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B-2016-2583CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2583 21111 RED FIR CT CUPERTINO, CA 95014-4254 (359 05 042) PLATEAU BUILDING GROUP INC SAN JOSE, CA 94128 OWNER'S NAME: MCEVILLY CARLOS DATE ISSUED: 08/24/2016 OWNER'S PHONE: 408-829-8052 PHONE NO: (408) 209-2364 LICENSED ONT A TOR' DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic. #21594Q Contractor PLATEAU BUILDING GROUP INC Date 05/31/2018 X BLDG X 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: RE -PIPE SFD (COPPER) FULL; REPLACE KITCHEN SINK & I hereby affirm under penalty of perjury one of the following two declarations: COUNTER; 1 ST FLR 1/2 BATH - REPLACE SINK, COUNTER TOP & 1. I have and will maintain a certificate of consent to self -insure for Worker's TOILET; 2ND FLR BATH - REPLACE SINK, COUNTER TOP, TOILET Compensation, as provided far by Section 3700 of the Labor Code, for the & SHOWER VALVE; INSTALL 3 (1) CEILING LIGHTS (DINING RM, performance of the work for which this permit is issued. UPSTAIRS BEDRM 1 & 2) z -' I have and will main ' W r -k -'s Compensation Insurance, as provided for by REV #1 - REPLACE WATER HEATER (SAME LOCATION) 7 ' lit L� Section 3700 of th o e, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $5000.00 permit is issued. APPLICA�N'T CERTIFICATION 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 359 05 042 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 per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature& Date 9/20/2016 Issued by: ABBY AYENDE J OWNER DECLARATIOIT Date: 08/24/2016 -BUILDER 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. 1, as owner of the propert} 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. 1, as owner of the property, an exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code).. Date: 9/20/2.016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued, 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 materials 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 exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 9/20/2016 I certify that I have read this application and state that the above information is c nNSTRUCTION LENDING AGENCY 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 understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 9/20/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 1000 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aQcupertino.orqCUPERTINO 16 1,SZ ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION 1 TI O<EVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN OWl'ERNAME S PHONE E-MAIL CCn I v 1 C eV/ f &�� Yl 2 iJ cJ STREET ADDRESSCITY; ST ZIP FAX G n e C� q 7 CONTACT NAME` PHO EE G !� ` E MAIL PEG Cn 1(n(1 f (> �. d s STREET ADDRESS CITY, STATE, ZIP FAX ❑ owNER ❑ OWNER-BUIIAER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTORAGEN'T ❑ ARCHRECT ❑ ENGIN'EER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME[1 PO LICENSENU-MBER �v LICENSET)p BUS. LIC r, �/� L (� Gid COMPANY NAME E-MAIL FAX ( ') F ?1 i! l (f FAX STREET ADDRESS L' CITY, STATE,ZI PHO N G ARCHITECT/ENGINEER'N??AME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 11 1 I I I I USE I TYPE I OCC. I SQ.FT. I VALUATION (S) Ii I i EXISTG NEW FLOOR 1 DEMO TOTAL AREA AREA AREA NET AREA BATHROOM I:TSCH73N OTHER REMODEL AREA REMODEL AREA REMODEL AREA LJATTACH DR'ELLLNG ITNITS:IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEINGADDED? .ONO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLAN'NLNG ADPL= ❑N'O PLAN'N'ING APPROVAL LETTER IS THE BLDG AN ❑ YESIVED EICHLER HOME? NO BY k--- z TOTAL VALUATION: By my signature below, I certify to each of the following: I arm the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of V,7ork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relaf q building coaction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: trDate: CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2583 21111 RED FIR CT CUPERTINO, CA 95014-4254 (359 05 042) PLATEAU BUILDING GROUP INC SAN JOSE, CA 94128 OWNER'S NAME: MCEVILLY CARLOS OWNER'S PHONE: 408-829-8052 LICENSED CONTRACTOR'S DECLARATION License Class B Lie. #9j594Q Contractor PLATEAU BUILDING GROUP INC Date 05/31/2018 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. 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. 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. APPLICANT CERTIFICATION 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 and state laws relating to building construction, and hereby 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 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applica,, understands and will comply with all non -point source regulations per Y4i Cupertino Municipal Code, Section 9.18. Signat4e':�T Date 08/24/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons:: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: 1. 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. z. 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so, as to become subject to the Worker's Compensation laws of California. If,; after making this certificate of 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 be deemed revoked. 