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B-2016-1428 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1428 22322 REGNART RD CUPERTINO,CA 95014-4825(366 39 003) (SAN JOSE PLUMBING INC) SAN JOSE,CA 95120 OWNER'S NAME: NELLIS ROBERT C JR TRUSTEE DATE ISSUED:02/24/2016 OWNER'S PHONE:408-252-7750 PHONE NO:408-410-3760 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#615156 Contractor(SAN JOSE PLUMBING INC)Date 02/24/2016 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: PARTIAL COPPER REPIPE KITCHEN-LAUNDRY AND 2 BATHS(3500 I hereby affirm under penalty of perjury one of the following two declarations: S.F.) 11 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 1 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for Section 3700 of the Labor Code,for the performance of the work for which is permit is issued. Sq.Ft Floor Area: Valuation:$7760.00 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction,and hereby 366 39 003 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 expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.. Code,Section 7. \ Issued by:ABBY AYENDE Date 02/24/2016 Date:02/24/2016 1 O NER-BUILDER DECLARATION RE-ROOFS: 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(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:02/24/2016 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. z. 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 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 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&$a fety C , cion '5505,25533,and 25534. 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 Owner or authorize agent: be deemed revoked. Date:02/24/2016 APPLICANT CERTIFICATION CO TON LENDING GEY certify that I have read this application and state that the above information is I hereby affirm that there construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) 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 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 I understand my plans shall be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date 02/24/2016 GENERAL P ERMIT APPL[CA 10N MEP COh MiLINITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE=CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333•build ina(EDcuoerino.org CUP ERTINO nu'sil'G ❑MV ECHANICAL ❑ELECTRIC?.L ❑ARSCEeLrtLryA��EOLS. PROJECT SDDRESS y1 1✓' j i .4PN' Vl v v OSKTiR N.41J' • � P;ip�r STREET?.DDRESS tri CITY,STrZIP I FAX of �. .3 2-Z Co.\TN.Sh p PFO E-1Ji4IL VLJ STREET ADDRE CITY,STATE.J LIP ( FAX � i 1 OH�--,R ❑ 0RqM--1-BTjMD-t ❑ ov".maAG\'T CO1.TP.4CTOR ❑CONTRACTORAGEvT ❑ ARcunc-, ❑FN-ci :R ❑ DEVELOPER ❑ TENkirT i CO?N1TP 4CTOR 2 A1,r" LICENSE -U.1 / I LIC .. 1 I BUS.LIC N % S C01111heYNIM I os VWJs,,q,.n la _ EET I E-NL4IL I F!X STRADDRESS I CITY,STATE,ZIP PHONE �12CHITECT/EnGiNZERtd4NF' I LICENSE MUMMER I BUS.LIC-1. CON3A>YNAME E-NVUL I F-- STREET ADDRESS I CITY,STATE,Z-IP I PHONE j USE OFSFD orDIIPLEX II 1J,i<LTI-FA1>�.Y .PRO�tCT LAT R'II.DLf ND ❑ Y:-S PROJECT LH - ❑.YES IS TF-;=BLDG AN:.. ❑ r'S: BJTT..DNIG: ❑COho,=�- CIAL URB.42\LNTERFACEA1E4 ❑ NO FLOOD ZOMB ❑ No I BICE=- HOME? ❑ NO DESCP.IFTIONTT OF VYORIK / oe 7gf-D —f RrC�I� D�1 '4 By my signature below,I certify to each of the follow iaa: I as the-property owner or authorized agent to act on the prope.ty o6ner'S 11ehalf. I have read this application and the informal6on I have-pr r' d is co ect I cave read he Desc p on of Work aad verify it is accurate. I agree to comply with all applicable local ordinances and sate lay;s vela`' o bu ld cons u tions I a>>` represen `ives of Duuertino to enter the above-identified propel ty for inspection purposes. Signature ofpplic�nU.-".get; Date: SU-'i PLEA6E.', AL NTORvIATIONT REQUIRED , _ or�aez sE onLi Y �FEll, 101 E�S " �lZ iiD x n/EPA4'1scApp_2011.doc revised 06/21/11 - wa sw'w A gi"R'1A,G S✓J4tl 6`'iT�wX�JG�:.np�.� OWNER CERTIFICATE OF COMPUANCE I& COMMUNITY DEVELOPMENT DEPARTMENT®BUILDING DIVISION CUPER INO 10300 TORRE AVENUE b CUPERTINO,CA 95014-3255 (408)777-3228 a FAX(408)777-3333,building cDcupe&o.ong FFIt--t'T CAN'NOT�BF r1NAIsFID AND CO M PLIFTjED U:NTXT�sy'��q'�H�IaS yCj��l��yly CA`I`F HAS:UXIEN S=- MWOW PURPOSE 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. GM,E AL I VORMATION Existing siizgle-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; ATRIA 5.140 >c A11 AIRM CO'AI,Ak1VA O'utside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On.every level of a dwelling,unit including basements X Within eacIrt sleeping room X Carbon Monoxide alarms are iLo,t required in dwellings which do i,iot contain fuel-burning appliances and that do