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B-2016-1211MIT
CITY OF SCUP ERTINO BUILDING PERMIT
IIUIILDINCADDRESS:
CONTRACTOR:
PERMIT NO- B-2016-12 11
11513 SEVEN SPRINGS LN CUPERTINO, CA 95014-5131 (366 52 013)
( WESTERN GENERAL
CONSTRUCTION INC)
SAN JOSE, CA 95122
OWVNIER'S NAME: HUKKOO AJAT AND PRITI
DATE ISSUED: 01/19/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. 4 q q l 7
Contractor ( WESTERN GENERAL CONSTRUCTION INC) Date
Di; BLDG — ELECT — PLUMB
]BCH X RESIDENTIAL _ _ COMMERCIAL
I hereby affirmthat I am licensed under the provisions of Chapter 9 {commencing
—
with Section 7000) of Division 3 of the business &a Professions Code and that my
lleense is In MR force and effect.
JOB DESCRIPTION:
REMODEL (E) 120 S.F. KITCHEN, NO STRUCTURAL CHANGES
I hereby affirm under penalty of perjury one of the following two 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,
2. 1 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
Sq, Ft Floor Area:
Valuation: $18000.00
this permit is issued.
APPLICANT CER'T'IFICATION
I certify that I have read this application and state that the above
IaPN Number:
Occu p y TYpe:
ant
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
366 52 013
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 con��ecfuence of theWITHIN
��� ��� OF PERMIT ISSUANCE OR
granting of this permit, Additionally, the applicant��e:riderstands and .will
comply with all non -point source regulations p r'fhe Cupertino Municipal
180 DAYS FROM LAST CALLED INSPECTION.
Code, Section 9.48.
/
VL
Issued bS[gnaturs
Dafe / j/ //�
ie ®®
IDate: QQ
OWNER-RIM,D (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. 1, 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 ofApplicant:
2. 1, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the project (Sec.7044, Business & Professions Code).
ALL ROOD' COVERINGS TO BE CLASS "A" OR BETTER
I lterehy affirm under penalty of perjury one of the fallowing three declarations;
a. 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
s. 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
air contaminants as defined by the Buy Area Air Quality Management District I
shallnot employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 n
Worker's Compensation laws of California, If, after making this certificate of
the health &z Safety Code, Sections 5 55 3 a d 2553
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, au h I agent:
be deemed revoked,
Dater f i
APPLICANT CERTIFICATION
0 CO STRUCTIO DING AGE Cil
I certify that l have read this application and state that the above Information is
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
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 8.48.
Licensed
Professional
Signature Date
CONSTRUCTION PERMIT APPLICATION
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COMMUNITY DEVELOPMENT DEPARTM NT � 411(15)
BUILDING DIVISION - CUPERTINO-]'fQuf Ioppr r
This set of plans and specifications MUST be kept a the ON C,116)1
;Ob site during corstruction. Itis unlawful tomake
-' y
-Ageo,M"altermio -on same, or to dev, to — therefrom, without wlihout approval from the Building Official.
The Stamping Of this pian and specifications SHALL NOT
be held to permit or to be an approval of the violation
Blany prt�v i o a °ity Ordinance or State Law.
DATE
PERMIT # F� –
APEPOV E D: 21-a2k;,1
TOMER:
SCALE " = FT. CUSTOMER: �p� Prod member ®6•
REVISED: ALL DIMENSIONS & SIZE DESIGNATIONS-'�C�t1"� 4 I 'PA -T1 rnarTB�f
rrofvtoner=
SUPERSEDES DRAWING GIVEN ARE SUBJECT TO VERIFICATION 60 -/470-) M61 r rnreum�
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COMMUNITY DEVELOPMENT DEPARTM NT � 411(15)
BUILDING DIVISION - CUPERTINO-]'fQuf Ioppr r
This set of plans and specifications MUST be kept a the ON C,116)1
;Ob site during corstruction. Itis unlawful tomake
-' y
-Ageo,M"altermio -on same, or to dev, to — therefrom, without wlihout approval from the Building Official.
The Stamping Of this pian and specifications SHALL NOT
be held to permit or to be an approval of the violation
Blany prt�v i o a °ity Ordinance or State Law.
