B-2016-1487 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1487
10931 LUCKY OAK ST CUPERTINO,CA 95014(326 51 071) (BROTHERS HOME
IMPROVEMENTINC)
ROCKLIN,CA 95765
OWNER'S NAME: GALYEZ HENRY AND TAMMY DATE ISSUED:03/08/2016
OWNER'S PHONE:408-470-0481 PRONE NO:800-672-3777
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class B.C-17 Lic.#399009
Contractor(BROTHERS HOME IMPROVEMENT INC)Date 03/08/2016 X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL
_COMMERCIAL
m
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
I hereby affirm.under penalty of perjury one of the following two declarations: REPLACE(E)PATIO DOOR,LIKE FOR LIKE
t. 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.
z., 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
t/ this permit is issued. Sq.Ft Floor Area: Valuation:$3283.00
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 APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 326 51 071
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 PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALL11 NSPECTION.
Code,Section 9.18.
Issued by:MELI AMES
Signatur Date 03/08/2016 Date:03/08/2
WNE - UIL CLARN RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is
following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1. I,as owner of the property,or my employees with wages as their sole inspection.
compensation,will do the work,and the structure is not intended or offered
for sale(Sec.7044,Business&Professions Code) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:03/08/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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 HAZARDOUS MATERIALSDISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
z. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will
by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the,Cupertino Municipal Code,Chapter 9.12 and the
this permit is issued. Health&Safety Code,Section 25532(x)should I store or handle hazardous
a. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined bkthe Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety jCode,Sec' 05,25533,and 25534.
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 Owner or authorized a
am
be deemed revoked. Date:03/08/2016
APPLICANT CERTIFICATION C 0"R TI E N CY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance
correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit!:! issued(Sec.3097,Civ C.)
relating to building construction,and hereby authorize representatives of this city Lender's Name
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address
judgments,costs,and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION
understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records.
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date 03/08/2016
i
ih
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
is
3228
{408)777- . FAX(408)777-3333•building(G)cupertino.org
cuP`R-r�r�o - 67 ZG 16-
❑NEW CONSTRUCTION ❑ ADDITION ElALTERATION/Tl ❑ REVISION/DEFERRED j,.ORIGINAL PERMIT 4
PROTECT ADDRESS APN 9
OVNERNAMEPHONE d �/�'y j � E_M,AIL
STREET ADDRESS � CITY, STATE,ZIP n V
CONTACT NAME PHONE 77 S- ! � pP E-1dAIL
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STREET ADDRESS CITY,STATE,ZIPFAX
❑ OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT ❑ CONTRACTOR NTRACTOR.AGENT ❑ ARCHITECT i I,❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEfW& LICENSENUMBER ,.q LICENSETYPEilf7el BUS.LIC 4 ^�
COMPANY NAME * / E-MAIL FAX Z.►�7
STREET ADDRESS`i `' CITY,STATE,ZIPpn /1 157,76 PHONE Cy® f(Q 7Z
3772
ARCHITECTIENGINE`ER NAME LICENSE NUMBER rL•`( y` (� l BUS.LIC#.(J
COMPANY NAME E-MAIL FAX
I'.
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK "C
a
ri
EXISTING USE - PROPOSED USE CONSTR TYPE 4 STORIES O
USE. TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN - - OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA:. DETACH
❑ATTACH
�DWELLn.GUNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO -ADDITION? [3NO _
PRE-APPLICATION ❑ITS IF YES,PROVIDE COPY OF IS THE BLDGREG -;;�* ,� - TOTAL VALUATION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER ❑N0 „-� ,.-- ., ,' *--
By my signature below,I certify to each of the following: I am the property owner or autIT1712ed agent to act propy 's behalf: I have read this
application and the information I have provided is correct. I have read the Description of Work an ' I is accurate.1I agree to comp y w le local
ordinances and state laws relating to ilding const I authorize representatives of Cupe Ir n�o to enter the above-id�entifie pr perty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLF-].IMN ATION.REQUIRED
ncarE _ .F �??ouTin sr 3e �.
New SFD or Multifamily dwellings: Apply for demolition permit for10-010� � - 'W-
�❑ OYER_�H
-Uy' ITER ` Bi3II DINS PZ 3 12EYI)1V
existing building(s). Demolition permit is required prior to issuance of building t= �n
permit for new building. �� �
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTAvDnlus Usi> wo
Form if any Hazardous Materials are being used as part of this project. x
�,-
_Copy of Planning Approval Letter or Meeting with Planning prior to
JOR � SA1\I�4RYSESERDISTRICT "
submittal of Building Permit application.
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BUiLDIN<-) DIVIS,10N 0 -'`RTINO
APPROVED
This set of pians a'� specifications 1 ti ST be kept at the
job site during construction. It is u^la.vful to make any
chances or aiterations on sanne, or to deviate 0 W "
therefrom,without approval from the Scalding Official. 7 j
j he Stamping of this plan and sp ecifi a wis SHALL NOT 0-1
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be held to pen it cr proval of the violation
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COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO,CA 95014-3255 -- tFCUPERTINO .
