B-2017-0489CITY OF CU
ERTINO BUILDING PERMIT
BUIL.DINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0489
19397 PHIL LN CUPERTINO, CA 95014 (375 05 032)
AIRPRO MASTER INC
LAS VEGAS, NV 89102
OWNER'S NAME: PONGURLEKAR JITENDRAAND KODE RUP
I TRUSTE
DATE ISSUED: 03/27/2017
OWNER'S PHONE: 408-8359172
PHONE NO: (702) 598-4174
LICENSED NCD ONT A TOR' DECLARATION
BUILDING PERMIT INFO:
License Class C -2Q Lic. #1012763
Contractor AIRPRO MASTER INC Date 04/30/2018
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 a
d that my
license is in full force and effect.
JOB DESCRIPTION:
(I) 50 GAL WATER HEATER - 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
r Worker's
Compensation, as provided for by Section 3700 of the Labor C
de, for the
performance of the work for which this permit is issued.
elJFf?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 wok
for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $1300.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordi
ances
and state laws relating to building construction, and hereby authori2
e
375 05 032
representatives of this city to enter upon the above mentioned prop
rty for
inspection purposes. (We) agree to save indemnify and keep harm
ass 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
Additionally, the applicant understands and willl comply with all non-
permit.
oint
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino unicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature ;&Ctl Date 03-27-
017
Issued by: Kim Dunbar
Date: 03/27/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law I
or 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 propert}; or my employees with wages as the
r 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 intendc
d or offered for
inspection.
sale (Scc.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 & Prof
ssions Code).
Date: 03-27-2017
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
or 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
ovided 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 wok
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
a. I certify that in the performance of the work for which this perr
fit 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 su
'ect 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 th
s 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 tl
ds permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 03-27-2017
1 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 st
3te laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representativ
sof this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purpose
. (We) agree
Lenders Name
to save indemnify and keep harmless the City of Cupertino against
iabilities,
judgments, costs, and expenses which may accrue against said Cit
I in
Lender's Address
consequence of the granting of this permit. Additionally, the applice
nt understands
and will comply with all non -point source regulations per the Cupert
no Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date- 7-
17
Professional
GENERAL PERMIT APPLICATION mmm E P
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
{` I 10300 TORRE AVENUE • C PERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 77-3333 • buildino(cr�.cupertino.org
I W A I S
I `TYLUIVIBING I MF.C'.HANTC'A I IFT P( -TP Ir AT F--1 T,,TTCflr7T T ANMnTro
PROJECT ADDRESS 3 f
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APN # -4-)-- —(!) 3 -),
OWNER N
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STREET ADDRESS i 3�
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CIT ,,ATE, Z n FAX
CONTACT NAMElA
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OA � S C�
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OwNER-BUILDER
❑ OWNER AGENT ❑ coNm
cToR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
r�.v1
LI
ENSE NUMBER„
LICENTSE YPE
G O 3
BUS. LIC # /�
-7
COMPANYNAME AE
-MAIL
FAX
STREET ADDRESS. t
CITY, STATE, ZIP /70�j'�
`Z j
PH ON i p(�j Y r 3
r J
ARCIITECT/ENGIIQEER NAME
Li
.ENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD m DUPLEX
BUILDING: ❑ COMMERCIAL
El MULTI -FAMILY
PROJECT IN
URBAN INT
LAATD ❑ YES
ACE AREA ❑ NO
PROJECT IN ❑YES
FLOOD ZONE ❑ NO
IS THE BLDG AN El 1"L -S
HCHLER HOME? ❑ NO
DESCRIPTION OF WORK
ry � r
� j � / � � _ n a 2
_
TOTAL VALUATION:
REC D Y<
By my signature below, I certify to each of the following: I am the p
application and the information I have provided is correct. I have rea
ordinances and state laws relating to b 'Iding construction. I a riz
Signature of Applicant/Agent:
operty owner or authorized agent to act o the property ownei ' N1 ehalf. I have read this
Description of Work and verify it is accurate. I agree to comply with all applicable local
presentatives of Cupertino to enter the above- dcnnri e pr erty fo , ection proposes.
SUPPLEMENTAL INFORMATION
REQUIRED
oFc USE only
11 'OVER-THE-COUNTER
F,
-- F' -
x.
❑ EdPRES5-
STANMARD,
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
3/28/2017
Scan 2.jpeg;
SMOKE I CARBON MONOXIDE ALARMS . /F
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
CupeRTINO 10300 TORRE AVENUE - CUPEkTJ NO, CA 95014-3255
(408) 7/7-3228 FAX (408) 777-3333 - buildigggoupertno.or
q
-ITICANNOT
ALti)L-INTL TMSCERTMCkTE:HAS *BEto.