DATE
PERMIT # F� –
APEPOV E D: 21-a2k;,1
TOMER:
SCALE " = FT. CUSTOMER: �p� Prod member ®6•
REVISED: ALL DIMENSIONS & SIZE DESIGNATIONS-'�C�t1"� 4 I 'PA -T1 rnarTB�f
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'HENS by MEYER
CONTRACTOR LICENSE 323DBI
650.968-7866
278 CASTRD ST.
MTN. VIEW, CA 94040
'Puff* s
U), CN) Naw
C�> (i�lh iINC�
w��
UPERTINO
tri llding Department
IPM 19 2016
.r
REVI ED FOR CODE COMPLIANCE
Review d By:
THIS IS AN ORIGINAL DESIGN ARID
MUST NOT BE RELEASED OR COPIED
UNLESS APPLICABLE FEE HAS BEEN
PAID OR JOB ORDER PLACED,
ee
'HENS by MEYER
CONTRACTOR LICENSE 323DBI
650.968-7866
278 CASTRD ST.
MTN. VIEW, CA 94040
'Puff* s
U), CN) Naw
C�> (i�lh iINC�
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UPERTINO
tri llding Department
IPM 19 2016
.r
REVI ED FOR CODE COMPLIANCE
Review d By:
THIS IS AN ORIGINAL DESIGN ARID
MUST NOT BE RELEASED OR COPIED
UNLESS APPLICABLE FEE HAS BEEN
PAID OR JOB ORDER PLACED,
DRAWING NO:
APPROVED:
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SUPERSEDES DRAWING
NO.
9 (g) 0110 rnpg_
SCALE —�V" _-I—_ FT.
ALL DIMENSIONS 81 SIZE DESIGNATIONS
GIVEN ARE SUBJECT TO VERIFICATION
ON JOB SITE AND ADJUSTMENT TO FIT
JOB CONDITIONS_
CUSTOMER:
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CUPERTINO
130dinJ Department
JAN 19 2916
FOR CODE COMPLIANCE
roed By. '4%--7311
---- 70
Proud member of =ECHENS &p� MEYER ' / ,p A
7LeljitvI CONTRACTOR LICE BE 323001 THIS IS AN ORIGINAL DESIGN AND Ij�'_ .I FJi\
r r dorsals 659-968-7866 MUST NOT BE RELEASED OR COPIED
t&lQafllnd ufry 278 CASTRO S7. UNLESS APPLICABLE FEE HAS BEEN
MTN. VIEW, CA 94049 PAID OR JOB ORDER PLACED.
DRAWING NO:
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Quiding Department
19 7.016
REVIEWED FOR CODE COMPLIANCE
'y 11 Reviewed By:
A I i-317-15-
APPROVED:GRID I
CUSTOMER: -y_ - ��-
SCALE " =�_ FT. Proal member oF. MTCHE �jS r I,
REVISED: AC11F"j 4 r'?t'(1 Hllictw TheFinae CONTRACTOR uc SEazaml THOS IS AN ORIGINAL DESIGN AND
ALL DIARESIOBJE SIZE DESIGNATIONS rarr. o a< 650.968-7866 MUST NOT BE RELEASED OR COPIED n ��
SUPERSEDES DRAWING ON JOB SITE AND GIVEN ARE SUBJECT ADJUSTMENT
TOt IT "nc�xmF" �7�✓
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ALL DIMENSIONS & SIZE DESIGNATIONS
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JOB CONDITIONS.
ISTOMER: Proud member f. KIT(CHENS L3LM
AJA-T4 rg-fl n F1 CONTRA OR Ll 323091
278 CASTRO ST.
MTN. VIEW, CA 94040
11CUPERTINO
sui'ding Dep7Ftlnenj
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EV'EWSD FOFJ C()r)Fj COMPUANCr
Reviewed By:
THIS IS AN ORIGINAL DESIGN AND
MUST NOT BE RELEASED OR COPIED
UNLESS APPLICABLE FEE HAS BEEN
PAID OR JOB ORDER PLACED.
11
ING NO:
(D I ` w\1A-r' &? N -
CUPERTINO
Building Departrnent
v
^� JAIN i J 20115
REVIEWED FOR CODE COMPLIANCE
Reviewed By: arc
SCALE 2' " =_�FT.
