B-2017-1366CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMTPNO: B-2017-1366
7518 RAINBOW DR CUPERTINO, CA 95014-5237 (366 11 046) U S CREATIVE
BUILDER
SAN JOSE, CA 95134
OWNER'S NAME: ABHIJIT Y. DESHPANDE I I DATE ISSUED: 08/17/2017 1
IS PHONE: 408-904-9941
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #102568Z
Contractor U S CREATIVE BUILDER Date 04/30/2019
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with by
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:
r. 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
erformance of the work for which this permit is issued.
ve and vi l 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.
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
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regujations per the Cupertino Municipal Code, Section 9.18.
Date 8/17/2017
PHONE NO: (408) 382-9550
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
BATHROOM REMODEL- (80 SF)
Sq. Ft Floor Area: I Valuation: $15000.00
APN Number: Occupancy Type:
366 11 046
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Jasmine Archbold
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 fust 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:8/17/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF
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.
2. 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.
s. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
certify that] 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 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 with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Date 8/17/2017
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. Lwill
maintain compliance with theCupertino Municipal Code, Chapter 9.12 and the
Health &Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533,, and 25534.
Ow authorized "agent:
D
CONS CTIOL G G CY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
�J I (408) 777-3228 building@cupertino.org PEMIT #B7 b 44P (10
—
CUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION'ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA
PROJECT ADDRESS
75f 9 Qoh l,o-i .Dy. e ffov\
APN #
OWNERNAME PHONE E-MAIL
n
STREET ADDRESS
CITY, STATE, ZIP
751'8 Dv,
Cu P T( W 0, GA, 9.5o t5
CONTRACTOR NAME ❑ OWNER -BUILDER
COMPANY NAME I
LICENSE NUMBER (�
LICENSE TYPE
%►)(i W01
c ue. U1�
STREETADDRESSM'Sc>
4-? d ��'sS�O�
,STATE, ZIP
CA-
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r
E-MAIL
tr4c- us c 4,„ridet3.
PHONE
qo g 3 6 z g s -s v
B . LIC #
❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT [I ENGINEER ❑ DEVELOPER ❑ TENANT
CONTACT NAME E-MAIL
STREET ADDRESS
CITY, STATE, ZIP PHONE
DECRIPTON
I '
INGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
f
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTING USE
EXLSTING SF
NEW FLOOR SF
PORCH
SF DECK SF
DEMO SF
STORIES #
TOTAL NET SF
REMODEL /
REMODEL KITCHEN
REMODEL OTHR GARAGE
❑ ATTACHED
BATHROOM SF ✓
SF
SF SF
❑ DETACHED
EXLSING ❑ YES
EICHLER ❑ YES
SECOND STORY ADDITION 0YES
FIRE SPRINKLERS [I NO
, , 11NO
NO
DWELLING SECOND DWELLING ❑ YES: ❑ ATTACHED❑ DETACHED OTHER
UNITS # UNIT ADDITON: . []'NO SF
I
POOLS ❑ FIBERGLASS' ❑ VINYL -LINED' ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA - SF + '.�i.. SPA ATTACHED ❑ YES ❑ NO TOTAL - SF
„
Tje@CMVED BY:
TOTAL VALUATION:
Commercial or Multi-Famila Buildines with Public Szoimminu Pools regnires Department ofEnvironmerdal Heath aimroval
0
RE -ROOF
EXISTING ROOF TYPE ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑
WOOD SHINGLES ❑TILE OTHER (SPECIFY)
REMOVE /REPLACE ❑ NO
IFNO
PLYWOOD ❑' 3/8"
PLYWOOD TYPE:
PITCH:
ROOF CLASS
E] YES
I #',OF LAYERS
THICKNESS ❑ 5/8" OTHER
❑ OSB EJCDX OTHER
^12
I A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑WOOD SHINGLES ❑ OTHER
p ;
*Provide a signed copy of the •Cupertino's Tear -Off Policy SF #of SQUARES
By my signature below I'certify to;each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I
have read this application and thednformation I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
#o comply with all applicable local ordinances state laws relating to building construction. I authorize representatives of Cupertino to
enter the above -identified &operty for inspec ' n urposes. I acknowledge and authorize all information contained on this application form
to be made available for ,pubh record.
Signature of Applicant/,Agent:—.' Date:
SUPPLEMENTAL INFORMATION REQUIRE
*New SFD/Second Dwelling Units/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provi'd'ea,cdmpleted Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a letter of approval from the Home Owner's Association
BldgApp 2017.doe revised 08/01/17
CUPERTINO
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 • buildin-ga-cupertino.org
FURYUb N;
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314, 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 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 8314 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. "7 1 $
Address: Permit No. Zola_
Specify Number of Alarms: 3 # Smoke Alarms: F� 2 # Carbon Monoxide Detectors: !�
I have read and agree to comoly with the fPrm.a and rnnrt;tinmof this Qfgf4- ,, not
Owner (or Owner Agent's) Name:'
Signature.............I Date:
......,................. .............................................. ..........................
.............. ........................:................................... ........................ ...............................
Contractor Name:
Signature.............:.....'............................................... Lic.# ......................................Date:
Smoke and CO fo»ia.doc revised 12115/16