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15030119CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 866 SEPTEMBER DR CONTRACTOR: PERFECT HOMES PERMIT NO: 15030119 CONSTRUCTION CORP OWNER'S NAME: DUTT HITENDRA K AND GAURI 382 LASSENPARK CIR DATE ISSUED: 05/06/2015 OWNER'S PHONE: 4087572581 SAN JOSE, CA 95136 PHONE NO: (408) 600'8033 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL 0 ❑ LICENSED CONTRACTOR'S DECLARATION CONSTRUCT ONE STORY ADDITION (661 SQ FT); / t� Lic. # b 5 )' CONVERT License Class k �� Contractor Jb_ � Date (100 SQ FT) OF GARAGE TO CONDITIONED SPACE; REPLACE (E) KITCHEN WINDOW & ADD N WINDOW IN I hereby affirm that I am licensed under the provisions of Chapter 9 (E) (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 Valuation: $80000 performance of the work for which this permit is issued. Sq. Ft Floor Area: I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36214016.00 Occupancy Type: 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 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 180 DAYS FROM LAST CALLED INSPECTION. 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 ' l �% Gam% Date: C� granting of this permit. Additionally, the applicant understands and will comply Issued by: with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. Signature Date _ 0 — 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. ❑ OWNER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I 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 (See.7044, Business & Professions Code). I 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 I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I 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 of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533 nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this j 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become 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 subject 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 918. Signature Date � CONSTRUCTION PERMIT APPLICATION (�\ B COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 1 `' . V� 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 � V (408) 77 -7 -3228 • FAX (408) 777 -3333 • building ED-cupertino.org CUPERTINO n -,mNv rnm z-mitr � rnu [JCI Arn)rrTnv AT.TPR ATInN / TT I—I REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN R 362— � f OV NER NAME I PHONE E-MAILLI STREET ADDRESS I CITY, STA7 €. ZIP. 1 FAX . CONTACT NAME PHON / r E -MAIL S STREETADDRESSI , CITY, Sr ZIP FAX 0' O1;WER ❑ OWNER - BUILDER ❑ oF'NERAGEN -r ❑ CONtRACTOR ❑ CONTRACTORAGEN*r ❑ ARCHITECT ASNGINE ER : . ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 5r Z s73 : 7 LICENSE Ti'PE BUS. LIC a COMPANY NAM , , E -MAIL FAX M par STREET DRESS R p IR (a CTTY, STATE, ZIP f PHONE O LICENSE NUMBER /+� ARCHITECT/ENGINEER NAME ,, C' BUS. LIC f COMPANY NAME 1 ; / � / S E MAIL } _ / 1 C. dj FAX //✓ /"r STREET ADDRESS �/� CITY, STATE, ZjP/ PHONED / DESCRIPTION OF WORK 4w 1/.� ... .. .. .. STING USE 11 PROPOSED USE CONS TYPE .' STORIES USE TYPE OCC. SQ.FT. \ ALUATION (S) EXISTG AREA 1 NEW FLOOR` AREAL � � DEMO AREA TOTAL NET AREA _ 10 BATHROOM KITCHEN REMODEL AREA REN40DEL AREA /�, OTHER REMODEL AREA �+ PORCH AREA DECK AREA TOTAL DECK/PO CH AREA GAR4GE AREA: DETACH `S �r TTACH k DWELLING UKTTS: IS A SECOND UNIT [:]YES SECOND STORY []YES / BEING ADDED? '�;ffO ADDITION? J;3?iO TOTAL VALUATION: PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES - PLAN-UNG APPL 0 )RWO PLANNDN *G APPROVAL LETTER EICHLERHOME? By my signature below, I certify to each of the following: I am the prope o authorized,agent n the property owner's behalf. I have read this application and the information I have provided S correct. I have read cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building c1ristructign. I authorize rep esentatives of Cupertino to enter the above -ide fied pro rty for inspection purposes. S ignature of Applicant/Agent: Date: SUPPLEMENTAL INF MA ON Q; PLA�rTCE may` o 4. _N-12LIR . _ D t THS�COURTER BUILDING PL 'IEi/i New SFD or Multifamily dwellings: Apply for emolition permit for existing building s). Demolition permit is required prior to issuance of building permit for new building. h ExpxESSti r.>hG: AEI, k _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosuresi�� -"��t; ❑ form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to �� X k - ' submittal of Building Permit application. J tR�5 Y'SE ER F Gj t❑ EAfi4ELi HE9TTH4 Y? Bldg,App_2011.doc revised 06121111 V 0 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 866 SEPTEMBER DR DATE: 03/19/2015 REVIEWED BY: MELISSA PC FEE ID APN: 362 14 016 BP #: �� VALUATION: $80,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P 2nd Unit? ' Yes • No OTC? 0 Yes (F) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADDITION TO FRONT OF SFD 710 S.F. INCLUDING COVERTING PORTION OF E GARAGE 70 SCOPE I S.F.) CREATE (N) MASTER BEDROOM. REPLACE (E) KITCHEN WINDOW & ADD (N) WINDOW INM OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,III- B,IV,V -B 710 $2,654.00 IR3PLNCK $1,666.00 IR3INSP PME Plan Check: $0.00 F-2-7 # $431.00 Window / Sliding Glass Door 1WINREP Replacement Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 TOTALS: 710 $2,654.00 $1,666.00 MECH, HOURLY 0 Yes G No PLUMB, HOURLY () Yes (j) No ELEC, HOURLY 0 Yes Q No MISC ITEMS Elec. Plan Check 0.0 1 hrs $0.00 $2,654.00 - Elec. Permit Fee: IEPERMIT ElOther Elec. Insp. 0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanuary Sewer visrricy ocnoae WL..... f — /,,.mad — fho nro/iminnnr ininrmn /inn availahle and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 11 -053 Ef ' if 1;13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $2,654.00 200 amps $48.00 Electrical IBELEC200 Services Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 F-2-7 # $431.00 Window / Sliding Glass Door 1WINREP Replacement Permit Fee: $1,666.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 T-1 � `rxs .rrttct?= Pt lcxz;, 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $99.40 Select a Non - Residential Building or Structure E) 0 i Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $10.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $4,529.801 $479.001 TOTAL FEE: $5,008.80 Revised: 02/14/2015 s SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION' 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(d)cupertino.org ' Permit_Na. �/ f nets She;? -� Carbon Monoxide:; PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN GL AN RAT FAXED TO THE BUILDING I?IVI$", 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 CSC 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. 7 have read and agree to comoly with the terms and conditions of this statement _caner (6_r_ Owner genYs)6Name:.- qq �� F'�_! i ` 3' - .. :. Date ........ ......... Si nafiure r ........ ................ ... ....... .... ...._.... -Gogacto _Name: J3/ t.� q rSi nafure Lic..�..;Dafe...... . Smoke and COforni.doc revised 03118114 WATER- CONSERVING PLUMBING FIXTURES I'a FILE OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 2.43 CUPERTINO 10300 TORRE AVENUE CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building ?a.cupertino.or _ g Owner Name �� o ��N � 9a ( &A t bM Permit Nof) t7o 3101 Address 1 I,` !i ►O �� . �i � � C.l�t�i� 1 C C L`l kq::' 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. No Go to Question 2. 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? El 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 form. �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. F�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.. 5. Please check ONE of the following: CJ�My property is a single-family residential real property. See Civil Code Section 1101.4. V 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 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 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 plum bjli� fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature's _) Date ),o t to Upon completing and signing this CertifizMe, please return it To the Building Division in order, to final your building permit. SB4072015.doc revised 08126115