—7 -
PURPOSE
TI -ds affidavit is a -self-certification for the installation of all required Smoke and Carbon Monoxide Alarinsfor
compliance. with 2016 -CRC Section 8314, R315, 221.6 CBC Sections 420.6 and -ere
907.2.11.2,wh -no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-fa.mily and multi -family dwellh gs shall be provided with Smoke darn. and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$10000, CRC Section 8314, 8315, and CBC Sections 9071.11.5 and 420.6 require that Smoke Alarms and/or
Carbon Monoxide Alarms be installed in the following locations:
AREA
SMOKE CO ALARM
Outside of each separate steeping area in the immediate vicinity of the
X X
b s) — (Smoke alarms shall not be located within 3 feet of bathroom door)
eyery le -vel of a dwelling unit including basernents and habitable attics
X X
�On
'Alithin each sleeping.room
...... .. ...
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
donot have an attached garage.-ionox
_Caxbonii ide alarms coxiabined 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 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 alarn-i(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and CaliforniaResidentialcodes. 17he *alarms spec'ified below have been tested and are operaiti6hal, as of the
date signed below.
Address: 19 'P 4 -r-L- LfA-N F GL) ? F_-9 T N 0 CA- iLoxterxiift No- 7 61
Specify Number of Alarnis:
YA
Smake and CO3form.doe reviseel 0111012017
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3/28/2017
Owner Name
Address
Scan 3.jpeg
WATER -CONSERVING PLUMBING- FIXTURES
OWNER CERT Fi AnE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPART . MENT - BUILDING DIVISION
10300 TORRE AVENUE * CUPERTINO, CA 95014-3255
(408) 777=32211: FAX (408) 777-3333 �
-bujidingo-�uDefflno.orn
161
IM
- Zo 7� W�
2
1. Is Your real property a registered historical site?
El Yes - Civil Code Sections 110 1- 1 through '1101.8 do. not apply, Skip the rest of the form and sign *bottom of forin.
-54- NO Go to Question 2.
2. Does Your real property have a licensed plu]Tlbercertifyiftg that, due to the age or configuration of the property or its
ins
Plurnbiiig,' WatiOn-of WaW-conserving plumbing fixtures "is not technically feasible?
n Yes Civil Code Sections 1101.1. through 1101.9 do -not apply.
13 Tile licensed.plumber's certification has been provided to the Building Division,
Skip the rest of the form and sign bottom of torm.
,N No Go to Question 3.
3, 1 Is water. service Pertimently 4is;onnectcd. foryourbuilding?
0 Yes Ci
- vil Code Sections 1101.1 through I 101.9 do n-
�lNo Go to Question 42 t apply. Skip the rest of the form and sign bottom of form,
4. Is :our real property built and available for use or occupancy on or before January 1.,1.9.94`?
0 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 forizi and sign bottobottomofform,
es My real property is built and available for use or occupancy on or before January 1,1X794,
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom ofform.. A
00beck 0NE o
f the feb �owtt 8
MyproyisasItzgljanI'I-I'
, identi �Ir
eal
?
, 'Oxp
e
Se
eCivil Co
de Section 1
101.4.�oandaerjanuarYl2014, building omri�protients,hallrequireall no
n-compliant piumb,ng fixtures vlwa�r-consmingpI ingfturethrohout the building. Onorbefore 1anuy1, 2017} all non-
colwIliitplunbing nxwre5StallbereP110�wi watonseryiig plumbing fixtures (regardless of whether
property undergoes alterations or. improvenients),
0 My property is a multijainfly residendal realptop0ty. See Civil Code Section 11011.5.
On and after January 1,2014, specified building alterations -or jmprovp-n=.*, ts shall require non- compliant
plumbing fixtures tobereplaced with ,%�tter-,POtlsdM-hg'pl.utnbiiig -fixtures.
On or before January 1, 2019, all non: -compliant plurnbing fixtures shall be. replaced With U.-ater-
conserving phurbing fixtures throughout the building (regardless of whether Property undergoes alterations or -
improvements),
El See-C-ivil-code Section 1101.5,
On and after January 1. 2014, speetri 6d building alterations or improvements shall require non- compliant
plumbing -Fixtures to be fixtures,
On or before January 1, 2019, all non-compliant ,plumbing fixtures shall be replaced with water- conserving
Plunibing-fi,\fttii,ilirougliout thebuilding (regardless of whether property undergoes alterations or improvements).
1, as the owner or owner's agent of this property, certify under penalty ofpeijury that non-compliantplurnbing fixtures wi ll. be
Mylaced prior to date specified above Mtb water -conserving plumbing fixtures iux accordance with Civil Code Sections 1101.1
through 1.101.8, the current California Plumbing Code and Califomia Green�Building Standards Code,, and manufacturer's
histallatiou rcquirenients, and that the water -conserving pl rab1112 flIxtures, comply with the requirements as indicated 11i t1je,
table on. the folloixin2 maze. r
Owner or Owner Agent's Signature: - M 2215L =-1-L Date: Q III I'll// I
Upon completing and signing this Certificate, pie return it -to the Building Division in order to Final your buildink pernii t.
S -B407 2015.dac revised 01i--05/17
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