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B-2017-1364CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1364 19250 TILSON AVE CUPERTINO, CA 95014-3529 (375 40 056) D L P CONSTRUCTION SAN JOSE, CA 95123 OWNER'S NAME: WINDERMAN STANLEY M AND SPERTELL EVAA TRUS DATE ISSUED: 08/17/2017 OWNER'S PHONE: 408-691-8708 PHONE NO: (408) 460-1717 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 51 Lic. #924279 Contractor D L P CONSTRUCTION Date 01/31/2019 X BLDG —ELECT —PLUMB — MECH X 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 license is in full force and effect. JOB DESCRIPTION: KITCHEN REMODEL - (150 SF) ADDITION OF PANTRY 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by ItSection 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: '$25000.00 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 APN Number: Occupancy Type: and state laws relating'to building construction, and hereby authorize 375 40 056 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 applica un rstands and will comply with all non-point source re tions per t e e o Municipal Code, Section 9.18. 186 DAYS FROM LAST CALLED INSPECTION.. Signatur Date 08-17-2017 Issued'by: Jasmine Archbold 40 Date: 08/17/2017 OWNER-BUILDER DECLARATION 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 (Se6.7044, Business & Professions Code) 2. I,as owner of the property, am exclusively contracting with licensed Signature of Applicant: ooniractors,to construct the project (Sec.7044, Business & Professions Code). Date: 08-17-2017 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' maintain 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. 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, 2553311. and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. 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 air contaminants as defined by the Ba rea Air lity anagement District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with pert► o M nic p ode, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safet` 505 33,'and 25534. Labor Code; .I must forthwith comply with such provisions or this permit shall C�odeios2 be deemed revoked. Owner or authorized agent: / APPLICANT CERTIFICATION Date: 08-17-2017 I certify that I have read this application and state that the above information is CONSTRUCTION END AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction I ding agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (S6c. 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. SignatureLicensed Date 08-17-2017 Professlonal CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTI NO, CA 95014-3255 (408) 777-3228 • buildin�pertino.org PEMIT #B - ZO CUPERTINO ❑ NEW CONSTRUCTION [—]ADDITION ALTERATION ❑ T.I. ❑ MEP ❑ RE -ROOF ❑ SWIMMING POOL/SPA PROJECT ADDRESS APN # 3 S-_ OWNER NAME PHONE CqC45 e reel E-MAIL STREET ADDRESS 1 q Z5o I t 15v wAve- CITY, STA'I'j; IP Cu �(_7I1T CONTRAACTOR NAME El OWNER -BUILDER COMPANY NAME LICCENNSE NUMBER LICE/NSSE TYPE CQyI$��!/LC-�)ll� \'ki2.7�) C� IG�G./q ✓ o STREET ADDRESS ^ S-)ql Iav�o �. CITY, STATE, ZIP 5-,vt ��5� CA SS�z-3 E-MAIL LPCOV6s 4iw. PHON,EI0 1 ` r a l� �'•— z160-1 BUS. LIC #© � 'S 'jl� [nnc► co ,� 3 ❑ ARCHITECT ❑ OWNER ❑ OWNER AGENT ❑ CONTRACTOR AGENT [I ENGINEER ❑ DEVELOPER ❑ TENANT CO TACT N ( E- L 1vat 1 va. 1�O'1k 1ZL� oc.Aa c' o. STREET ADDRESS Hyl CITY, STATE, ZIP PHONE 5aavt se. C,4- 9512 DECRIPTONk \+C�L 2. a C — _�cv-0vg-, A- �� I�c� \� CCA LF�5 C6u%�C4� ACAct.A c4c, INGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL USE TYPE OCC SQ.FT. VALUATION ($) XISTING USE I EXISTING SF NEW FLOOR SF I PORCH SF DECK SF DEMO SF I STORIES # I TOTAL NET SF REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ ATTACHED BATHROOM SF SF 1 —a SF SF ❑ DETACHED EXLSING ❑ YES FIRE SPRINKLERS NO ICHLIiII E�Q7 YES 4d NO SECOND STORY ADDITION []YES 0 NO DWELLING SECONDDWELLING ❑YES,,❑ATTACHEDQDETACHED OTHER UNC # UNITADDITON: ❑ NO S F POOLS ❑ FIBERGLASS ❑ VINYL -LINED. ❑ GUNITE ❑ PREFABRICATED POOL - SF SPA -SF— I SPA ATTACHED ❑ YES ❑ NO TOTAL - SF RE TOTAL VALUATION: Commercial or Multi -Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval So O RE -ROOF EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ TILE OTHER (SPECIFY) REMOVE /REPIrACE ❑ NO IF NO PLYWOOD ❑ 'h" ❑ 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS E] YES I # OF LAYERS THICKNESS ❑ 5/8" OTHER ❑ OSB ❑ CDX OTHER 12 I A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER *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 the infogA 'd is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ors relating to building construction. I authorize representatives of Cupertino to enter the above -identified propert I acknowledge and authorize all information contained on this application form to be made available for public record. r Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION QUIRED *New SFD/Second Dwelling Units/Multifamily Dwellin .�De olition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed 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 B1dgApp_2017.doc revised 08/01/17 SMOKE / CARBON MONOXIDE ALARMS a ( OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• building(..cupertino.orq P0011I1 CANNOT, MALED UNTIE T$VS CERTIFICATE HAS BEEN CE11 PI,E L D,SIGNED AND RETUR D TO THE..BUIE13.ING 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 R314,2016 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 X X the bedroom(s) 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 907.2.114 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- / q /5 Permit No. 1 C" Specify Number of Alarms: #Smoke #Carbon Monoxide Detectors. /( 2. I I have read and agree to co, ply with t.r -FMS and conditions of this statement Owner(or Owner Agent's),Name: Ef4 51) p {� Signature . .� Date:0.e)/Contractor Name1: 1 / q q� Ter . Signature ! .. Lic.# 1.?1147. Date: �!J 1�1 c t2Z1 117 . .. . . . Smoke and CO fo»n.doc revised 12/15/16