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B-2016-3224CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-201&3224 22126 HIBISCUS DR CUPERTINO, CA 95014-0109 (326 02 027) JEMICO LLC HAYWARD, CA 94544 OWNER'S NAME: MINN MICHAEL AND ANN DATE ISSUED:12/07/2016 OWNER'S PHONE: 408-245-0657 PHONE NO: (866) 420-4109 LICENSED ONTRA TOR' DECLARATION BUILDING PERMIT INFO: License Class a Lic. #972702 Contractor JEMICO LLC Date 05/31/2018 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH X RESIDENTIAL _ COMMERCL4,L with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE PATIO DOOR, LIKE FOR LIKE I 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 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 permit is issued. Sq. Ft Floor Area: Valuation: $4405.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 02 027 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the licant understands and will comply with all non -point source regula Ions er the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 12/07/2016 Issued b OWNERA DER DECT A- Dat I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: 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) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 12/07/2016 i I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California. Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued I Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject tthe air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, ecti ns 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. - Owner or authorized agent.; f_ APPLICANT CERTIFICATION Date: 12/07/2016 -_; I certify that I have read this application and state that the above information is t"ONSTRUCTION TENDING AGENCY 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 relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree ` Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender°s Address consequence of the granting of this permit. Additionally, the applicant understands DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 12/07/2016 g Professional I 1 0 C 1PERTINO F1 NF.W CONSTRTTCTTON CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408)777-3228 • FAX (408) 777-3333 • buildinq(a.cupertino.org Q - �(y ^ (,6 _ F-1 AT)T)TTT0IJ I I AI TPP ATTnNT ITT (� DTn7TQTnhT/ll'cVUnT)Un !fDTn- ATn _-7 PROJECT ADDRESS fy ]_ -7N # OWNER NAME f ` 4® - PHON,LIEy 2.. '7 E-MAIL s� P STREET ADDRESS f2 �f J `.i_ ' $L -!r to `78 ►I` S � CITY, STATE, ZIP V�� C,��-. 15�otY. FAX - CONTACT NAME uR r ` PHONE1 E-MAIL L e ' a 1 -Gr > Ilk STREET ADDRESS 1u" V y� CITY, STATE, ZIP/( L�Ifins� /S_ q FAX ❑ OWNER ❑. OWNER -BUILDER ❑- OWNERAGENT -CONTRACTOR ElcONTRACTORAGENT ❑; ARCHITECTS ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENS"E�R ®� LICENSE TYPE BUS. LIC #1 f COMPANY NAME `- _ �� E- f + FAX STREET ADDRESS 3o$®o SAeJA JA S't CITY, STATE, ZIP I v�-d �� 5 L PHONE ���02-4>3_ 3r i G ARCHITECTXNGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK V7�i� y a." . - L ti- � 9'-8' L- c - EXISTING USE PROPOSED USE - CONSTR. E # STORIES - - - 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 GARAGE AREA: 0 DETACH _ ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES. SECOND STORY ❑ YES BEINGADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS T.HE BLDG AN ISE TOVALUATI PLANNINGAPPL# ANO PLANNING APPROVAL LETTER EICHLER ' Qj i ! I Lt 0 CCDD 5, L9 By my signature below, I certify to each of the following: I am the property owner or auent to act on the property owner's behalf. I have read this application and the information I have rovided 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 ding construction. I authorize representatives of Cupertino to enter the above-id-ntified property for inspection purposes. Signature of Applicant/Agent: Date: l 6 SUPPLEMENTAt INFORMATION REQUIRED PLAN CHECK TYPE ROTITING SLIP ❑ OVER-THE-COUNTER ❑ BInLDING PLAN REVIEW _ 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 ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ P-UBLlcwoRKs form if any Hazardous Materials are being used as pati of this project. ❑ ❑ LARGE FI@EDEFT _ Copy of Planning Approval Letter or Meeting with Planning prior to E MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTALHEALTR BIdgApp_201].doe Devised 061211,11 CUP-ERTf1V0 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.cupertino.org 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 bedrooms) 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 alan(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. ir G _ 3� -AcTclress: �- � �L ' � � �`� �.' ��/Permi4il�To. "?rC+C rShecify Number of Alarms: #T Smoke Monoxide I have read and agree to compiy<ith the to s and co ions -of this statement Owner (or Owner Agent's) Name:V. l Signatures; .. .. ...•••°•"",1...................................Date: ........................................................................ Contractor Name: Signature.................................................................. Lic.# ......................................Date: Smoke and C'O foi-m.doc revised 09.%%27116 CUPERTINO Owner Nam V\A k 7-11;Z f� WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT m BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 9-5014-32s5 (408) 777-3228 FAX (408x) 7j77-3333 i _ts_uilding uperlino.oea (� LC�c P M ) `St /Lf Permit Nol 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 wafter -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 form. _j"o 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. �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 January1, 199'4. Civil. Code Sections 1101.1 through 1101.8 apply. Check one of the three following. statements and sign bottom of form.. 5. ease check ONE of the following My property is a sirtgrle fatnily� residential real property. See Civil Code Section 110'1.4. On and after January 1;, 2014, building alterations or improveients 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 wafer -conserving plumbing fixtures (regardless of whether property undergoes alterations or, improvements). ❑ My property is a rtrcdt family 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-conservingg plumbing. fixtures. On or bef©re January 1, 2019,. all. non: -compliant plumbing fixtures shall be replaced with water - conserving plumbingfixtures throughout the building. (regardless of whether property undergoes alterations or improveinents). 0 My property is a commercial reale property. See Civil Code Section 11011.5. 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„ 20019,. all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing, fixtures throughoutthe building (regardless of whether property undergoes alterations, or improvements). 1,; as the owner or, owner" s, agent of'thiss 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 It 101.8„ than current, CalifomiaPlumbing Code and. Califomia Green Building Standard's Code„ and manufacturer's installation requirements;,, and that the water=conservin�p-lumbing. fixtures comply with therequirements as indicated: in the tableon. the followinz Daae: d A , n A /� Ail , , Owner or Owner Agent"s Upon completing and signing this Certifcate, please return: it to the Building Division, in order to final your buiflding�permit. SB'4'0-7 201115.doc revised 0'8/26/15