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B-2017-0848CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0848 22356 RANCHO VENTURA ST CUPERTINO, CA 95014-2736 (357 03 055) PURONICS SERVICE INC LIVERMORE, CA 94551 OWNER'S NAME: EDELSON DANIEL R TRUSTEE DATE ISSUED: 05/30/2017 OWNER'S PHONE: 909-762-5039 PHONE NO: (925) 456-7000 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Safi Lic. #928595 Contractor PURONICS SERVICE INC Date 02/28/2019 X BLDG —ELECT X PLUMB 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: INSTALL WATER SOFTENER SYSTEM - GARAGE 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 Sq. Ft Floor Area: Valuation: $4045.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 357 03 055 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 5/30/2017 Issued by: Abby Ayende Date: 05/30/2017 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 roofmg 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 Code). Date: 5/30/2017 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 permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. 1 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 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: 5/30/2017 ��---� 1 certify that I have read this application and state that the above information is CON TRUCTI DING 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'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 5/30/2017 Professional CUPERTINO j3_ W q-- Out GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building0cupertino.orq PLUMBING El MECHANICAL FIELECTRICAL MISCELLANEOUS MEP MISC PROJECT ADDRESS / ^ y / -17V t' C _ 1 ' /� APN #` j r Oar 055 OWNER NAME 1)/�J�_50"j 0 " PHOS - / 6 Z � E-MAIL STR DDRESS, CITY, STATE, ZIP 2'7,,)O , cA q:501 FAX CONTACT NAME JEFF RAINEY PHONE 510-427-4260 E-MAIL jeffrey.rainey@aft.net STREET ADDRESS 1069 EDGEMERE LANE CITY, STATE, ZIP HAYWARD, CA 945454 FAX510-783-1041 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR C4 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /' LICENSE NUMBER 928595 TLICENSETYPE C36 BUS. LIC # 40137 COMPANY NAME Puronics E-MAIL FAX 925-456-7010 STREET ADDRESS 5775 Las Positas Rd CITY, STATE, ZIP Livermore, CA 928595 PHONE 925-456-7000 ARCHITECT/ENGINEER. NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FerSFD or DUPLEX ❑ MULTI -FAMILY BUILDING 0 COMMERCIAL PROJECT IN WILDLAND [I YES URBAN INTERFACE AREA E] NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME' ❑ NO DESCRIPTION OF WORK. 1'j I / �`�2 _ -�� `�� ! /1--7-4 I TOTALVALUATION: Lf" �Lf- RECEIVED BY: 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 building construction. Signature of Applicant/Agenc I am the property owner or authorized agent to act on the property owner's 6ehalf I have read this I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date:S / 3 c>% SUPPLEMENTAL RM ION REQUIRED OFFICE USE ONLY w ❑ OVER-THE-COUNTER ❑ EXPRESS W I� ❑ STANDARD C4; ❑ LARGE ❑ MAJOR MEPMiscApp_2011.doc revised 06/21111 CUP.ERTINO 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 • building(qcupertino.orq ' PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section 8314, 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 ALARM Outside of each separate sleeping 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 I X, Date:................... 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. \ r Address: ��3s� � � V n �� Permit No. &_2100_09 e Specify Number of Alarms: # Smoke Alarms: = # Carbon Monoxide Detectors: F_/ 7 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: 9co IC, � /� t Signa ure ....� ............................................... Df��Z..... Contractor Name: Signature...................................................................... Lic.#........................................ Date:................... Smoke and CO form.doc revised 01/10./2017 CUPERTINO Owner Name WATER-CONSERVINP PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �`408)�7 -325 FAX (408) 777-3333 • buildinaCa cupertino.ora i og 5� Permit No. � 7 ^ Y Address 2,2 5-4, R-c1y O Ven ty n, S C' )e'i +l 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections. 1101.1 through"]. 101.8 do not apply. Skip the rest of the form and sign bottom of forin. 2"N"o 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. %L�No 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. %2"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:. Z' 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-conseiving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily reside77t1al 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-coinpliant 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-conseiving 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 Owner Agent's Signature: Date: 5-Z� �? upon compieung ana srgmng rms t,erancate, please return it to the Budding Division in order to final your building permit. SB4072015.doc revised 01;05/17 � a