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B-2017-0575CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0575 23500 CRISTO REY DR UNIT 319D CUPERTINO, CA 95014-6528 (342 53 098) �BAYAREA OWNER'S NAME: STEARNS MARY B TRUSTEE OWNER'S PHONE: 650-944-0118 LICENSED CONTRACTOR'S DECLARATION License Class 5 Lic. # 18 7817 Contractor BAY AREA ENTERPRISE Date 03/31/2019 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. 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 SAN JOSE, CA 95148 ISSUED: 04/12/2017 NO: (408) 238-5043 PERMIT INFO: BLDG X ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: UNIT 319D - INSTALL (N) LED RECESSED LIGHTS (6); REPLACE BATHROOM FANS (2); REMODEL MASTER BATH SHOWER - CULTURED MARBLE WALLS, PAN & SHOWER VALVE 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 Section 3700 of the Labor Code, for the performance of the work for which this C permit is issued. Sq. Ft Floor Area: Valuation: $6500.00 APPLICANT CERTIFICATION 1 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 pe C p Municipal Code, Section 9.18. Signature / _ Date 04/12/2017 "N Number: Occupancy Type: 342 53 098 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 04/12/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the I RF,ROOFS2 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 contractors to construct the project (Sec.7044, Business & Professions Code). 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. 3. 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 04/12/2017 Signature of Applicant: Date: 04/12/2017 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 QuaHtY.Management District I will maintain compliance with the . ipal Code, Chapter 9.12 and the Health & Saf ection 505, 25533, and 25534. Owner or authorized agent: Date: 04/12/2017 / 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 ARC'HITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professional CUPEftTINO I F-1 NFUI('nWQTRrT!'TrnTJ CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinga-cupertino.org ��f' �� sC6-47 F-1 AT1T,iTTl1TT ivi . n - 1v1�� BldgApp 2011.doc revised 06121/11 PROJECT ADDRESS2,55-00 � Jd VAIN 3 f q p ® `- P ® APN # 31ifa g g � � ® J OWNER NAME ma -eq /r H P 't L 5b 7l/-Otte.lfd.pie E-MAIL STREET ADDRESS /�rB �� / !r �, CITY, STA, ZIP ., �-y,� FAX ® b WI (/ 64 CONTACT NAMES6rlpm G PHONE ® — 2_ EMAIL t'C G - S 7 * _ STREET ADDRESS / y CITY, SPTAyTrE, ZIP �y FAX ❑ OWNER ❑ OWNER BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME e� LICENSE NUMBER LICENSE TYPE BUS. LIC # S COMPANYNAME E-MAIL `s -L Q/� % CO/IICP/`j P FAX STREET ` 1110 CITY, TATE, ZIP ` 419 pga v t^�q3 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME MAII FAX rd STREET ADDRESS CITY, STATE, ZIP NE DESCRIPTION OF WORK - � / 1 � 41, v� lad, c k G✓Gf e5 d it NOW 5 6( VkdW Qd �P-W Ls EXIST USE PROPOSED USE CONSTR TYPE # STORIES 1 USE TYPE OCC. SQ.FT. VALUATION ($) EX%TG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGE AREA: El DETACH ❑ ATTACH #DWELLINGUNITS: ISA SECOND UNrr OYES SECONDSTORY OYES BEINGADDED? ONO ADDMON? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF` IS THE BLDG AN 0 YES �� Rl✓CEiVEi].BY _.. - -- -_. -- - ``- : -- :�_..-� T TAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EI ER HOME? ❑NO By my signature below, I certify to each of the lowing: the property owner or authorized agent to act on the property owner's be If ave read this application and the information I have provide s 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 to buildi ctio I authorize representatives of Cupertino to enter the above -identified prope forhinsp chop purp(Is U Signature ofApplicant(Agent: Date: 1/ SUPPLEMENTAL INFORtIWN REQUIRED PLANAHECK TYPE xoo�IN SLIP C I=� T cQI�I+tz; R f3 $tlannv rxEvtw 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. EXPRESS ©--rr,Atvl�lnvrL�Ivzv�w _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure [ sIAloaiu} rusLic,woIs form if any Hazardous Materials are being used as part of this project. LARGE- - PIPS DEFT-; _ Copy of Planning Approval Letter or Meeting with Planning prior to Il_ MAJOR i S INIfiARYSERERDYSTRTCT -: submittal ofBuilding Permit application. EIVVIROIV'MENTAL-HEAITH BldgApp 2011.doc revised 06121/11 "^ • PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cuoertino.org PERMIT C.vNNO 1111: FIN \11J) UNTIL TIL TFHS CERTIFICATE HAS BEEN' C(Y) 11'1_E FD, SIfIN I), AN 1) RE'l IJ'\1°1) TO'hIIE BUILDI ; Dl�_ISIO 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 ALAR_ M 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 IX 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 specified below have been tested and are operational, as of the date signed below. Address: pv Z121 S�Ty JCC K 62/2 fj Permit NokZ'10 —:: Specify Number of Alarms: _ #Smoke Alarms: �/L�# Carbon Monoxide Detectors' ` �J I have read and agree to comply with the terms and conditions of this statement Owner (or er Agent's) Name: Signature................ ...................................................................... Da�9 ............. Contr to am . Signature...................................................................... Lic.#........................................ Date:................... Smoke and COforrn.doc revised 01/10/2017 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Cl11PN=RTtfdp I (408) 777-3228 • FAX (408) 777-3333 • building(tupertino.org Owner Name 's ;rn5A a 0-k-< Permit No.1�- 2017 - Address 2_7512L-! T (x:12 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. V No Go to Question 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 fonn. • K 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. E�=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 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. ❑ 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.. 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). ❑ 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 plumbing fixtures comply with the requirements as indicated in the table on the following page. i I Owner or Owner Agent's Signature: _/ 4 , __ Date: /^fid —,-T I Upon cornpleting and signing this Ce r tev se return it to the Building Division in order to final your building uennit. SB407 2015.doc revised 01/05/17