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B-2016-2074 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2074 21593 CASTLETON ST CUPERTINO,CA 95014-4702(356 18 05 ) NOECON ALVISO,CA 95002 OWNER'S NAME: JERBIC CHRISTOPHER C AND LU TING- In1l TRUSTE DATE ISSUED:06/06/2016 OWNER'S PHONE:408-476-9738 PHONE NO:(650)630-5967 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class A Lic.#953898 Contractor NOECON Date 10/31/2016 X BLDG —ELECT —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: POOL DEMO-FILL FOR LANDSCAPE PURPOSES ONLY 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 performance of the work for which this permit is issued. 1� \ I have and will maintain Worker's Compensation Insurance,as provided for by 1j(\ Section 3700 of the Labor Code,for the performance of tke work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8500.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the abo e information is correct.I agree to comply with all city and count ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 356 18 059 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 Ii ilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said C' inconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISS ANCE OR Additionally,the applicant derstands an ill comply with all non-point source regulations a the upertin nicipal Code,Section 9.18. 180 DAYS FROM LAST % LE ECTION. Signature Date 6/6/2016 Issued by:Alex Vallelunea Date:06/06/2016 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: I All roofs shall be inspected prior to any roofing material being installed.If a roof is t. 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(Sce.7044,Business&Professions Code) Signature z. I,as owner of the property;am exclusively contracting with licensed Si gn ofA pplicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/6/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER t. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Lalii r Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. 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,Sections5505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Mun opal 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)sho Id I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipmen or devices which emit hazardous ��I air contaminants as defined by the Bay Area Quality anagement District I Worker's Compensation laws of California. If,after makuig this certificate of will maintain compliance with the Cu ertino unic' Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensationprovisions of the the Health&Safety Code, c'ons 533,and 5534. Labor Code,I must forthwith comply with such provisio or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:6/6/2016 1 certify that I have read this application and state that the above information is CO STRU N LENDING AGENCY correct.I agree to comply with all city and county ordinances a�d state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize represematives 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 purp� ses. (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 Cu ertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date 6.2 1 Licensed Si g Professional SIl1fiMMING PO I Ll SPA PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•ICUPERTINO, CA 95014-3255 S P CUPERTENO (408)777-3228• FAX(408)777-3333•building g-) 101 LPZ� PROJECT ADDRESS /j APN r n I r V!1 S OWNER NAME - JJ PHONE _ 2 b E-bfAl - r1 " // i2C d 7�` �O - 6✓ rG e, r614r�cawl STREET ADDRESS(r S /,r�� � � CITY, STATE,ZIP /J� �na q q.5-61 �6 J FAX CONTACT NAME 3 (/ PHONE /l/• E-MAIL oklv STREET ADDRESS,,/ CITY,STATE,ZIP//� `I� �/1 FAX rg on7 rjf f7 d�( 19f,OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ElCONTRACTOR ElCONTRACTORAGENC El ARCHITECT 1:1 ENGINEER El DEVELOPER El TENANT CONTRACTOR NAMEI� �,� LICENSE NUMBER LICENSE TYPE BUS.LIC ti��� COMPANY NAME /AVl / VEL E-MAIL FAX V P Al STREET ADDRESS Q di, J CITY,STATE,ZIPUT ��y PHONE&U ARCHITECTlENGINEER NAME G LICENSENUMBER (f,` BUS.LIC 4 5 67 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK USE OF -SFD or Duplex ❑ Multi-Family TYPE MATERIAL TYPE(CODE) AREA (SQ.FT.) VALUATION (S) STRUCTURE: ❑ Commercial POOL ' POOL/SPA MATERIAL TYPE CODES: SPA V - VINYL-LINED F - FIBERGLASS DEN40 ^�Q Q / D l �- G - GUNITE P - PREFABRICATED CEIVEDBI TOTAL VALUATION: n r. s. By my signature below,1 certify to each of the folio in : I am thl property owner or authoriz ag act e property owner's behalf. I have read this application and the information I have provW*, re—cct. have�ead theDescription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildiauthorize representatives of Cupertino to enter the above-identified property fo inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL 01'FORMATION REQUIRED „of r"ICEus`E onl r PLAN`CIIECK T,PPE ROUTING SLIP _Commercial or Multi-Family Buildings with Public SvNimming Pools: x ❑-p\Eft THE COUI\I ER BUILDING DEPT Department of Enviromnental Health approval required. f ❑ EXPRDSS ❑ PLANNING DEPT �❑`STANDARD s ❑ PUBLIC WORKS DEPT ❑ LARGE ' ❑ En\IRONNIENT"HEALTH ❑,,,.MAJOR,^ ..�,. ❑,-SaiAiTAR\;SEWERDISTRICT,' < I SmimPoolApp_2011.doc revised 03/16/11 OWNER CERTIFICATE E OF COMPLIANCE j COMMUNITY DEVELOPMENT!DEPARTMENT—BUILDING DIVISION rC,iJ1TCF�1 10300 TORRE AVENUE CUPERTINO,CA 95014-3255 (408)777-3228 e FAX(408)777-3333*ibuilding(d�cupertino oro f � - 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. G,-ENP,R,AL MPORMATION, 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 $1:000.00,CRC Section 8314 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: AUEA SSUDKE ALAAI CO'ALARl1 Outside of each,separate sleeping area in the immediate vicinity of the X X bedroorn(s) Or,every level of a dwellin,.,.tnit including basements X - - GVithin each sleeping roor, X Carbon Monoxide alarms are not required in dwellings which clo not contain fu.el-burning appliances and that do nat Have an attached garage Carbon morioxide alarms combined with smoke alarms shall corm ply with CBC Section 420.6 a-td shall be approved by the Office of the State Fire Marshal. Power Supply:In dwelluzg units with no coir m re i power supply, alarm(s),may be solely battery operated. In existing dwelling units;alar ms are permitted to be solely battery operated where repairs or alherafioin,&do not result in the removal of waif aild ceiling fi islaes or there is no access by means of attic,basennent or crawl( space Refer to CRC Section R31'.4 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for alarins which must be cokmaected to the buiilding wkh-tg. As owner of the above-referenced property,..Ihereby certify that the alarin(s)referenced ab©>ve has/have been:, installed in accordance with the manufacturers instructions and in compliance wit, the California Buil`dulo- and Califontia Residential Codes.The alarms Inave been tested and are operational,as of the date signed b below. t ha ara ands a ,ree fo m;t,r fh:the feernsn, conditions of this s(aCemenf ... .... J { r f Rat WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCEFILE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION T l K- CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 —------- 408)777-3228•FAX(4p8)777-3333•building(rD_cupertino.orn q3 Owner Name /rl Q a G• Permit No. Address ax _q 1. Is your real property a registered historical site? 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 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. ,RNo Go to Question 3, 3. 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. 40"No Go to Question 4. I 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 of form. i es 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: 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, 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). 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 Pluimbin Code alifomia Green Building Standards Code,and manufacturer's installation requirements,and'that the ter-c sere' p mbing fixtures comply with the requirements as indicated in the table on the following age. Owner or Owner Agent's Signature: Date: t' Upon completing and signing this rtificate,ple e return it to the Building Division in order to final your building permit. SB4072015.doc revised 08126115 \ l