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B-2017-0560CITY OF CUPERTINO BUILDING PERMIT �AVECUPERTINO, BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0560 10290 STERN CA 95014-3687((375 14 035) MIDLANDS RESTORATION INC CAMPBELL, CA 95008 OWNER'S NAME: VENKATASUBRAMANIAN GANESAN AND VISWESWARAN DATE ISSUED: 04/11/2017 OWNER'S PHONE: 408-780-4975 PHONE NO: (408) 379-9852 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic. #736056 RESTORATION INC Date 05/31/2017 XBLDG X ELECT _ PLUMB _ Contractor MIDLANDS MECH 7X RESIDENTIAL_ COMMERCIAL I 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 JOB DESCRIPTION: license is in full force and effect. REMODEL/RECONFIGURE MASTER BATH AT "SEWING ROOM" (40 1 hereby affirm under penalty of perjury one of the following two declarations: S.F.) 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 REV#1 - ADD LIGHTS (7) - ISSUED 5/10/2017 (�performance of the work for which this permit is issued. z. i�have and will maintain Worker's Compensation htsurance, 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:- $5225.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 375 14 035 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 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 applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source regulations pe Cupertino Municipal Code, Section 9.18. r r Signature Date 05/10/2017 Issued by: MELISSA NAMES Date: 04/11/2017 OWNER-BUIL DERDF�ATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: I, of the or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for inspection. t. as owner property, compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 05/10/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BET'T'ER 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 nA7ARDOUS h!ATERIALS DISCLOSURE performance of the work for which this permit is issued. z. 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 & Safety Code, Sections 25505, 25533, and 25534. 1 will Section 3700 of the Labor Code, for the performance of the work for which this California Health maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. 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 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, Secti s 25505, 25533, d 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: CERTIFICATION Date: 05/10/2017 E APPLICANT I certify that I have read this application and state that the above information is CON T I hereby affirm that there is a construction lending agen a performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is 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 understands ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 05/10/2017 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • t10300 TORRE AVENUE • CUPERTINO, CA 9501MVISON #.I. �- 8 • FAX 408 777-3333 • buildinana cupertino.or ' S C (408) 77, 322 ( ) �� O �� CUPERTtNC7 () ❑PLUMBING ❑MECHANICAL ©ELECTRICAL ❑MISCEL.LA/NEO SD PROJECT 'ADDRESSp APN # 3✓/� 5 3_5S TLY� ONR NAM�nMrot v STREET ADDRESS S or�� �� CITY, C d FAX Sad'�f AIL MAIL E- PHONE`S�QCONTACT NAME rL � — F CITY, STATE, ZIPFAXSTREET ADDRESS (� J ` C K ❑ OWNER ElOWNER-BUILDER ❑ OWNER AGENT CONTRACTOR E3 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENG A'EER 13 DEVELOPER ElTENA.NT LICENSE NUMBER LICENSE TYPE BUS. LIC # CONTRACTOR NAME � \p� COMPAN"M • E-MAIL M w FAX ;on E � 6 CITY, STATE, ZIP pn PHONE I C 7O ,^Q 4 STREET ADDRESS t/ J �+ Car. �,g1,�, �'� ` LICENSE NUTNIBER BUS. L.IC # ARCHITECT/E-.NGINEERNAM { % ±E-N4AIL FAX COMPANY NAME, STATE, 'LIP PHONE STREET ADDRESS YES PROJECT IN ❑YES IS THE BLDG AN ❑ 1"L -S LJSF OF ❑ SFD or DUPLEX ❑ MULTI FAMILY PROJECT INW ILDLAND ❑ r C FLOOD ZOi\E ❑ NO EICHLER HOME? ❑ NO BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ c DESCRIPTION OF WORK /� C ` } S — YL _ 6, 1 (� h TOTAL\ALUATIO. ` 2,-Z�� RE ED By my signature below, I certify to each of the following: I am the property owner or authonzed aLent to act on the property owners behalf. I have read this application and the information I have provi ed 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' cons tru on. I a Drize representatives of Cupertino to enter the above-identified Perry for inspection purposes. Date: S 4 Signature of Applicant/Agent: — SUP ENTAL INF A ON REQUIRED OFFICE USE ONLY W ❑ OVER-THE-COUNTER H ❑ EXPRESS L.7 STANDARD U G ❑ LARGE ❑ A,,JOR t11EPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0560 10290 STERN AVE CUPERTINO, CA 95014-3687 (375 14 035) MIDLANDS RESTORATION INC CAMPBELL, CA 95008 OWNER'S NAME: VENKATASUBRAMANIAN GANESAN AND VISWESWARAN DATE ISSUED: 04/11/2017 OWNER'S PHONE: 408-780-4975 PHONE NO: (408) 379-9852 LICENSED ONT A TOR' AR ATION BUILDING PERMIT INFO: License Class 5 Lic. #736056 Contractor MIDLANDS RESTORATION INCDate 05/31/2017 X_BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REMODEL/RECONFIGURE MASTER BATH AT "SEWING ROOM" (40 I hereby affirm under penalty of perjury one of the following two declarations: S.F.) 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. 