B-2016-1451CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1451
10631 GLENVIEW AVE CUPERTINO, CA 95014-4514 (369 26 027)
( QUALITY PLUMBING
& REPIPE INC)
SAN JOSE, CA 95112
OWNER'S NAME: MARVIN GREGORY S SR AND PATRICIA
DATE ISSUED:I 03/01/2016
OWNER'S PHONE:
PHONE NO: 4084376207
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C6 Lic. #1007379
Contractor ( QUALITY PLUMBING & REPIPE INC ) Date 3/1/2016
X BLDG —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:
INTERIOR COPPER REPIPE; REMOVE AND REPLACE WATER
I hereby affirm under penalty of perjury one of the following two declarations:
HEATER, SAME LOCATION; REPLACE BUILDING WASTE LINES IN
i. I have and will maintain a certificate of consent to self -insure for Worker's
CRAWLSPACE
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
Sq. Ft Floor Area:
Valuation: $6400.00
this permit is issued.
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
APN Number:
Occupancy Type':
ordinances and state laws relating to building construction, and hereby
36926.027
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 consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point so rce regulations per the Cupertino Municipal
180 DAYS FROM LAS CALLED INSPECTION.
Code, Section _9.18.
Issued by: PAUL O'SULLIVAN
Signatur Date 3/1/2016Date:
3/1/2016
OWNER -BUILDER 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
n. I, 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 of Applicant:
z. I, as owner of the property, am exclusively contracting with licensed
Date:/1/3 2016
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
n. 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
2. i have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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
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
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Sections 5, 25533, and 25534.
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 authorized agent:
be deemed revoked.
Date: 3/1/2016
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I 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
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
I understand my plans shall be used as public records.
understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date1/3/ 2016
CUPER.TINO
GENERAL PERMIT APPLICATION �b °' 4 I N=1 E mr
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 = = Isc
(408) 777-3228 • FAX (408) 777-3333 •- buildingQcupertino.org all
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PROJECT ADDRESS
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OWNER NAME
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CONTACT NAME
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STREET ADDRESS
CITY, STATE, ZIP
❑ owNER ❑. owNER-BuI DER
❑ OwNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENTT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER
❑ TENANT
CONTRACTOR NA
LI NSE NUMBER
LICENSE T E
BUS. LIC #
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ARCHITECT/ENGINEERNAME
LICENSE NUMBER
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E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES
BUILDING: ❑ COMMERCIAL URBAN. INTERFACE ANO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN
EICHLER HOME?
❑. YES
❑ NO
DESCRIPTION OF WORK
f
TOTAL VALUATION: RECEIVED B3,
By my signature below, I , e ify to each of the following: I am the property owner or authorized agent to act on the property owner's be'alf. I have read flus
application and the information I have provided is olrect. I have read the Description of NVork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildings struction. I authorize representatives of Cupertino to enter the above-iden ' Ied pr erty for inspection purposes.
Signature ofApplicant/Age t: — Date:
SUPPLEMENTAL INFORMATION REQUIRED, ,,;..n.. oFz it tlsE anY . _ .
A,fEPA,fiscApp_201 ].doe revised 06/21/11
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OWNER CERTIFICATE OF COMPLIANCE
A 41141,N. COMMUNITY DEVELOPMENT DEPARTMENT 0 BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE 6 CUPERTINO,CA 95014-3255
(408)777-3228.FAX(408)777-3333.buildinqAcupertino.orq
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PERMIT CANNOT DE FINALED AND COMPLETED UNTIL TILLS CERTIFICATE
HAS WEN Malra AND,lattann TO'AVE BALDING DIVISJON
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--—
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 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:
APIA SMOKE ALARM Co ALARM
1 , Outside of each separate sleeping area in the immediate vicinity of the X X
I
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
J1 Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
i 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 The Marshal
,1
i 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 R31i4 and CET Sections 907.2.11 4 and 4206.2.An electrical permit is rewired for
1
1 Anil-its 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
instalTed in accordame with the manufacturer's instructions and in compliance with the California Binigcliing
and California ResiderIga Cedes.The alarms have been tested and are operational, as of the date signed
below
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\,,,„,/./ WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
4",1.
,5`.`` COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-g333• ildinq(a�cupertino.orq /
Owner Name est,>1 5 illV /P Permit Nof 1 I 61, (� / c1r1
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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.
c ❑ 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.
I "iJ ❑ No Go to Question 3.
it
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.
f ) CINo Go to Question 4.
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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 through1101.8 do not apply. the rest of the form and sign bottom Skip of form.
;tet ❑ 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:
❑ 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
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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
1I improvements).
1 ❑ 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.
1 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 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
1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
i li installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
1 table on the following page.
Owner or Owner Agent's Signature(
! Date: 7
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