B-2017-0295 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0295
1425 S STELLING RD CUPERTINO,CA 95014-5264(366 26 036) NEW LIFE PLUMBING
INC
SAN JOSE,CA 95126
OWNER'S NAME: KANT SASHI AND TYAGI PRAGYA DATE ISSUED:02/22/2017
OWNER'S PHONE:408-368-4759 PHONE NO:(408)261-3460
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CM Lic.#521990
Contractor NEW LIFE PLUMBING INC Date 04/30/2018 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:
INSTALL GAS LINE;(1)N BBQ,(1)N FIREPIT
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.
k-r 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
permit is issued.
Sq.Ft Floor Area: Valuation:$7500.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 366 26 036
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 I P'WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature MIAAJ Date 02/22/2017 Issued by:Kim Dunbar
Date:02/22/2017
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 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)
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:02/22/2017
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
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
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
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 25 05,25533,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:02/22/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
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
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. I understand my plans shall be used as public records.
Licensed
Signature Date 02/22/2017 Professional
- - • ----------1/./.' ' . GENERAL PERMIT APPLICATION MEP
•
,.• : , . COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
. ..:- ..
,-.L:;.. ..--... 10300 TORRE AVENUE.CUPERTINO, CA 95014-3255 •
(408)777-3228-FAX(408)777-3333•buildinacuoertirto.orq , •
MISC
CUPERTINO
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Iri PLUMBING El MECHANICAL DELECTRICAL El MISCELLANTEOUS
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PROJECT ADDRESS /.
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APNil e"7 i
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OWNER NAME i
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CONTACT NAME ' • PHONE E-MAIL
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. . ,...., OWNER 0 OWNER-BUILDER 0 OWNER AGENT. 0 CONTRACTOR 0 CONTRACTOR AGENT 0.ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT '
' CONTRACTOR NAME
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LICENSE NUMBER
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COMPANY NAAS
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC 4
COMPANY NAME I E-MAIL FAX ,
STREET ADDRESS . CITY,STATE,ZIP PHONE
• , USE OF E SFS)or DUPLEX El MULTI-FAMILY I PROJECT IN WISDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES
BUILDLNG: o C0RSNERCLAL • 1 URBAN INTERFACE AREA D. NO FLOOD ZONE 0 NO . EICHLER HOME? 0 NO
OF WORK
DESCRIPTION
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TOTAL VALUATION
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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 build. nstiuction. utho . e representatives of Cupertino to enter the above-identified property for inspection purposes. - • •
Signature of Applicant1Agent: Date: Z"'1,-"7'/7
SUPPLEMENTAL INFORMATION REQUIRED :Ega44aze.4"..a.ifi-0'1,EtiNi:
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MEPMiscApp_2011.doc revised 06/21/11
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0UPERTINO
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.„:
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a-)-cupertino.ora
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with. 2016 CRC Section R314, 8315, 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
$1000.00, CRC Section R314, R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed.in the following locations:
AREA
SMOKE ALARA!
CO ALARAI
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
I On every level of a dwelling unit including basements and habitable attics
X
X
X
i Within each sleeping room.
Signature.................................................................. Lic.+ ......................................Date:..................
X
Carbon Monoxide alarms are not required in dwellings wli.ch do not contain fug
do not have an attached garage. Carbon monoxide alarms combined with. smoke
1 -burning appliances and -hal
alarms shall comply ivith
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
rower supply: In U1vtLu_n- ULULS VVIUI iLU LUllUlielt.:ldl FU1vel SIA�J�Jly, dldlllL`b) llLdy UC SUlely Ud W:IV Upend VU.
Jn existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above=referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and u-1 compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below.�7g --
Addr_ess: L4-9$ G [JI,PC=ice T Permit No.
Specify Number of Alarms: S -make Alariiis: � � t_C`arbolrMono�icle Detectors:
I have read and aoree to comaly with the terms and conditions of this statement
Owner (or Owner Agent's) Name: —
�� 1 r r
Signature' ...............::................................................................................... Date:...+.....<:'
Contractor Name:
�'
Signature.................................................................. Lic.+ ......................................Date:..................
Smoke and COfo7777.doc remised 01/1012017
CUPERT11titEi
9wner Name
Address
WATER -CONSERVING PLUMBING FIXTURES.
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buHdingP_cupertino.org _
9 i } 1 r Yernit No'
L__
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.
'�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.
°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.
LQ/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.
N'es 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..
��Plea�,5e check ONE of the following:
,i/Nly 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-conseiving plumbing fixtures.
On or before January 1, 20.19, 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 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).
1, as the owner or owner's agent"of this properly, 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 Co4e and California Green Building Standards Code, and manufacturer's
installation requirements, and that the water-consen g plurmbing fixtures comply with the requirements as indicated in the
table on the following pale. A \ � , ,
(,,_Owner _or Owner Agent's Signature: Date: bill � u 1 / I
Upon completing and signing this Certificate, flease return it to the Building Division in order to final your buildina permit.
SB407 2015. doe revised 08126/15