(408)777-3228 FAX(408)777-3333•buildingftcupertino.oro '
q I� Da
1z R1i IT C Np,Off' E I Nt1I�F11 AND Gdl' I'X,ETEID UNTIL IS C R1 F OA`t
-MR, WAPTNODIVNION
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.
GEN EHAt 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
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed nh the following locations:
ARJEA
SM"CPK 1G XILARM CO ALARM
Outside of,each separate sleeping area in the immediate vicinity of the X X A
bedroom('S)`'
On,every,level of a dwelling unit including basements X X
Wrfhin;each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not containfuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Powerr Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operatfed.
In existing dweIlnx=g units; alarms are permitted to be solely battery aperated where repairs or alterahong do=
not result kt the removal of wall and ceiling fimslie&or, there is no access by means of attic;basement or crawl
space.Refer to CRC Section R3=14 and CBC Sections 9D7.2.11.4 and 420..6.2.An electrical perudit is r:equi i ed for
alarmswhichmustbe connected to the building w17hrg.
As.owner of the above-referenced property,I hereby certify that thke,alarm(s)refeireilced above has/have Ween,
,4 nsta!fed m:.accord=artce�with fhe ma.ni ifacturer's instructiyons ankd in, e em.pfil f ee with the Calfforzaia Burldliz,
axndl Califon-da,Res idem—ig Colles.The alanrns have been testedl aff d!are operatronall, as,of the daile sigAedi
I:Maveiread andsa wee.tocpm.!rw �tbr,sianadlwndWen,softftlisatatbme-n1'.
ua w.% 1 I
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Sigrla#ure,.. .....Ll ......... Data :
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COMMUNiTy D;E1 LIJM,AME IDEl?AR IIA-ENT*11BU(L®.lNG Il'!1/!S'.tON
lDQ°i�6�$;it�tC 10300, TO�RR.E.AVElNUE-O "RTIN0,CA 95014-3255
(�49) -322.8•,F �7 77-3333 buildigg@g- t'nonrq
Owner Nam Permit No -®( �-- �
Address _ �l 3 (.Cvlkc ci
1. Is your real property-a registered historical site?
❑,Yes Cit it 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?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
F
WShip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service pe -ently disconnected for your building?
Cy Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
j No Go to Question 4.
4. Is your real property built and available for use or occupahty on or before January 1,1994?
❑ No Ivly 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 properly is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 thrortgli 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check O'NIJ of the following
my pr+op'Aly rs a sfhgtefttly residetatal real property. See Civil Code Sectiois 1101.4.
On and after January 1, 2014,budding alteratiorrs or improvements shall require all non-compliant plumbing,fixtures
to be replaced with water-conserving plumbing fixtures throughout the buildiatg.G or before January 1,2017,all non-
compliant plurnbng fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improve nents)?
it Ivlypropertyrs a:midrifamtily restdentral realproperty. gee Civil,Code Sectio i.1101.5.
On and after January 1,2014,specified building;alterations or impfevements shall requ re,non-compliant
p1Umbrn9fixtures tube replaced with water conserving plumbing fxtures.
On or before January 1,2019;alt non-eoinphantplumbing.fixtures shall lie replaced wit l water-
conserving pfumbi nxg fixtures throughout the buifding,(regardless of whetherproperty tw&rgoes alterations or
improvermenfs),."
❑, My property is,a cammereial'real'property. See Civil'.Code Section 110'1.5.
On and after January 1,.2014,.specified`,buififfing,01cratiorts or,improvements shall require non-compliant
Plumbing fixtures ter,be replaced with water-conserving,plumbing fixtures.
Go or before:7annuary 1„ 20>1;5„ all non-compliant, p1bivubing fixtures shall be replaced with water- conserving
plurrrb�g,fixtures tlnroughantt tl e:building.(regardless o-f whether;property undergoes alfiera tions or,improvements)!.
I,,as the owner or owner"s,agent of this property,certify under perialty of perjury that non-compliant plumbing,fixtures will,be
r<egtaced prior;to datz specified above;with water-conserving:.plumbing fixtures in-accordance with Civil Code"Sections 11,01.1
thsough 1104.&,they eurrent C'alYforniia.Plumbing Code arid'+California Green=Buildi ng,Standards,Code,and manufacturer''s.
installation requizements„and that the.water conserving p1uzrrbrng fixtures comply with fire requirements as indicatedi i+rr the
table on the fohinwrn:r page.
Oltntnnror+CrwnerAgpntts Signature g.� Dafi �l '2.
U'Veni eompietiirg,,,and;signing this;CerGifieat'ep1r re ru is to the Building Di,vision in:order=to final.your building.perrni?t. '
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