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 and state laws relating to building construction, and hereby 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 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date 08/24/2016 ISSUED: 08/24/2016 NO: (408) 209-2364 BUILDING PERMIT INFO: X BLDG X ELECT X PLUME _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: RE -PIPE SED (COPPER) FULL; REPLACE KITCHEN SINK & COUNTER;,1 ST FLR 1/2 BATH - REPLACE SINK, COUNTER TOP & TOILET; 2ND FLR BATH - REPLACE SINK, COUNTER TOP, TOILET & SHOWER VALVE; INSTALL 3 (N) CEILING LIGHTS (DINING RM, UPSTAIRS BEDRM 1 & 2) Sq. Ft Floor Area: f Valuation: $5000.00 APN Number: Occupancy Type: 359 05 042 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROMLAST-C ED INSPECTION. Issued by: MEL". Date: 08/24/2011 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 08/24/2016 COVERINGS TO BE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read. the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health & Safety Code, Seco/onsA, 5505, 25533, and 25534. Owner or authorized agent'., -' Date: 08/24/2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lenders Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed i GENERAL PERMIT APPLICATIONE F ftj COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255, 1 S jorAk (408) 777-3228 • FAX (408) 777-3333 • building(cDcuperti'no.org CUPER' INO NLUMBING MECHANICAL ��ELECTRJIC ❑rmZISCE�LL PROJECT ADDRESS/ APN r 1 4t—�n 7,� ( 1 Imo. (�� ,�1i f Ci r� bwivir IB Iv 1 C l✓i%0 l 1\- P��/lJ 71 � t� v�� �s1a,0J_ eDtce_ 0I @ ly � Y6 kad -C(n�'1 $TRE(ETA�DDRESS (( (1� ® V I Ce 5' �J kIh FAX GG CONTAC e ( PHO , 097(aSD E-A L7 0 �i� ` Ajn STREET ADDRESS CITY, STATE, ZIP `r FAX (� ❑ OHR.'ER ❑ OWNER -BUILDER ❑ OWNTER AGENT IP CO1,7RACTOR ❑ CONTRACTORAGENTT ❑ ARCHITECT ❑ ENGINEER 11 DE<•'ELOPER ❑ TENANT CONT T611=1 LICEh1Cz *n "'" LIC TYPE BLTS L - E MAtI ` ` rip , FAX644 STREET AD _ CI STATE: a Ul� ARCHITECT WEER NAME LICENSE NUMBER BUS. LIC r COMPKNY NAME E-MAIL FAX STREET ADDRESS r CITY, STATE, ZIP PHOIdF USE OF [jSFD Or Duplex Xs lulti-Family PROJECT IN IN ILDLAND I PROJECT IN ,A STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No I FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK �, �I � �� (�.� 4,s -C r tit nler �i $16, o- dti �� �� C�.c��n Vtzp Ii1'y �rUrns�,�iue �rl���,c�a�vr'�bile��-5)wwtivice e�✓1 ` RECEIVED MOD," _,i-�►-com Bedroom 1, -_7-, 01r�_ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is orrect. 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 to building c s ction. I auth representatives of Ci ertmo to enter the above -identified property for inspection proposes. Signature of Applicant/Agent ;Date: f � j'p, AlfEPAlfiscApp_2011.doc revised 03116%11 SMOKE ICAMBION MONOXIDE ALARMS 0W, JE -0, 'PlIZATFIE OF C,'UMPLIANCE 09MM11`NITYDE-V 'EL'OPtK4ENT DEPARTMENT ® BUILDING DIIVI S,I ON I 103001-,GRR-EA-�VEN;UJ,E-QUiPI-ERTrN,, ,255 Wo , 014-3 MY TT I I MMI MT Nil UP( This affidavit is a self -certification for the installation of -0 required Smoke and Carbon Monoxide Alarms fo . r com"PRan-ce with 2013 CIBC Section 8314, 2013 CBC Sections 4,20.6 and 907.2.11.2 where no interior access for inspectiovs, are required. G-MIRAL WoRwAnm P--:kd9ft-hI9- single -4 amd multi -family dwellings 8,hall be provided. with,, Smoke Alarms and, Carban MID"RO'Xide 942fW. Wl en. the valuatio-A of additions, alterations-, or repairs to ex-latmig dwelling units5 exceeds R3i d CBC 3 cfFo is 907.2,11.5 and 42x.6 req ire that Smoke Alarrm ancl�o'r Calc an Mew -Aide Adarm-g,-be insialled in the fgllc-rw, in& lot, atlighs., ARIA Cpl AL 01,841die, of each-, separate steeping area in the immediate, viemity of the x W96ft Carboni Mo-Aw,3didle alarms ne not reqpired ift, dwellwh ichd,0'tot, con f, uel-bv ming apVlia mc, ff a and Shae Pvwev, Sqplty- am, d1welllimg, 1D m-ifts WA no, cmmm erl ciall- power - suTylly, alar, m (�s) inay saver lbafffffy 01"Ma3ted. In, e -A dtomfiling -Uqrt alla-rum are ptrmdifledt t9 be W, b adMeity &per, ate-idi wj-D?-ze y eyaws, ug wNeTtafimirs, & , not re.swIN im the rem-vila,11 of wall and ceilk%, fhajis-kes" or ld"M-Ee t, 1mg. access by me. imi of @Afic� b)asei, ME cuawi &-pace,., ReffevtoiCRC S-edmo-ift, 13114 aficild CDC Secfik'ns, 5@71U.11.4 ar-ild 420.6.2.. An electrik, 11 e mimitiis, , � - , �, a F re fur, aTaxiin& wffidch must be c m wr-ected to, the buddmg wrzi n& ye ins,taililled, inaccoudiamce, with- ffiemi afirL,,u,�hctutiter"S,StYacti@Fts, amd int, carnplance )d &e� Calif' a b IN 1 Wit a m, dt Cal if- und a, Re n CUPERTINO Owner Name] ce Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE a CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 a buildingO=Dertino.ora - ulfi- 1. Is your real property a registered historical site? D Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 9 No Go to Question 2. 2. Does your real propertyhave 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. ES/ No Go to Question 3. s ; 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. E(No Go to Question 4. L 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. 4 WYes 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 k - following: MYprope�Y is a single-family residential realproperty. 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 shalt be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). 0 My property is a multifamily residential real propeity. See Civil Code Section 1101.5. On and, after January 1,. 2014,; specified building alterations or improvements shalt require non- compliant f 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). El 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). 1,, as the owner or, owner'sagent of this property, certify under penalty of penury 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.&, the current California Plumbing Code and California Green Building Stand'ard's: 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. Owner or Owner Agent's. Signature Date_ Iq1,1114 _ Upon completing and signing this Cettifncate, pl se etum it to the Building, Division in order to final your building permit. SB4072015.doc revised 08126115