2have and will maintain Worker's Compensation Insurance, as provided for by fSection 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $4000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 375 14 035 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 this permit. Additionally, the applicant understands and will comply with all ll non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations Wr the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST SPECTION. Signature 44�Date 04/11/2017 Issued by: OWNER-B IIID R DECLARATION Date: 04/11/2 I hereby affirm that I am exempt from the Contractor's License Law for one of the - following two reasons: Allroofs 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 of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 04/11/2017 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 ofthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 1 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 3. 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cuper 'no Municipal Co, e, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health &Safety Code, Se ns 255 , 25533, d 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 04/11/2017 I certify that I have read this application and state that the above information is CONSTRUCTIOWENDIN,G AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the rformance 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 and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 04/11/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95094-3255 (408) 777-3228 - FAX (408) 777-3333 - building cupertino.org �Z r B Z�ol� — oS6�j ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #1 PROJECT ADDRESS 10290 STERN AVENUE APN# 375-14035 't'A fiN VENKATASUBRAMANIAN PHONE 408 -780-497 ;TE -MAIL STREET ADDRESS 10290 STERN AVENUE CITY, STATE, ZIP FAX Cupertino, CA 95014 CONTACT NAME Jeff Bailey/Shari Parker PHONE 408-379-9852 E-NLAIL STREET ADDRESS 562 Division Street CITY, STATE, Camp ell, Ca 95008 FAx 408-379-9857 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENI CONTRACTOR !P CONIRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME JM Construction LICENSE NUMBER 7 3 6 0 5 6 LICENSE TYPE BUS. LIC #20955 20955 B COMPANYNAME JM Construction rA�i CL SEN FAX 408-379-9857 C`eS'rl YL YAC . STREETADDRESS 562 Division Street CITY, STATE, ZIP Campbell, Ca 95008 PHONE 408-379-9852 ARCHTTECT/ENGiNEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAB, FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA GGGG� REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:DETACH ❑ ATTACH # DWELLING UNITS: ISA SECOND UNIT ❑YES SECONDSTORY OYESBEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES---REC Y: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO _ By my signature below, I certify to each of the following: I am the property owner or authorize 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 buil ' onstruction. I authorize representatives of Cupertino to enter the above -i enter `d property for inspection purposes. �f Signature of Applicant/Agent: �Y Date: / SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑. ovER TgE-COUNT Ex El BUILnrNG"PLAN RRvIw. 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 ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE TIEF r _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. CI ENVIRONMENTAL HEALTH_ BldgApp 2011. doe revised 06/21/11 X1`2 - D 6-6 0 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTIFdO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a cupertino.org PERMIT.CANNOTNBE FINALED UNTIL THIS: CERTIFICATE HAS BEEN COMPLETED, SIGNED, AND RETURNED- 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 ALAR_ M 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 907.2.11.4 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 specified below have been tested and are operational, as of the date signed below. Address: f0'2_90 AN f—:: rJy E LvP ':j_12'T I N D ; CA ��)Vermit No. Specify Number of Alarms: _ # Smoke Alarms: F-07 # Carbon Monoxide Detectors: 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: GAj465(k,i NbJ"'-ATRSoBRAd\AW ,Aa Signature.. .......................................... Date: .911 ....... Contractor Name: Signature...................................................................... Lic.#........................................ Date:................... Smoke and CO forrn.doc revised 01/10/2017 10012 A 3 if 12115071 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 Owner Name C q Ne_S p N U tryl< R --T A S_u G -KA -m F\ fJ I A�J Permit No. 93 -k t 76 5-6b Address 021-D S f F 2r`I N CEJ 0 >= C J li F- 12 -T P ,j --, C A 9 S of y 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. 'g No Go to Question 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. Skip the rest of the form and sign bottom of form. Y�T 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. 'J�T 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.. Ple e check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4. 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 plumbing fixtures comply with the requirements as indicated in the table on the following pace. I Owner or Owner Agent's Signature: C� Ve^ Date:7 10/ (11 I Upon completing and signing this Certificate, please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 01105/17