not Have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CB CS ec dion,420.6-and shall be approved by the Office of the State Fire Marshal. Power Supply 1n dwelliing tuAts with,no commercial power supply, alarm(s) t ay be solely battery operated. In existing,dweltmg,imits;alaurms are permitted to be,solely battery operated wlner=e repairs or alliterations-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 R3,14 and CBC Sections 907.2.11.4 and,420?f.2.Ain electrical permit is requAredfor alla,n a'wlf6,ch mmstbe connected,to tine b-alildijag wiring. A&owner of time above-referenced propezty,I hereby certify that. tlne ala+n (�s)refieite reed above has/lnave beeiz:. instalfed,in, av-cordamvet �wir&the 2manuf acturer's instmictions and in ca{,pili ,,nee with the Calif oznia %i�zldlinYa andl Q6,10ei;t Resrderitial Colles.The ailavmsn halve beeim tested ,nd!are operas ional,as,of the date signe dl b b elo�w.. !E haus read andf agr ;focanes(1wt taer„s,ar ©ncdins othis,sffe ant, Gbnlj� fot Marne: `Cc j If ' nfdGe% ......... ....................... Daf a.r.. �. Sn;oke,ands C0sfbrnr clo t revise,03/1,'811=4) WMATER-CONSFAVING PLUMBINGXTURIEmS iF CERFATE()F C,�O , Cp Oo:M�f.UNIT� Y pMLOPtgEW1"jor—EptARTMC-NT•gUTLD[ttG:DivIsSO cupeatINO -10300 TORRE.AiJENtffi•CtVEEi IN01 ,CA 95,014=3255 Owner Nam (aos) -3228•F (40` 777-3333 p buifdina r uA�ino bm . a�� � 1'.ermit N Address z � 1. Is your real property a registered historical site? ❑ Yes Civil Cade Sections 1101.1 through 1101.8 do not apply. Skip the Test of the form and sign bottom of form: � No Go to Question 2. g 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 futures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101;8 do not apply. ❑ The licensed plumber's ceitifcation,has been provided to the Building Division. Skip the rest of the form and sign bottom of form-. No Go to Question 3, 3. Is water servicepermaiiently disconnected for yourbuilding? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Al X 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. CiAr Code Sections 1101.1 through 1101.9 do not apply. Skip the rest of the form and sign bottom of form. Yes Ivly real pr©perty is built and available for use or occupancy on or before January 1, 199`4. Civil Code Sections 1101.1 through 1101..8 apply. Check one of the three following statements and sign bettor,of form.. 5. Please check ONE of the following: lv$yproperty xs aXstngle farictly rsdenticri'real property. See Civil Code Section 11(11.4. GA and after,Jarivaay 1, 2014,bui ding alterations or,improvements shall require all non-compliant plamb7ng futures to be replaced with.water conserving plumbing€ixtu'res throughout the building.Un, or before January 1,2017,all non- comphanf plumbing fixtures shall be replaced with water-conserving plurnbhig futures (regardless of whether property undergoes alterations or i mpfievements). ❑ ivly .propertyts a:rnrt[t fam iy rest'dential real property. See Civil Code Section 11011.5. On.and after January 1,,20'sE4,sped{{fieri birilding alterations or improvements shall requ%e non-compliant plumbing;fixtures fo be replaced wvtht wafer conservirlg plumbing.fixtures. Oh,or before January 1„20=19; all non-comphant.plum b ng fixtures;shall'bt replaced wit, water- cons ewing ater-conserving.phuubing,fixtures througheAit the building ,regardless of whetkerproperty vadergoes alterations or improvelnentsl. ❑° My property is,a c©m-mercicrl real propert— y. See Civil Code Section 1101.5. On and after January,1,201`4,,specified.building alkermioris or improvements sha11 require non compliant plum,bing,Ektures:to)be replaced,with water comerving plumbing f xtures. On or before:January, 1,, 20119„ all non-compliant, plmnbimg fixtures shall be replaced with water= conserving. plurnlirn fixtu m thxoaghout the;burl ding;(regardl'ess of whether:property undergoes afterations or=improvements) 1,as the•owner or owner's,agent of this property,certify under penalty of penury than non-com pli-ant plumbing fixtures wi�1f be replaced Prior to date specif ed}abovewith water-cQnservtng pluinbn•g Fxtures in.accordance witheC�vil Ggde Sections.l 101.1 through 110`1,$,,the current CahfamumPluimbing Code and California Green:Buiilding Standards,'C`ode,.and manufae urer's rnsta=;iation,requinerments,,and:thazt the:water-conservi g.plurnbing fixtures comply with the requirts emenas indicated in the table on thm;followia pa -e. OwinerorOW,nnerRganf7's,Sign'atu e';* t y Upon completlaig;and signing this>Certificate,please return it to the Building Division in ardev toy final?your building perrn;q, S,3'07 2015:doc revised 68126115