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B-2016-2472 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2472 917 OLD TOWN CT CUPERTINO,CA 95014-4024(356 11 034) TRENCHFREE INC SAN JOSE,CA 95151 OWNER'S NAME: NATTIV MOSHE AND ESTHER DATE ISSUED:08/08/2016 OWNER'S PHONE: PHONE NO:(408)726-7926 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36 C-12 Lic.#971016 Contractor TRENCHFREE INC Date 03/39/2018 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: REPLACE BUILDING SEWER/REPLACE SEWER MAIN;CLEANOUT 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. 2 `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 �J permit is issued. Sq.Ft Floor Area: Valuation:$3000.00 APPLICANT CERTIFICATION 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 3561 034 Number: Occupancy Type: 3 and state laws relating to building construction,and hereby authorize 5b 1 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,52/ —Date 8/8/2016 Issued by:Abby-Ay-endo Date:08/08/2016 OWNER-BUILDER 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 employeeswith wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: / /8 8 2016 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 2. 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 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 25505,25533,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:8/8/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING 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, 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 8/8/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(a)cupertino.org MISIC FkIPLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS q T fj ��k/n APN# 1 0� OWNER NAME #V► D r w PHONE E-MAIL STREET ADDRESS r [/ -10W CITY,STATE,ZIP/? �78 � FAX b^"Jug CONTACT NAMEPHONE E- L tka-& T 14M-21 2A STREET ADDRESS6 CITY,STATE,ZI orl g,� FAX ElowNER El OWNER-BUILDER El OWNER AGENT 19 CONTRACTOR ❑'CONTRACTOR AGENT f/❑1 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMELICENSE NUMBER LICENSE T ,E5� BUS.LIC#�y ,0 fp COMPANY NAME - l E-MAIL FAX a STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK ( �jj TOTAL VALUATION: 3 00� RECEIVED BY By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildp'aVconstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED `D�Fir> tsi a_NLY' ❑y VER—TBE-COUNTER ,'; Q`r EXPRESS W STANDAR U � LARGE ..� MAJOk MEPMiscApp 2011.doc revised 03116111 SMOKE 1 CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT,BUILDING DIVISION UPEP.TCNO 10300 TORRE AVENUE•CUPERTINO,Grp 95014-3266 (408)777-3228=FAX(408)777-3333>tujJdin2Qc,.raer ind.a ca r 6 Address _ "'° -, of Alarms Smoke: . Carbon Monoxide: - `-gid==�� � '�'":_; �"� + .A.Fr�r.� emr_.. ,2 $. ga"� '.'�`..�'" .�. _�` p� _-.;1 -3., .€u.n����"�'��`' �"�''�a•�e•o-,k...«.> PURPOSE This affida--rit is a self-certification for the installation of all required Smaike and Carbon`10onoxide Alarms for compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and W.2.11.2-where no interior access for inspections are required. GENERAL.INFORMATION Existing single-f airdly and multi-family dwellings shall be provided w itb.:Srnoke Alarms and Carbon Monoxide alarms. VVIlen the valuation of additions,alterations,or repairs to existing dwelling units exceeds $7.000.00,CRC Section X614 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/gar Carbon Monoxide Alarms be installed in the following locations: AREA 'SMOKE ALARM, CO ALARM Outside of each separate sleeping area in-Che iilmnediate vicinity of the X X bedroorn{s) On every level of a dwelling unit i#ducijLn basemetits X ?c Within eachKlee ins room � X Carborrc Monoxide alarms are not required in duiFellings which do not contain fuel-burning appliances and that o not have an attached garage. Carbon monoxide alarms combined wfth smoke alarms shall col ply with CBC Section 420.6 and shall be approved by the Office of the State Tire Marshal. Power Supply:In dwelling units with no cots-rnercial power supply,alarm(a)may be solely battery operated. In existing divrelling units,alarms are permitted to be solely battery operated cohere repair: or alterations do not result in the removal of wall and ceiling finishes or there is no access°by mean,—,of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 90-7.2.11.4 and 420.6.2,Art electrical permit is required for alarms which roust be connectdd to the building wiring As ow-ner 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 alat:ans have been tested and are operational,as of the date signed below. 1 hafva read and agreetq comply with tha terrns and oLnditions at this staternent Owner dor Owner APent's)tame: Date: e...,_4 Cants:lar Mama: LE ;#t .,. Crate, � WATER-CONSERVING PLUMBING FIXTURES �.OWNER CERTIFICATE OF COMPLIANCE COMMUNITY;DEVELOPMENT DEPARTMENT-BUILDING DIVISION mum PERTIN10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUO (408)Y77-32� !8,_�FAX(408)777-3333•buildinqa_cupertlno.orq Owner Name Permit No. .6 Address 1. Is your real property y a registered historical site? 11 Yes Civil Code Sections 1101.1 through 1101.8do not apply. Skip the rest of the fonn and sign bottom of form. 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 ofwater-conserving plumbing fixtures is not technically feasible? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply [I The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sip bottom of form. I No Go to Question 3. 3. Is water service permanently disconnected for your building?. F-1 Yes Civil Code Sections 1101.1 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of f6rm. No Go to Question 4. 4, Is your real property built and available for use or occupancy on or before January 1, 1994? 0 No My real property is built and available fbr�se or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the restof 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: My property is a single-fiunify residbntial real property. See Civil Code Section 1101.4. fixture On and after January 1,2014, building alterations or improvements shall require all non-compliant plumbings to be replaced with water-conserving plumbing fixturesthroughout 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 nultifamily 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 cominercial 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 futures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owiier or owner's agent of this property,certify under penalty of peijury 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 Nvith the requirements as indicated in the table-on the following page. v- Owner or Owner Agent's Signature:L11 L------LIV/ date: ' Upon completing and signingn in order to final your building permit. this Certificate,-please return it to the Building,Divisio SB4072015.docrevised O8126115 ............­­­­­.­­..................... .....................