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B-2016-1856 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-1856 1273 ASTER LN CUPERTINO,CA 95014-5215(366 11 086) J P WHITNEY CONSTRUCTION SANTA CLARA,CA 95051 OWNER'S NAME: PATEL PANKAJ B AND KAUSHIKA P TRUSTEE DATE ISSUED:04/29/2016 OWNER'S PHONE:408-348-1174 PHONE NO:(408)249-2845 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic.#334AA6 Contractor J P WHITNEY CONSTRUCTION Date 12/31/2016 X BLDG —ELECT —PLUME 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: REMOVE(E)TILE DECK 44 SQ FT,WATER PROOFING AND I hereby affirm under penalty of perjury one of the following two declarations: PLYWOOD AND REPLACE WITH NEW MATCHING SYSTEM-NO 1. I have and will maintain a certificate of consent to self-insure for Worker's STRUCTURAL CHANGE 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:$10000.00 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 ordinances Number: Occupancy Type: 36611 086 and state laws relating to building construction,and hereby authorize 366 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 applicant understands and will comply with all non-point source regulations p the Cupertino Munici ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Y4nature ate 4/29/2016 Issued by:AbbyAXende ., l „' Date:04/29/2016 �M ER-B D R DECLARATI 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 r. I,as owner of the property,or my employees with wages as their sole installed without first 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(See.7044,Business&Professions Code). Date:4/29/2016 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I 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 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 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 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,Cter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, ?tios 25505,25533 an 5534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Winer or authorized agent: APPLICANT CERTIFICATION ate:4/29/2016 I certify that I have read this application and state that the above information is CON TRU T 0 END ENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a cont ction len in agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec. 7,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. Licensed Signature Date 4/29/2016 Professional .._.......................................... CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(a)cupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS I`2�3 in APN# .�U�p I_(& OWNERNAME Y 1 PHONE EE--MAIL STREET ADDRESS CITY, STATE,ZIP .,� FAX CONTACT NAME PHO>,-'z,,. 1 E-MAIL STREET ADDRESS' �U��uLs U�y L C CITY,STAT�J � G� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT T R' �ONT'RAACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT9R N�'I,�N� LICENSE NUMBER,J�L / LICENSE TYPE BUS.LIC#j;O^ COMPANY NAME c"( E-MAIL T fo FAX 4� L du/Y 74,ve G��u s7,P�+� yl.✓ I� sP v I c c�✓�- STREET ADDRESS CITY,STATE,ZIP PH E 6 e, L"+S-I# vh'I c S,4K, -� c&AAA C,4, VI) AR.CHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# 44 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK s s f� ��- EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES OFFICE USE ONLY - y OCC. TYPE DESCRIPTION " S .FT, VALUATION EXISTG NEW FLOOR DEMOTOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH-kREA GARAGE AREA:❑ DETACH Y/ ❑ ATTACH #DWELLING UNITS: IS A SECOND UNIT F-1YESSECOND STORY E:]YES BEINGADDED? ❑NO ADDITION? ❑NO B PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: RECEIVED Y:.' rf` � T_�'AL VALU ON: PLANNING APPL# ❑ NO PLANNING APPROVAL LETTER ��V v By my signature below,I certify to each of the following: I am the property owAer or authorized agent to act on the rope .owner's behal I have read this application and the information I have provided is correct. I have re d the De iption of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil cons ct n. I aut e repr ntatives of Cupertino to enter the above-identifie property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTORMAT D PLAN`CHECKTYPE ROUTING SLIP New SFD or Multifamily d llings: Appl r demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESSr, ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD' ❑ ruBttc woaKs form if any Hazardous Materials are being used as part of this project. ❑ 'LARGE ❑.FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑, n!AaoR ❑ SANITARY.SEWER DIS TR cT submittal of Building Permit application. ❑ ENVIRONAfENTALHEALTH BldgApp_201 Ldoc revised 03/16/11 mrommmi MINMENNE 0 a 0-010-- 1 ■■ m ■ ■ mini■EMMEMMe � ■ e �� CMEN MOEN ■ PWwlrW.,qq= 9"Zd a "FAMEMEME MORMEMMEMOMMEMOMM M mom M 0 0 No ME , MEN MMEMEMEMEMM MMMEIMMMrM M'di 1 !3 =1 t j7A WEAMEMEMEM SON NOME MMEMMMMMMMMMMNMMMMM MEN MEN :"ILNM IMME MEME rlffmmFR-?m- MMMMMlm EMEREEMEMMENMENIM MEMESEMEN ME .01mommill 4=1 ME m SEE WTV - I mmffmmmm��Wlwwm NEMEMMIM m MEN SEEM I ME RE m- IM - 'a"T -N-.EE mmimmmmmolommom momms om 0 mom M al"MoMMEMEM ME MOSINEE NESIME 0 'm No 0 IN mi a BE a 0 MEMEMBINEMINXIM ME 0' I Zia MEMEMMUMMENMEM No ME MEN �ME 0 i1 'iIi■i ■ MOEN Gde '■MEMMEMEME ME ��i No M M on M M Ell M ENE MOSIM 0 mom sm—EMMUMM 11 1111 MOM No MOM M MOM No MOMEMM man mom on MMM EMSmss■ mom IEEE■ ■ ■ � 7� � ., ■�M■■vMINE ENOMMEMEMEM . WA OMNI 3 i MOM MOEN ONE 0 No ME 'eNEI • No IMEME No EMEM IN MOM MEMO ME 0 1Ag rs io r m A A molm IS so INS 0 LEM Em- ME Fib mom 0 ME NNE MEMEME MOM EMS 0 MOME M MEN ME ■ Qi 0 MM 0 ME m ME ml RUN MOM M M 0 No ME No ■ E' L SMOKE / CARBON MONOXIDE ALARMS 1.& OWNER CERTIFICATE OF COMPLIANCE 'y COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• building( cupertino.orp �d,d�ress r 1 ' s � } # � .�-0 $�jRa ERMIjctf AUNT W1 , AM PURPOSE Tliis 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 ac 2ess.for inspections are-required. GENERAL IN,FORMATION 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 2xceeds $1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/o Carbon Monoxide Alarms be installed in the following locations: _ AREA SMOKE ALARM CO LA1ZM Outside of each separate sleeping area in the immediate vicinity of the X X bedrooni(s) On every level of a dwelling,unit including basements X X Within each sleeping room X Carboni Monoxide alarm's-are not required in dwellings which do not contain fuel=burning appliance and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comp y with CBC Section 420`.6 and slia11 be approved by the Office of the State Fire Marshal. Power Supply.In dwelling units with no comrnercial power supply, alarm(s)may be solely battery operated. In existing,dwelling units,alarms are permitted to be solely battery operated where repairs or altera ions do not result in the removal of wall and ceiling finishes or there is no access by meansof attic,basem ent or crawl space.Refer: to CRC Section R314 and.CBC Sections 907.2.11.4 and 420`.6.2.An electrical permit is req:sired for alarm 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 Cal fformia,Building and Califonua Residential Codes.'Me e al'+arms.have been tested and are operational, as of the date si ned below.. T have read and agree,to comply ,with.the terms and conditions of this:statement llam ............................. f .. f SI"hateira: ,... . .......... ......... ............ i�:`:.................. a 1 Sa nature::: ........ ..f: .. .......Lied.r . ...tDa e ; • .. . ED F WATER—CONSERVING PLUMBING FIXTURES - o OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERTfNO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408,777-3228•FAX(408)777-3333-building(�_bcupertino.org , {Owner Name �� 'c 1'c - Permit No. Address n 3 vrZ 1\t cu t#_ Cis t�j , 1. Is your real property a registered historical site?' ❑ Yes Civil Code Sections 1101.1 through l 101.8 do not apply. Skip the rest of the form and sign bottom of form. 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 oi its plumbing,installation of water-conserving plumbing fixtures is not technically feasible? ElYes;. Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed pluinlier's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. , No Go to Question 3. 1. 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 ol form. KNo Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? El 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 o form. ❑ Yes Ivly 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: 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 xequire all non-compliant plumbing fixtures to be'replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,201 ,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). El 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 o 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, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plurnbing fixtures 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-compliant 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 page. /l' - Date: Owner or Owner Agent's Signature: l Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08126115