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Home My WebLink AboutB-2017-1618CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1618 10194 MINER PL CUPERTINO, CA 95014-2202 (316 26 079) MARTZ DESIGNS PLUMBING TRACY, CA 95376 OWNER'S NAME: NISSEN PEGGY ANN TRUSTEE OWNER'S PHONE: 408-255-1607 1► C 1 1' 1 1► License Class j} Lic. #1010543 Contractor MARTZ DESIGNS PLUMBING Date 01/31/2018 1 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 t. I have and will maintain a certificate of consent to self -insure for Worker's 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 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 ppplicant understands and will comply with all non -point source regulatighs per the Cupprtinojlvlunicipal Code, Section 9.18. Date 9/20/2017 I hereby affirm that I ant exempt from the Contractor's License Law for one of the following two reasons: 1, 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) 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: t. 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. 3. 1 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 W, 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 9/20/2017 DATE ISSUED: 09/20/2017 PHONE NO: (209) 640.0222 BUILDING PERMIT INFO: X BLDG X ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: KITCHEN REMODEL (192 S.F.); PANEL UPGRADE (200 AMPS) Sq. Ft Floor Area: I Valuation: $10000.00 APN Number: Occupancy Type: 316 26 079 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: 09/20/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Applicant: Date: 9/20/2017 "An 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 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cu ertino Municipal Code, Chapter 9.12 and the Health & Safety Code, ctions 2550 2553 , and 25534. ner or authorized agent: Date: 9/20/2017 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 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �I,, (408) 777-3228 • buildin g cupertino.org PEMIT #B -ao�� lu CUPERTINO REV a DEFa ❑ NEW CONSTRUCTION ❑ ADDITION LTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS S cJ APN v� / / r eAp OWNER NAME PHONE' j 6 E-MAIL STREET ADDRESS CITY, STATE, ZIP CO TRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE L STREET ADDRESS Try, STATE, ZIP 36) 1 CL E-MAIL / _ ^d BUS. LIC ► r Z,PHONE ❑ ARCHITECT ❑ O NER ❑ WNER A NT ❑ CONTRACTOR AGENT[] ENGINEER ❑ DEVELOPER ❑ TENANT / E-MAIL CONTACT NAME dlv" e STREET A DR j CiCY, ATE, ZIP ea PI IE� O� ^ t r�I 0-3 1A/ c� l DECRIPfON rem. ' do 1 C ►-� c, , SINGLE-FAMILY/DUPLEX [_1 MULTI -FAMILY El INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) STING USE r I EXISTING SF NEW FLOOR SF I PORCH SF DECK SF DEMO SF STORIES a TOTAL NET SF REMODEL REMODEL KITCHEN REMODELOTHR GARAGE ❑ ATTACHED BATHROOM SF SF SF SF ❑ DETACHED EXISTNG ❑ YES EICHLER ❑ YES SECOND STORY ADDITION ❑ YES FIRE SPRINKLERS.R NO NO JRNO DWELLING SECOND DWELLING []YES ❑ATTACHED❑DETACHED OTHER UNITS! UNITADDTTON: O SF POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED POOL -SF SPA - SF SPA ATTACHED M YES ❑ NO TOTAL -SF RE EIVED BY: TO L VAALUATION: Commercial or Multi -Family Buildings with Publir 5winmfing Pools requires Deaartmeni of Envirmimnilal Heath approval till RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES❑ WOOD SHAKES ❑ WOOD SHI GLES ❑ E OTHER (SPECIFY) REMOVE /REPLACE[:] NO IFNO PLYWOOD ❑'� ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS [ YES A OF LAYERS THICKNESS E:]5/8" OTHER I ❑ OSB ❑ CDX OTH ER .12 A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER "Provide a signed copy of the Cupertino's Tear -Off Policy SF aof SQUARES 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. 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. I authorize representatives of Cupertino to enter the above -identified property for nspection p rpos s. I acknowledge and authorize all information contained this application form to be made available for public record. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED "New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction. "Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. "Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. "HOA -Provide a letter of approval from the Home Owner's Association B/dgApp_20/7.doc revised 08/0///7 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT iDEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org PERMIT CANNOT BE F'INALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED, SGNED, AND RE,��t�tNE� D TO THE BUILDING DIVISION PURPOSE 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 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. 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 907.2.114 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. /G j----A)&LC15-. C ii,�c�� ; r�t.'� , L" 9c-e✓L/ Permit No. C! r7 ` G? / Specify Number of Alarms # Smoke Alarms F-7-1 # Carbon Monoxide Detectors l have read and agree to comply with the terms and conditions of this statement O er (or Owner Agent's) Name: � Sinatures L ": , . .. N'^.L� ...Date: Contractor Name: ,ry/j �CaGv'G 14 vr! ice---� ` V j Signature Lic.# !C'�l �13 �4 Date: t_. Smoke and CO form.doc revised 0111012017