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07100108 CITY OF CUPERTINO ' ' ° ` BUiLDING DIVISION PERMIT �� Z��T�� ,:. ; _ ..:.. . ,. ..::. .::: BUILD AD RESS: PERMIT NQ. ��315 RANCHO DEEP CLI DR AIR QUA�ITY HEATING & AIR 07100108 � OW NER'S NAME: PERMIT LSSUE DATE DAVID BALWEBER 714 NOR THRUP ST .ONE: SAMTARY NO. CONTROL NO. (408)293-7138 ARCHITECT/ENG[NEER: BUILDING PERMIT INFO HLDG ELECT PLUMB MECH � 0 � � i p p LICENSED CONTRACTOR'S DECLARA7'ION JOU DeSCilptl0❑ ; V� I hcreby aCfirm that I arn licenscd undcr provisions aC CAaptcr 9(commcncing ; Z� with Sccuon 7000) of Di�ison 3 of ihc Busincss and Profcssiuns Codc, and y licensc is RE PLAC E PAC KAGE HEAT / C OOL jJI� I T ONTO ROOF �� y in full Corce and f�ect � � v� Z Licensc Class _ L�. � : F , p Dam Contraclor � ( ARCHiTECI'S DECLA 7 o�G a 1 undcrstanJ my plans shall 6c uscd as puhlic records )yU ' n. y Licensed Pmfcssional � y � OWNER-BUILDER DECLARATION I hcrcby al7irm thnt 1 am cxcmpt (mm thc Con�ractors Liccnu law [ar �hc � p O [ollawing rcuon. (Section 7031.5, Busincss and Profcssiuns Coctc: Any city or munty . �°„ � which rcquires a pertnit to conswct, al�cr, improvc, dcmolish, or repair any stcucmcc ° Z} p^or w i�s issuancc, also rcquircs thc applicant for suc6 pertnit to filc a signcd statcmem �< that he is liccnscd pursuant �o thc provisions o( thc Conuacu�i s Liccnsc Law (Chaptcr 9 ;>q. Ft. Floor Area Valuation k I �(commencing wi�h Section 7000) of Division 3 of the Businus and Professions Code) or $ r J � � � i�� that 6e is e:emp� the�ctrom md the basu [or the allcgcd eumption. Any violation at Section 7031.5 by arry applicant for a pertnit subjects �he applicant to a civil pcnatty of 7 y�� T Number Oeeupaney Type not more than five hundred dollars (5500). 3 5 6 � 2 � 4 Z� V ❑ I, u owner of ttie propccty, or my cmployces with wages u �heir solc compensaUoa, willdothcworkaadiheswcwceisnotintendedorof[eredforsale{Sec.7044,Buoness Re uired Ins ections and ProFessions Code: The Conuacwrk I.icense Law dors �roi apply to m ow�xr of q P propeny wha builds or improves thereon, and who does such work himsel[or tlwugh 6is owa employces, provided that such improvements are not imended or o[fered for sale. [f. however, lhe buildiag or improvement is wld within one yesr oCwmpleGon, ihe owner- buildu will have �he burden of proving that he did no� build or improvc for pmpose af saleJ. ❑ I, as owner of the propeny, am exclusively con4acting with liansed conuact�s w wnstnut �he pcojen (Sec. 7044. Businas aad Professions Code:) The Coau�acmr's Li- cense Law docs not apply to an owner of propeny who builds or improves 16eROn, u�d . who conlracls Cor such pmjccLS wilh a conl[actor(s) Gcensed pursuant to U�e Convxtals License Law. ❑ I am uempi undu Sec . B dc P C for �his mawn Ownu Date _.. _ WORKERS COMPENSAT[ON DECLARA170N 1 hereby �rm under penalty of peryury onc of the following declantions: ❑ 1 hs.�e and will maimain a Cenificate of Consent to self-insure (or Workcrs Canpen- sation, as provided for by Section 3700 0[ [he [abor Code, for the pedarmance oC Urc wo�ic Co� which this permit is issued. 