CUSTOMER:
Proud member of.-
MTOE Ns �D MEYEP.
REVISED:
CONTRACTOR LICE E32SM1
PHOS IS AN ORIGINAL DESIGN AND
SUPERSEDES DRAWING
ALL DIMENSIONS & SIZE DESIGNATIONS
GIVEN ARE SUBJECT TO VERIFICATION
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MUST NOT BE RELEASED OR COPIED
UNLESS APPLICABLE FEE WAS BEEN
ON JOB SITE AND ADJUSTMENT TO FIT
II'�L'�'�Qk'IN L,�if
MTN. VIEW, CA 94040
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APP 11
id _ CUSTOMER: 'Proud member of. �i°w�' �H��' Typg IS AN ORIGGNAL DESIGN AND
SCALE t �FT, coNiRgcTgaucENse'azawt
REVISED: 7 nP 650.988.7886 MUST NOT BE RELEASED O.R COPIED
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ALL DI ENSION5lI<SIZE DESIGNATIONS Pnfe°°°°'
�ITt—�fA�(SP(% mfaox«u°A 278CASTROSL UNLESS APPL9CABLE FEE kiAS BEEN �:r
SUPERSEDES DRAWING GIVEN ARE SUBJECT TO VERIFICATION �����//� &'n°°�°° so-y MTN. VIEW, CA 94040 PAID OR JOB ORDER PLACED.
ON JOB SITE AND ADJUSTMENT TO FIT I I�f ``✓�'�'11
N0. JOB CONDITIONS.
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CUSTOMER:
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h-o.dmemberof
TCHIENS
IU WYE
CONTRACTORUNKE32HOi
T IS AN DESIGN AND
ORIGINAL
DRAWING
SUPERSEDESCATION
DESIGNATIONS ALL DIMENSIONS& SIZE DESIGN
GIVEN ARE SUBJECT TO VERIFICATION
New
I
650-968-7866
MUST
LIST NOT BE RELEASED OR COPIED
NO.
ON JOB SITE AND ADJUSTMENT TO FIT
�LAPXTI
278 CASTRO ST
MTN. VIEW, CA 94040
UNLESS APPLICABLE FEE HAS BEEN
PAID OR JOB ORDER PLACED.
JOB CONDITIONS.
7.* SMOKE!CARBON MONOXIDE ALARMS
•
ly/ OWNER CERTIFICATE OF COMPLIANCE ETI FiLr
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION eaS 3ra3lit,
10300 TORRE AVENUE.b CUPERTINO,CA 95014-3255
CUPERTINO
, (408)777-3228.FAX(408)777-3333•buildinci(&,cuDertino.orq
:07? 2 016 i 2-1
Sex-r—A SY ,‘, f :„-;14 473alukto 0 tide:
PERMIT CANNOT BE IFINALED AND cogtunD UNTIL THIS CERTIFICATE
BI op d Toktoggugiponigviwei
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section p14,: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 CO ALARM
Outside of each separate sleeping area ihi 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.
Power Supply:In dwelling units with no commercial power supply,alarm(s).may be solely battery operated.
In existing dwellingunits, alarms are permitted to be solely battery operated where repairs or alterations do.
not result in the removal of wall and ceiling finishes ofthere is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.62.An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,Ti hereby certify that the alarm(s)referenced above has/have been
installled in accordance with the manufactoirer's instructions and in compliance with the California Buillding
and California Residentith Codes.The alarms have been tested and are operational, as of the date signed
below.
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\\ 11/ WATER-CONSERVING PLUMBING FIXTURES r
TILE
OWNER CERTIFICATE OF COMPLIANCE
-
: COMMUNITY =
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION Rft, •
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333.buildincacuoertino.orq
Owner Name. PR I T 1 la =\(.._oo . . Permit No; g .2-61 1 Z.l e
Address l 15 '32 SeArr.AA SpyNLIAciA, Uri) a_ukz) c-a` 5' o 14
1. Is your real property a registered historical site? "
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
-'1Vo 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.
0 The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
W4To 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.
0 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.
Yes 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:
f [VMy 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 shallbe replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
O 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 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. .
Owner or Ownerfigent's Signature c - -� c� Dat6':) l 3 ! �"
4--
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08/26/15