B-2016-3081CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10630 GLENVIEW AVE CUPERTINO, CA 95014-4568 (369 25 002)
OWNER'S NAME: PABON GUS C AND SUSAN TRUSTEE
OWNER'S PHONE: 408-425-3335
LICENSED CONTRACTOR'S DECLARATION
License Class 5 Lic. #916589
Contractor'PARROTT CONSTRUCTION Date 06/30/2018
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.
affirm under penalty of perjury one of the following two declarations:
- I have and will maintain a certificate of consent to self -insure for Worker's
CONTRACTOR: PERMIT NO: B-2016-3081
PARROTT
CONSTRUCTION
CUPERTINO, CA 95014
DATE ISSUED: 11/09/2016
PHONE NO: (408) 316-7365
BUILDING PERMIT INFO:
BLDG —ELECT PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REMODEL HALL BATH, LIKE FOR LIFE (40 S.F.)
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: $5000.00
APPLICANT CERTIFICATION
I certify that 1 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 appli hinder§ ar ds and will comply with all non -point
source regulations rthff Cupaftipb Municipal Code, Section 9.18.
Signature Date 11/09/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three 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.
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 this
permit is issued.
3. 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
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 regulations per the Cupertino Municipal
Code, Section 9.18..
Signature Date 11/09/2016
"N Number: Occupancy Type:
369 25 002
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALL_SPECTION.
by:
RE -ROOFS;
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 11/09/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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. I wip
maintain compliance with the Cupertino 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 BayA a -Air Quality Management District I
will ith maintain compliance wthe Cu$eftino T16nicipal Code, Chapter 9.12 and
the Health & Safety Code ��;K
ctio�ns 2550 5533, and 2 534.
Owner or authorized agent: F "
Date: 11109/2016
CONSTRUCTION LENDING AGENCY
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
(.understand my plans shall be used as public records.
Licensed
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OUPER.€ EMO
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CONS T RUCTICN PERNUT APPLICATION
COMMUNITY DEVELOP10ENT DEPAR T MiENT • BUILDING DIVISION
10300 T ORAE AVENUE - CUPER'T INO, CA 95014-3255 B'
(40j8')) 777-3228 • FA,- (408) 777-3333 • buildina(od)cucFrtino.ora
r,C)NT 1 I d T) IiTS(11:I 1-7 n T TCI A 17.111 I IT n - \✓ r z o l `'
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Owner
WATER -CONSERVING PLUME
OWNER CERTIFICATE OF CO
C01411' UNITY ®EC VELOWENT DEPARTMENT -
10300 TORE AVENUE - CUPERTINO, CA 9501
140A 777-s32,28 z f—AX, (408) 777-!3333,k buildina(a'
FIXTURES
ANCE FILE
�!G OMSION
1. Is your real prqert 91 q
y a registered site? I
El Yes Civil Code Sections 1101.1 through 11-01.8 do not apply. Skip the res t of the form and sign bottom of form.
%ryl
7 No Go toQuestion 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 donot apply.
Q The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the foftn and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building? 1
El 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?
0 No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through i I -ou ., 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..
5. Please check ONE of'the following:
myproperty is asinglefermialV i&i*nfial 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 undergaeg, alterations or i m pro , tg,),.
r venien
D My property is a mutt residential real property. See Civil Code Section, 1101.5.
On and after January 1, 2014, specified building alterations or improvements shallI require non- compliant
plumbing fixtures to be replaced with water-conserving'plumbng. fixtures. i
On or before 4,ftuarY 1, 20,19� all non-compliant plumbing fixtures sha,11, be. replaced with,h water-
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
EJ My prop T-r.t. is, a commercial real ,property. See Civil Code Section, 1104.5.
0b, and after January 1, 26,14, specified, building, alterations or i inprovements shall require non- compliant
Plumbing fixtures to be replaced, with. water -conserving plumbing fixtures.
On or before January 1, 2015, all., non compliant plumbing fixtures shall! III be replaced with,, water- conserving
- vi Ing
plumbing fixtures throughout the building (regardless. of whether property undergoes alterations or finprovem ents).
L as,, the owner or, owfte r, " s, agent of this property, certify un dcr penalty of perjury that non-compliant plumbing fixtures will be
-dpr date specified above water-consem.ing, plum, fixtures in accordance with, Civil Codt. Sections, 1101. 1
replace prior to d, -: speGif , d with,
through'. 1101. 8,,, the current California Plumbing Code an Calif u Mla Green-, Building,Stand'ards, Code;, and m anufachurer"'s.
installation requirements, and that the water=con rving plum � 15,)fixhures, comply with the requirements nents as. indicated in the
tnhl,�, nn the, fc),11w+n
'n -o,- 7A iA
Owner; or 0 -wrier, Aqent.`,s
Upon compteting., and signing this Ceiflficat,e, release return it to theBuilding Division int order to fina,111, your building permit..
SB'4072015,.d6c revised, 081,26/15
SMOKE f CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
PURPOSE
n ss affidavit is a self -certification for the uzstallation 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 ulterior access for
inspections are required.
GENERAL INFORMATION
Existing silgle-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
ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
_SMOKE
X
X
On every level of a dwelling unit including basements
X
X
Within Baelz sleepin 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: fit dwelling units with no commercial power supply, alarm(s) may be solely battery: operated.
ha 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 firdshes 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 wluc_h 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: 10 o d Cy -i s -4 -on Permit No. f3zo ( V ,()
Specify Number of Alarms:
Alarms:
Carbon M,
J have read and aaree fio r:omnly with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
Signature Date: �(t
%h
.........
...................................................................................................................................
Contracto ame:
Signature............................................................::.... Lic.# ......... -........................... Date:
Smoke and CO fo7-m. doc 7•evised 09127/16
PURPOSE
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 c( cupertino.org
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED, SIGNED AND RETURNED TO THE BUILDING DIVISION
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 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 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. 6-
Address: Ill 4 �/,��, >tr �� ift,G� Permit No. �/J� 31/ Ol
Specify Number of Alarms:
S
Owner (or Own ent's) Name:
Signature
Q
.� . Date:
..................
.......14 U
Contractor Name:
Signature.................................................................. Lic.# ......................................Date:
Smoke and CO form.doc revised 09/27116
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