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B-2017-0541CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0541 10434 ALICIA CT CUPERTINO, CA 95014-2634 (342 45 025) FORMOSA ELECTRIC CORP NEWARK, CA 94560 OWNER'S NAME: SANFORD KARL J AND CATHERINE M TRUSTEE DATE ISSUED: 04/04/2017 OWNER'S PHONE: 408-332-6519 PHONE NO: (510) 709-5978 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Q10 Lic. #976353 Contractor FORMOSA ELECTRIC CORP Date 09/30/2018 X BLDG X 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: UPGRADE (E) 100 AMP MAIN PANEL TO (1) 125 AMP, SAME I hereby affirm under penalty of perjury one of the following two declarations: LOCATION 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. z. have and will maintain Worker's Compensation Insurance, as provided for by C Section 3700 of the Labor Code, for the performance of the work for which this Vv/ permit is issued. Sq. Ft Floor Area: Valuation: $2000.00 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 42 Number: Occupancy Type: 3 and state laws relating to building construction, and hereby authorize 342 45 025 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 regul7onsr the Cu ertino Municipal Code, Section 9.18. 180 DAYS FROM L ��ECTION�. i nature Date 04!04/2017 Issued b : MELI AN Sg Y V V/ Date: 04/04/2017 OWNERAR II DER DECLARATION 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 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) z. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Cade). Date: 04/04/2017 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 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, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. 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 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 3, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent / APPLICANT CERTLFICATION Date: 04/04/2017 I certify that I have read this application and state that the above information is CONSTRUCTIONLENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is construction truction 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, 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 ARCHITECT'S DECLARATION and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 04/04/2017 Professional CUPERTINO GENERAL 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 3� n PLUMBING n MECHANICAL ELECTRICAL MISC 0,0/31 -0.rv/ ❑ MISCELLANEOUS PROJECT ADDRESS1( ♦os, Gh ff �! ® APN # J V (JT OWNER NAME Xu r i PHONE( � e /� E-MAIL )<Sa I er-,0 ,MM i �- STREET ADDRESS+ ` ` ` CITY, STATE, ZIP Vi Cj S FAX CA 0 CONTACT NAME po�o,r PHONE �j E-MAIL a -K 0 '^fl od STREET ADDRESS ey S O r min ! ,( CITY, STATE, ZIP C �p rf _ FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 6S0. eC 1 �1 P Y (� LICENSE NUMBER �/ LICENSE TYPE s O BUS. LIC #'40 -� ® 9 COMPANY NAME - N E-MAILlO 0(f►1oSa ® M I FAX STREET ADDRESS ,(Moor CITY, STAT ZIP n PH °+S ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF X3 SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WR,DLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN FLOOD ZONE ❑ YES ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK 0 0 TOTAL VALUATION:i/t CEIVED BY:f By my signature below, I certify to each of the following: application and the information I have provided is correct. ordinances and state laws relating to buil ing struc Signature of Applicant/Agent: I am the property owner or authorized agent to acts pr owne ' have read this 1 have read the Description of Work and verify it is accura e. I agr comply with all applicable local authorize representatives of Cupertino to enter the above-ide Ified operty for inspection purposes. Date: SUPIkEEMEtTAVINFORMATION REQUIRED . - OFFICEUSE ONLY w . - ❑ OVER-THE-COUNTER E- ❑ EXPRESS - x ' ❑ STAND 1itA ❑ LARGE - - p, . ❑ NLAJOR MEPtIfiscApp_2011.doc revised 06/21/11 c6m CUPERTINO PURPOoL SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(d)cuDertinn nrn This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314; R315, 2016 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, R315, 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 ALAR_ M Outside of each separate sleepiiLg area in the immediate vicinity of the bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door) X X On every level of a dwelling unit including basements and habitable attics 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 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, basement 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 has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below %. Address: 1iAj` Specify Number of Alarms:i# Smoke Alarms: Permit iVo..�� r r �# Carbon Monoxide Detectors: 1 have read and agree to comply with the terms and conditions of this statement ow}er (or 0 a er Age - Snature....- .................... d. ............ ........... .......... .......... ............ ................. Date:................... Coy,eme: t a Signature.. ......................... ................kz�.............................. ...-.......................... .. Date:................... Mi Smoke aced CO foren.doc revised 0U101_22017 Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 • FAX1(40Q�7;7-3333 • buildingAcupertino.org M 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. E`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 ,Vbing, installation of water -conserving plumbing fixtures is not technically feasible? VYes Civil Code Sections 110 1. 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. ❑ No Go to Question 3. 3. WYes er service permanently disconnected for your building? 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 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? L�,/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: Wor 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 innprovements 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 inTrovements). 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 nage. A _ jr I Owner or Owner Agent's Signature: `\� "` Date: --' Upon completing and signing this Certificate, please return it to t e Building Division in order to final your building permit SB407 2015. doc revised 01105/17