ion til Qr{l r TO -final Z`Qut I�tt IrTirio n..=rmit
i
t .
SB4072015.doc revised 081261.=75