1 have and will maintain Worker's Compencation Insunnce, as �cyuired by Section o( thc Labor Codc. Cor the performance af �he work fo� which Nis permii is issued. My Warker's Compensauon Insu ce carcicr and Policy number Cartier. liry No.: CERTIFICA OF EXE P170N FRO O CERS' COMPENSATION iNSURANCE (This scction nccd not bc complctcd it the permit is for onc hundred do�ars (5100) or Icss.) ' I cenify that in the perfarn�ancc af �hc work for which Wis pertnit is issucd. I shall na cenploy any person in any manner w az w beeome subject to ihe Worken' Compensation Laws o[ Califomia. Datc Applicant NOTICE TO APPLICAM: If, aftcr making this CeniGca�c ot Excmption, you shouW become subjca �o thc Worker's Compensauon provisions of thc Labor Codc, yau must � O foMwith comply with such provisions or this permi� shall bc dcemcd awokcd Z ""' CONSTRUCf10N LENDING AGENCY (� � 1 heceby aflirtn that there is a cor�suuctian Iending agency Cor the performance o( _ a. thc wurk Cur which ihis pertnit is issucd (Scc. 3097. Civ. C.) W� Q Lendcr's Namc ' a � L.cnder's Address () � I ccrtify ihat 1 havc read this application and statc thai thc a6ove infamation is w � cortect. I agree ta comply with all ciiy and county orelinancu and sute laws relating w 0 U building conswction. and hcrcby authori�e represcntativcs of ihis city to cntcr upon thc � W above-mentioned property for inspecuon purposes. a (We) agree �o save, indcmnity and kecp harmless the Ciiy of Cupertino agaiast � N liabitities, judgmcnts, costs and expenses which may in any way accruc against said �ry / U z in conxquence of thc granting o( Ihis permit. DSIe O � APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P INT Issued by: ( � _ SO E REGU ATIONS. !� [7 Re-roofs Si awrc of A plican on r T of R�of � HAZARDOUS MATERIALS DISCLOSURE }�� Will lhe applicant or future building occupant storc or handle haarardous muerial az dcfincd by Ihe Cupertino Municipal Codc. CF�ap�cr 9.12. and the Hcal[h and Safety C«Ic.Scction 25532(a)? {{{ppp All roofs :�hall be inspected prior to any roofing material being installed. � y� /� No , /` If a roof i:o installed without first obtaining an inspection, I agree to remove Will thc applicant or fuwre building occupant ux cyuipmcnt or d�wiccc whic6 cmi� harardous air conuminamc az ckfined by the Bay Arca Air Quality Managcment all new m aterials for inspecrion. asv�c�? p Ycs �Nu I havc reacl the hvardous ma�crials requircmcn�t undcr Chap�cr 6.95 oCUx Cali(w- nia HcalU� & Safcry Cadc, Scctions 25505, 25533 and 25534. I undcrstand �hat iCU�c 6uilding docs no� curtcnUy havc a tcnan4 �� y rcspoesibility w nodfy thc occupam of ihe rcyui wni 'orw uanuo(aCcniGca�co� cu Signature ofApplicant Date All roof coverings to be Class "B" or better Own r or auihorizcd agcm � ` J`--� � � � � � CITY OF (vUPERTINO ��.1�.�.�:�/�� CUPEI�TINO PERMIT APPL[CATION FORM APN # � Date: �� O �-{- � o a � �D /�' t� Building Address: . �Z �. Owner's Name: Phone #: � __-��2/ �'�,� _ /�/��(�-/--��_ � 3 I C� O C;ontractor: �'hone: License #: � �G ` � 4 —� �- 3° �°� �� Contact: Phone: Cupertino Business License #: �{�� .3' — J�" c�l � ( Building Permit Info: Bldg ❑ Elect �'- F'lumb � Mech Job Description: ��'� ;'� C� Residential Commercial ❑ For Residential Installations: Attic � 1 St floor � 2 fI00r � Adhere to min set back requirement ❑ For Commercial Installations: Zeplacement same weight ❑ Additional weight (s �jctural calcs) � Structural Calculations required for new installation New installation Planning A roval Re uired ❑ Cost of Project: �,•,: Type of C�truc:ion: Occupan gro : ��D c� � � Strapped ❑ On Platform ❑ Bonded'� Sq.Ft. Floor Area: New Location � Re lacement � Qty. if Ap licab Fee ID Fee Descri tion Fee Grou BENERGY En ergy BUILDING BREMFURN ,/ Fumace MECHANICAL BREMACOVER A/ � Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/ � Units <= 10, 000 cfin MECHANICAL BREMRECEPT Re c tl, Switch & Outlets ELECTRICAL BSEISMICRE `� Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE � El�;c Permit Issuance ELECTRICAL MPERMITFEE .. Mf;ch Permit Issuance MECHANICAL PPERMITFEE ✓ Phunbing Permit Issue PLUMBING BPERMFEE Bl�ig Permit Fees BUILDING BPLANCHK Pl�n Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING CITY OF CUPERTINO 6 ITEMS OF 6 PERMI`[' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1lc: Lot: APN ......... 