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B-2016-2022
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2022 22656 ROYAL OAK WAY CUPERTINO,CA 95014-5619(342 32 132) CUPERTINO PLUMBING INC SAN JOSE,CA 95124 OWNER'S NAME: KANTERSADRIANUS AND JANNETJE TRUSTEE DATE ISSUED:05/25/2016 OWNER'S PHONE:408-253-7480 PHONE NO:(408)253-0618 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic.#fi2A9U X BLDG _ELECT X PLUMB Contractor CUPERTINO PLUMBING INC Date 04/30/2018 — 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: COOPER REPIPE AND REPLACE WATER MAIN I hereby affirm under penalty of perjury one of the following two 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 erformance of the work for which this permit is issued. I e 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 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 342 32 132 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 regulationsp Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. r.Signature Date 5/25/2016 Issued by:Abby AyCUende n Q Date:05/25/2016OAAZIA OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: 1. 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(Sec.7044,Business&Professions Code). Date:5/25/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 1 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 p 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 Worker's Compensation laws of Califoniia. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the.Health&Safety Code,Sectif 53 d 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. ; Owner or authorized agent: APPLICANT CERTIFICATION Date:5/25/201 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending 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.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'SDECLARATION Code,Section 9.18. I understand my plans shal1l1bbee used sed as public records. Licensed Signature Date 5/25/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• buildinoCcDcuoertino.ong ,3-`Zol& CUPERT[NO l� 2 PLUI\BING ❑MECIi4NICAL ❑ELECTRICAL 2- ❑ NMISCELLAEOUS PROJECTADDRESS / �G J 5 IA"N"247- �JL'I�7- OWNER NAA4E 6 I E-MAII STREET ADDRESS - ?,Qqo R l ©aY, CITY,STATE,ZIP FAX CONTACT NAME PHONE E-NQ IL Gv STREET ADDRESS CITY,STATE, IP FAX C.4, S 1 Z ❑ OR'1.`ER ❑ ORR\'ER.BuILDER ❑ Ot1?.MAGE-117T EJ C0\TR4CTOR. ❑coNTRACTOR.4GENT ❑ ARCHITECT ❑ENG➢ER ❑ DEVELOPER ❑ TEN,,-NT CONTR4 3 LICEN E I R�p G_�; I LICENSE TYPE BUS.LIC n P I IL COMP 'Y N IE / E-MAIL c— FAX �! D 'SS�' GS C6J�� yam, CITY:STATE:ZIP \ J F �^ Q�� I 0`F -22-29 q AR CHITECT/ENGLNEERNAN'IE � LIC E'SE NUMBER -_—_ � BUS.LIC 9 _— COMPANYNAME E-A•L4IL I FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ 1,4liLT1-FAMILY PROJECT LN WILDLAND '❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ ]TS BUII.DLNG: ❑CO1,,MERC1-4L URBAN II\TERFACEAREA [3 NO FLOODZOI\'E ❑NO EICHLERHOME? ❑ NO DESCRIPTION OF WORT TOTAL VALUATION: O RECEIVED B] I. ' By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property o mer's be al£ I have read this application and the information I have provided is correct. I e ptio f W'Ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws re lat _ uildina co on. I pr 1 f Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant�k Date: 5--2- 5-- �- SUPPL .ITAL LNFORMATION REQUIRED ; `. ;asi ICE isE.'onL] ti,x> �•� ❑ O\ER THE-CO U'�TER Mlm ? \ b x ?IlEPlultscApp_20.11.doc remised 06/21/11 SMOKE 1 CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION Ctfi 'CllC3 10300 TORRE AVENUE•CUPERTINO,CA 95014-.3255 (408)777-3228•FAX(408)777-3333•buildingCcDcupertino.org CA trpdj* Permit No. 2C .- Address 2240540 ( OP& VJ=4 #of Alarms Smoke:j. 41 Carbon Monoxide: P +1 R�vIITGA�fNQT S EINALED ANll COIPLETRD-�TTIL THIS GERTIFICAT " 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. 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 CoALARM Outside 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 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. N Power Supply:In dwelling units with no commercial power supply,alarm(s)maybe 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,basemE nt 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 ha /have been. installed in.accordance with the manufacturer's instructions and in compliance with the,California Building and California Residential Codes.The alarms have been tested and are operational,as of the date signed below. i have read and agree to comply pith the termsand conditions of this statement Own�j(or Owner Agent's)Name: tJ'�"s,l� Signature....... ... .... ......... .............. ate: .. Contractor Name: Signature...................................................................Lic.#...................................... Date: ................... Smoke and COform.doc revised 03118114 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE Of COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION EdPIERT (�IC3 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333 buildingP-cupertino.org Owner Name ' J a Permit N o. Address ZZ (o S O r (0r,-j' Ujzz.i pq_f' n C_I r qvsof 1. 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. VNo Go to Question 2. 2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property oj 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. LINO Go to Question 3. 3. Is water service permanently disconnected for your building? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Cd/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. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. CVYes 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. check ONE of the following: Xy 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 1,201 all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether roperty undergoes alterations or improvements). EV 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 plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improve m nts). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing tures 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 plu Bing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: 5 . Date: Upon completing and signing this :tifi e,please return it to the Building Division in order to final your building permit. SB407 2015.dol revised 08/26/15