15120146 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20248 NORTHWEST SQ CONTRACTOR:MIKE COUNSIL PERMIT NO: 15120146
PLUMBING INC
OWNER'S NAME: FIANCE FLORENCE S TRUSTEE 1915 O'TOOLE WAY DATE ISSUED: 12/16/2015
OWNER'S PHONE: SAN JOSE,CA 95131 PHONE NO:(408)2724900
_I`1 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
UPGRADE SUB-PANEL.TO 100 AMP
License Class / Lic.#
Contractor Date
I hereby Yng
that I am licensed under the provisions of Chapter 9
(commenwith 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:
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. Sq.Ft Floor Area: Valuation:$2000
q
ave 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 APN Number:31639046.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORD IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, y 1 I
costs,and expenses which may accrue against said City in consequence of the 116
granting of this permit. Additionally,the applicant understands and will comply Issued by:_ �(/t/�®VLA-) Date:
with all non-point source regulatio s per the Cupertino M�ipal Code,Section
9.18.
RE-ROOFS:
Signature v amu - Date L L 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,
05,25533,, rd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: - Date:
permit is issued. i
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revolted. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
i
GENERAL PERMIT APPLICATIONM E P`
COIVINiUNITY DEVELOPI\4ENT DEPARTMENT- BUILDING DIVISION
10300 T ORRE AVENUE• CUPERTINO, CA 85014-3255
(408)777-3228 • FAX(=;08)777-3333 • buildin0(CDCuoert1no.org
CUPERE.II10M I
-
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❑PLTj],M N'r, ❑MECKkNTIC.L, ELECTRICAL ❑h�SCELL!S OUS
PROIi.CT ADDRESS � �n � �'� �� I ti3>\
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CONI;ACTOR I:ah / % ,� /Z� ` I LICENSE'2NUN BER I LICENSE TYPE I BUS.LIC N
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STREET ADDRESS � � ^yyFY,STATE,ZIP
pRCETECTANGDNEER N.01E LICENSE I\'UMBER,S U 2 � �; /t BUS.LIC f
COW34i.'Y NAI�Z5 E-?J,AM
STREET ADDRESS CITY,STATE,ZIP Pri02�i
us_=Or ❑SFD.,DUPLEX ❑ MULTI-FAiuLy .PROTZCT LN W DL,4 N ❑ Y'S PRO-LCT IN ❑ Y S IS TFC BLDG tN ❑ ti=S
BuMDP.G: ❑CMDIERCLAL I URB? R\rl- ACEARFA ❑ 1.0 FLOOD ZOIT--- ❑ NO EICFLRHONE? ❑ 1"0
DESCRIPTION OF WORK
TOT.d.LVALUATIO-\T L/Vp
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By my signature below,I certify to each of the following: I am the property owner or autborized agent to act on the property ty owner's behalf. I have read this
application and he information I have provided is coirect. I have read the Desciiption of Work an-&verify it is accurate. I agree to comply with all applicable local
ordinances and sate lav;,s relating to b i.1" :onstruc`-' a. I authorize representatives of Cupertino to enter the above-ideuti-Eed prop-i-'for inspec ion purposes.
17
Signa=e of Applicant/Agent: Date:
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SL-PPLE<��iAI.L�rORv1A I01�REQULR.ED
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A1ffP-4/isc,4pp_0J1.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
-! ADDRESS: 20248 Northwest Sq DATE: 12/16/2015 REVIEWED BY: Phuong
APN: 316 39 046 BP#: *VALUATION: 1$2,000
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP
USE: PERMIT TYPE:
WORK U grade sub-panel to 100 am
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 100 Amps $48
TOTALS: $48.00
"eeh. Pion Chi"•- 1'ia�Ftrl3.I'ic�sT :'�z°cu Elec.Plan Check FO.Oj hrs $0.00
%afet`I'i.:''r'tt aft fee: :'Id?3t?3.Petraii: ..,.. Elec.Permit Fee: IEPERAIIT
C:a>�a, ..g,r:�;��ir. 7r-:x�. OiAl,•`'HO)"b f;�-sA Other Elec.Insp. 766 hrs $48.00
11'e"t1.zsns . P,"e t-b. 1•'£'e;
NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the Dept./or addn'l in o.
FEEp ITEMyS (Fee Resolution.1.1-053.Fff. 7/11.132 FEE QTY/FEE MISC ITEMS
Y
PME Plan Check: $0.00
PME Unit Fee: $48.00
PME Permit Fee: $48.00
(."C1f,�iiI�uction .T iy .
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes (E) No $0.00
r
.11!77:rdT3,
Travel Documentation Fee: ITRA VDOC $48.00
Strong.Motion Fee: I BSEISMICR $0.50 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
SUBTOTALS:: $190.50 $0.00 TOTAL FEE: $190.50
Revised: 10/01/2015
SMO' 0�CARB0N MONOXIDE ALARMS
OWNER CERTIFICATE OF COMP 8ANCE
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO,CA 95014-3255
(408)777-3228 o FAX(408)777-3333• bull ding Ca)cupertino.org
7
1 ___'1NqA3 A6 f2A11 #f � eke: j. 1 a�1
PERAUT CANNOT DE FI>~ALED AND COMPLETED UNTIL THIS CE,RTYFYCATE
HAS h3�N Sb 1,. Ari �f k �l'���[��3�`JJ���D Q p i[�:����'0-N
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.
GENERAL RNFORMATION
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 in 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 dweEhig,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 8314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for
alarins 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 inn,accordance with the mmanufacturer s instructions and im comph.nce with the California Building
and Call toxnnma Residential Codes. The alarms have been tested in d are operational, as of the date signed
below..
t have,readand:a,,Fee to cornLtt withn they terms,andt con6,tiQns of thi'�'s statement
5l: ait7re.. -
Con'"ad rvMam ; 1? {e:
1 1
s,:O`akure_.... ._.. lac Dafe.
_ ......... ........ ........ _ y'
Smoke and CO fbrna.dbe revised,03%1'8/14'
OWNER CERTIFIC ATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT,,BUILDING DIVISION -
CUPfERro"o 10300 TORRE AVENUE o CUPERTINO,CA 95014-3255
(408)777-3228®FAX(408)777-3333-building(a.cupertino.oro 12—
Owner
2—Owner Name Permit No. 0V 671—
Address
C
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 f
orm.
orm.�a1 l 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.
ro 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.
llo 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.
Tyes My realproperty 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:
filiP` 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).
0 My property is a multifamily residential Leal property. See Civil Code Section 1104.5.
On and after,January 1, 2014,specified buildingalterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or befove January 1,.2019,,,all non-compliant plum.bing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
Q My property is a comaiTer•ciRl real prepeifiy. See Civil Code Section 1101.5.
On and.after January 1, 2014,specified builduig alterations or improvements shall require non-compliant
phiinbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be repPaced with water- conserving
plurnB ng fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
1,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 plu�a g tures in accordance with Civil Code Sections 1101.1
tluough P 101 8,the.current California.Plumbing Cod and ip orn reen Building Standards Code,and manufacturer's
installation requirements, and that the water-cons umbi ixtures comply with the requireiments as indicated in the
table on the fol-Tiowing page.
Owner or OwrueF Agent"s Signatp--cgl
Upon completing and signing this Ceit' he,ple r rn it to the wild'` ivision.in order to final youa building permit.
SB4'0'7 20,15.doe revised 08/26/1.5