35�i02042.00 DATE ISSUED.......: 10,'15/2007 RECEIPT #.........: BS()00002992 REFERENCE ID # ...: 07:_00108 � SITE ADDRE5S .....: 22:�15 RANCHO DEEP CLI DR SUBDIVISION ....... CITY .............. CUI�ERTINO IMPACT AREA ....... OWNER ............: DA�'ID BALWEBER ADDRESS ..........: 22;�15 RANCHO DEEP CLIFF DR CITY/STATE/ZIP ...: CU�'ERTINO CA, 95014-3927 RECEIVED FROM ....: AIF; QUALITY HEATING CONTRACTOR .......: MA7'THEW FARBER LIC # 22791 COMPANY ..........: AIF: QUALITY HEATING & AIR ADDRESS ..........: 714 NORTHRUP ST CITY/STATE/ZIP ...: SArf JOSE, CA 95128 TELEPHONE ........: (4C�8)293 FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 5,000.00 0:50 0.00 0.50 0.00 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 172.04 0.00 172.04 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 172.04 #53709 --------------- TOTAL RECEIPT : 172.04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL �; � �, � Community Development �$ 10300 Torre Avenue ;;'' � Cupertino CA 95014 ;� �,:. Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �'UPEi�TINO Buildin De artment jOB ADDRESS: PERMIT # o r'� 0� ?D� OWNER'S NAME: t �,r/C' � PHONE # "� �— J GENERAL CONTRACTOR: FAX # I am not using any subcontractors: �� 1 v i;nature - Da e Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIl`dESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Fini.shing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping� Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal �heet Rock Tile Owner/Contractor Signature Date WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 •FAX (408) 777-3333 • buildinoCaDcuoertino.org Owner Name D Av1 b .4 .LW_FBEll Permit No. Address X2.3/5 RAHC;10 DELP C1_/FF-b ['4G�RTinle, CA, 95814 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 fon-nand sign bottom of form. 12 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 fonn 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. 1,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. A 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.. 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 property undergoes alterations or unprovements). ❑ 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 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 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 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 with the requirements as indicated in the table on the following page. J Tom.U 1 Owner or Owner Agent's Signature-: Date:]A ^2J� Upon completing and signing this Certificate, please return it to the Building Division in order to tinal your building permit. SB407 2015.doc revised 08/26/15 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.or4 Permit No. Address RA NGS DEL -P CUfF 13R, Ott PcIzT1 rho # of Alarms Smoke: Carbon Monoxide: PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DMSION 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: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X 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 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 R314 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 in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: DAVID , A1_LWF,Ql lk Signature.. . ........................................Date: i..:?%~.�. Contractor Name: Signature...................................................................Lic.#...................................... Date: ................... Smoke and COform.doc remised 03/18/14