B-2016-1364CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10432 JOHNSON AVE CUPERTINO, CA 95014-3814 26 048)
CONTRACTOR:
PERMIT NO: B-2016-1364
(375
( DRAIN DOCTOR INC)
SANTA CLARA, CA
95054
OWNER'S NAME: SALMAN MUTHANNA D AND NIDAL M W TRUSTEE
DATE ISSUED: 02/16/2016
OWNER'S PHONE: 4085644346
PHONE NO: 4089703834
LICENSED CONIRACTORIS DECLARATION
BUILDING PERMIT INFO:
License Class C36, C42 Lie. #643458
Contractor (DRAIN DOCTOR INC ) Date/2 16/2016
X BLDG _ELECT X 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:
I hereby affirm under penalty of perjury one of the following two declarations:
INSTALL (1) BUILDING CLEANOUT; (I) PROPERTY LINECLEANOUT
AND REPLACE 25' OF SEWER LINE "SUNNYVALE
1. I have and will maintain a certificate of consent to self -insure for Worker's
SANITARY"
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: $4500.00
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
375 26 048
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenseswhich may acerae against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9:18.
r
A
Issued by: PAUL O'SULLIVAN r _
i CI N
Signature C Date 2/1 612 0 1 6
Date: 2/16/2016
RF -ROOFS:
OWNER -BUILDER DEC ARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (See..7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 2/16/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
s. 1 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
the Health & Safety Code, Sections 25505, 25533, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
i
Labor Code, I must forthwith comply with such provisions or this permit shall
- C
Owner or authorized agent \ c�
be deemed revoked.
=�
Date: 2/1612016
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
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
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
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Signature Date 2/16/2016
Professional
cep
GENERAL PERMIT APPLICATION �
5*
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION MEP
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 buiiding(a)cupertino.ora MISC
PLUMBING ❑ MECHANICAL ❑ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS e CV
t21-.2- GA Y"So- i APN # O
OVKXUIIAMEA PHONE
E-MAIL
CA w. u �, � 0 5 -
ST ®ETADDISS CITY, STATE, ZIP FAX
CON ACT NAME �. 9 i PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
❑ OWNER. ❑. OA+NER-BUILDER ❑ OWNERAGENT
❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑. TENANT
ONTRACTOR' SAME
C PA NAME L
(3cr\. v
LICENSE NUM3 4B
P4 E-MAIL
LICENSE TYPE C
BUS. LIC
FAX
S REET DRESS
Ck, STATE,ZIP
(3,
�a �1
PHONE
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF - SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT INWILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
7T BLDG AN
EICHLER HOME?
❑ YES
❑ NO
DESCRIPTION OF WPRK
I q CQ
TOTAL VALUATION:
SO 0 _::Z, RECEIVED BY > `•
By my signature belo 5 I certify to each of the following: I am the property owner or authorized agent to act on the p operty owner's behalf. I have read this
application and the information I have pr vided 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 t buil ing construction. represen „�iv�es of Cupertino to enter the above -identified property
p'ropertyrr oinspection purposes.
ent: f
Signature of Applicant/Ag� /�Gvd/L Date: 2__ / [1 .fes
SUPPLEMENTAL INFORMATION REQUIRED
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO 16
ERE FEE ESTIMATOR — RT1TT.1lIN[' "11VT0.T(11V
19 ADDRESS: 10432 Johnson Ave
FEE
DATE: 02/16/2016
REVIEWED BY: PAUL
APN: 375 26 048
BP#:
1 hrs
VALUATION: 1$4,500
"PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PME
PME Plan Check:
,' emnit Fe,..
PENTAMATION
PERMIT TYPE: 1RPSSA
WORK
INSTALL N BUILDING CLEANOUT;
N PROPERTY LINECLEANOUT AND REPLACE 25'01F
SCOPE
SEWER LINE
_ _
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Building 1PRSEWER 1 # $25
Sewer, Sanitary 1PRSEWER 1 # $25
TOTALS: $50.00
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distrtet, etc . 'These fees are based on the preliminary information available and are only an estimate.. Contact the Dent foraddn'l into.
FEE ITEMS (Fee.Resolution 1.1-053 Lf. 7,71.13)
FEE
QTY/FEE
MISC ITEMS
Plumb. Plan Check
10.0
1 hrs
$0.00
PME
PME Plan Check:
,' emnit Fe,..
Plumb, Permit Fee:
IPPERtit7T
.4,,..
PME Unit Fee:
$50.00
PME Permit Fee:
Other Plumb Ins P.
0.0
r
hs
1 $48.00
004-�?Mss;:El
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Travel Documentation Fee: ITRA IVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.59
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
A,i.z, t F }fix. F .,,
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distrtet, etc . 'These fees are based on the preliminary information available and are only an estimate.. Contact the Dent foraddn'l into.
FEE ITEMS (Fee.Resolution 1.1-053 Lf. 7,71.13)
FEE
QTY/FEE
MISC ITEMS
#{ Ice
PME
PME Plan Check:
$0.00
? S ^p f J'
PME Unit Fee:
$50.00
PME Permit Fee:
$48.00
0.
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Travel Documentation Fee: ITRA IVDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.59
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SiTBTTALSs $192.59 $OA0 TOTAL FE $192.59
Re ed: 01/01/2016)
PURPOSE
SMOKE I CARBON M-ONOXIDEALAWS
OWNIER CERTIFICATE OF COMPLIANCE FILE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(ftupertino.org
V'
Kj'jP-,-W, _C10-DR68
PFRWT CAi.NNOT IRV, MNALVI) AND COMPLETED UNTIL TMS CERTIFICATE
TWIMM'N &Q=,A1NTD To f
-_TH t14ViJL N-GpIVI, L
go -N
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.
GEN,ERAL 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
With -in 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 u
reqiredfor
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify thatthe alarm(s) referenced above has/have -been
mstallied in accordance with the manufacturer's instr uctions and in c am, plianace with, the California Buflidlihh-
anid Cailifond;al Residential Codes. The alarms have beert, tested an id are operational, as of the, date signed.
below..
I,' have read and agree t.6 c o maq i y with, thhet be r mm & and c on, dI.ions. . o>, this: s ha emit
t
S,h.tok,e,ai,id=CO-?fv,irni.,.db.c reAsed,-;03XJ,'88,?4j
140� .......... ...... .......... .......... .............
ConiF - N,
Sj G
S,h.tok,e,ai,id=CO-?fv,irni.,.db.c reAsed,-;03XJ,'88,?4j
Owner
Address.
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPUANCE
COMMUNITY DEVELOPMENT'DEPART ENT + BUILDING DIVISION
10300 TORRF AVENUE .r CUPERTINO, CA.95014-3255
2
(408) 777-3228 • FAX (408) 777-3333 e buitdigg(o7c uggq no.org
66 136`
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.
.lT 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 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.
0,
No Go to Question 3.
t
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.
U/ No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
I,;2'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.
O 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:
Jef 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, 20.19, all non-compliant plumbing fixtures shall be replaced with water- conserving
plurnbing futures 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-compl`:iant 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. nage. I
Owner or OwnerAgent's
Upon completing and signing this Certificate, please return it to the Building Division in. order to final: your building permit.
SB40.7 2015.doc revised 08/26/15