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15060136CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10821 NORTHOAK SQ CONTRACTOR: JOHN SULLIVAN PERMIT NO: 15060136 CONSTRUCTION OWNER'S NAME: MEDAMPALLI THfRULOGACHANDAR&SUJATHA 960 OPAL DR DATE ISSUED: 06/23/2015 OWNER'S PHONE: 6128454135 SAN .LOSE, CA 95117 PHONE NO: (408) 3154254 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL [� f� II �t�'3 7 LEGALIZE PRIOR WORK DONE WITHOUT A PERMIT. License Class J 1 Lic. 4 3 EXISTING BEDROOM DIVIDED INTO 2 BEDROOMS �OtitA G — 3,(S� Contractor l �. Vf/1�1 nS Date (ADDED l WALL) 2ND FLOOR (REMODEL AREA 473 S.F.), I hereby affirm that 1 am licensed under the provisions of Chapter 9 BATHROOM (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: 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 Sq. Ft Floor Area: Valuation: $10000 performance of the work for which this permit is issued. 1 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 APN Number: 31641022.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued b Date: y� +��//�� / .] with all non -point source regulation per the Cupertino Municipal Code, Section 9.18. L�3 RE -ROOFS: Signature v Date 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, 5534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued._ 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION CC I COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(ocupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS F''� rv0M- E"l IV APN # _ - w 31,6 I t OWNER A ....... �� ` / 1'' ` U- !)ti PHONE6 12 - H N (L f 1/•' �'/� "�[ a`W STREET A RESS 16921 mo gMOAk CITY, T TE, ZIP[J FAX CONTACT NAMErr �� mlwl>— PHO 2 2 E-M.AIL I'i STREETA hk1afWVCT. 9A CITY S A ZIP ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 1 - w� LICENSWUMBEER7 LICE SE TYPE BUS. LIC H COMPANY NAMEE-MAIL Sul �v�,�af► �� s��<<��►—cn�s� %4 had��I� FAX STREET ADDRESS ,nln r 1 rJ ` CITY, ,ST�ATE,`Z�SC O Py.S�u J ARCHITECT/ENGINEER A LICENSE NUMBER BUS LIC H COMPANY NAME "� (/ F -MAIL_,__( ,� „ A C FAX STREET DRESS CITY, STATE, Z PHO oe ` DESCRI (30 i �,/ � (f^l�f&�J j,j�Jy1(�F tom, Nt/ - (� �9UV VD- GAl! V WV AT— V ANu/`� EXISTING USE 11[//�rj-j�VI PROPOSED USE CONSTR TYPE Vt, d STORIES USE TYPE OCC. SQ.FT. VALUATIONgr�($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET .AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA AREA GARAGE AREA: LJDETACH T7ALDECKIPORCH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF NO PLANNING APPROVAETTER PLANNING APPL # ❑ L L IS THE BLDG AN ❑ YES EICHLRR HOME? ❑ NO VLD $ i +r' u, G TOTAL VALUATION: /n V By my signature below, l certify to each of the following: I am the property owner or authorize agent to act on the property owner's behalf. 1 have read this application and the information 1 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 build' n ctio utho ze representatives of Cupertino to enter the above -identified prroojpertyy for inspection purposes. Date: Signature ofApplicant/Agent SUPPLEMENTAL A*Tlm 16E UIRED;.;;r> >: ', New SFD or Multifamily dwellings: Apply for demolition permit for building(s). Demolition is required to issuance of building thbTa�2c PnavR�zEw existing permit prior permit for new building. VXPIR S " �, /0",ii[NG PL,3NlR �'LtW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure „.. '. I.;grlunRts ;' -, „ . PIJBLIf itURKS' form if any Hazardous Materials are being used as part of this project." [+M DEN`t ; Copy of Planning Approval Letter or Meeting with Planning prior to�' Q MdtiR "':. i� t5ANi7 WILY Skil PR 1fI$TRl # submittal of Building Permit application..,, , ,,,, ,,;, , iViTicNi1t+tTAhFtALix B1dgApp_201 ].doe revised 06/21/11 CITY OF CUPERTINO ��60 I13G FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 MI.' 711113) ADDRESS: 10821 Northoak Square DATE: 06/22/2015 REVIEWED BY: Paul Plumb. Permit Fee: IPPERMIT APN: 316 41 022 BP#: 3 (C'2 'VALUATION: j$10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition $0.00 PRIMARY USE: SFD orDuplex PENTAMATION PERMIT TYPE: 1 R3SFDREM WOR Bedroom on 2nd Floor Remodel Area 473 S.f. Bathroom remodel 36 S.. Add Vanity in SCOPE Hallway, New Gas Line to Kitchen Range 0.0 hrs NOTE: This estimate does not include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 MI.' 711113) FEE Plumb. Plan Check 0.0 1 hrs $0.00 MISC ITEMS "P"-/ Plumb. Permit Fee: IPPERMIT $0.00 bl("p Other Plumb Insp. 0.0 �s$48.00 I1,sn. �rcJz. 1��5�z /"/' P/11 b, / r ). I _i_. 0'', NOTE: This estimate does not include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 MI.' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s. f. $503.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 36 1 s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 # Plumbing $72.00 IPGASRES �' Piping, Gas <=4 Outlets PME Unit Fee: $0.00 PME Permit Fee: $48.00 (arzNa ;', L,,._ Administrative Fee: IADMIN - $45.00 0 0 Work Without Permit? C) Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 A Travel Documentation Fee: ITRA VDOC $48.00 Strom; Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $143.301$1,22:0 00 TOTAL FEE �, $1,363.30 Revised: 05/07/2015 CUIPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408777-3228 Fax: 408-777-3333 JOB ADDRESS: r ,"✓' PERMIT OWNER'S NAME. /l%= �- PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: _ CITY/ZIPCODE:_ _ ry" "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL UBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date WATER -CONSERVING PLUMBING FIXTURES 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)cupertino.org 135 Owner Name 1-0-V !��? �� la f�C NA --JPA - "'-\DPr� i P ALAI Permit No. `-�c- ` Address t rV v :rc}i-. p ;1% S� `1, C.�P�'v ; fNJ . C A Please refer to the attached California Civil Code Sections 1101.1 — 1101.8 which are part of this Certification form. Is yotrrreal property a registered historical site? y__ real Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: ` 1 V d'%lo Go to Question 2. U"\ Date:,-� -712—( zo i 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 110 1. 1 through 1101.8 do not apply. ❑ The licensed plurnber's certification has been provided to the Building Division. Sign below and skip the rest of the form. Date: Owner' Signature: ru No Go to Question 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: f C� No Go to Question 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 110 1. 1 through 1101.8 o not apply. Sign below and skip the rest of the form. n^ (� /7,;; 1 Owner' Signature: A, V' Date: � � Z� Er -`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. Refer to the attached. 0 --my property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or unprovements 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 i nprovements). ❑ 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. SB407 2015.doc revised 02104115 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/We, the owner(s) of this property, 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 110 1. 1 through 1101.8, the current California Plumbing Code and Calif o 'a Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving pluwmnbing s comply with the requirements as indicated in the table below. Owner's (or Owner Agent's) Signature: FV k_-� t Date: ,-)T Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015.doc revised 02104115 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015.doc revised 02104115 CUPERTINO Address 10% 1 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 • buildina ancugertino.or4 P, ir11" Permit No. I I I �JCi PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 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 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) X X On every 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 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 have been tested and are operational, as of the date signed below. 1 have read and agree to comply with the tefms and conditions of this statement OOvner (or Owner Agent's) Name: p Signature .......................... ........................ Date Contractor Name: Signature................................................................... 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