15090137 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10225 ANTHONY PL CONTRACTOR: PERMIT NO: 15090137
�—D
OWNER'S NAME: MINOGUE DAVID DATE ISSUED:09/21/2015
OWNER'S PHONE: 6505448005 PHONE NO:
01 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
UPGRADE(E)100 AMP PANEL TO(N)200 AMP PANEL
License Class C_to Lic.# o Td— (SAME LOCATION)
r
Contractor �1-�4 F_-LE-(_TR.tC Date C[pZ Al
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
(ride and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations: Sq.Ft Floor Area: Valuation:$5700
t 1 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 %PN Number:34212075.00 Occuparin l cpe:
performance of the work for which this permit is issued.
2 1 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. PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is 180 DAYS FRO LED INSPECTIO
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 to enter z /
_?upon the above mentioned property for inspection purposes. (We)agree to save Date:
indemnify and keep harmless the City of Cupertino against liabilities,judgments
costs,and expenses which may accrue against said City in consequence of the
:;ranting of this permit. Additionally,the applicant understands and will comply with RE-ROOFS:
all non-point source regulations per the Cu ertmo Municipal Code,Section 9.18. All roofs shall be inspected prior to any roofing material being installed.If a roof is
Signature Date '7/a% It installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
1. I,as owner of the property,or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for HAZARDOUS MATERIALS DISCLOSURE
sale(Sec.7044,Business&Professions Code) 1 have read the hazardous materials requirements under Chapter 6.95 of the
2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(x)should I store or handle hazardous material.
1 hereby affirm under penalty of perjury one of the following three declarations: Additionally,should 1 use equipment or devices which emit hazardous air
t. 1 have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will
Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
2. I have and will maintain Worker's Compensation Insurance,as provided for by Owner or authorized
Section 3700 of the Labor Code,for the performance of the work for which this ��7 Date:
permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked. Lender's Address
APPLICANT CERTIFICATION ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is I understand my plans shall be used as public records.
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 to enter Licensed Professional
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 may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply with
all non-point source regulations per the Cupertino Municipal Code,Section 9.18.
Signature Date
GENERAL PERMIT APPLICATIONMEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE- CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildinacDCUDertino.oro TOISC
❑PLUhSI'vG ❑MECHANICAL ❑ELECTRICAL ❑bCSCELLAI\-EOUS
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OWNERNAMb t, PHO10F �1•I✓�eII
STREET P.DDRESS A CITY, STATE,ZIP I FAX
CONTACT NAME PHp S� - E-IvIAII,
STREET ADDRESS CITY,STATE, ZIP FAX
❑ O)AN''rER ❑ OWNER-BUILDER ❑ OW?v'FRAGENT L C017PACTOR ❑CO`.TRACTORAGENT ❑ ARC=CT ❑ ENGAFR ❑ DF%'ELOPER ❑ TFr:f,1,?
CONTRACTOR NAIL LICE SE LTBER� � LICENSE T5YE BUS.LIC
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COMPANY N.AJ�M E-MAIL FAX
STREET ADDRESS 1 U e+aJ CITY AAT£,ZIP PHONE
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RCETECT.EN•GATER N.AT4E LICEI SE NU?IBER BL';.LIC
COMPANY NAME E-MAIL Fay,
STREET ADDRESS CITY,STATE,ZIP FO17\ -
USE OF ❑SFD or DUPLEX ❑ J✓,ULTI-F.AIIrLY PROJECT LN WILDLAI.T ❑ YES PROJECT IN ❑ Y't5 IS THE BLDG." ❑ �.S
BLTII N'G: ❑COMMERCIAL URBAN IJ.TERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ N3
DESCRIPTION OF WORK �_ 1 c
l� Y e-
l"0 CA--r-
TOTAL
TOTAL.VALUATION: � � -� R-7-:C:5 D F' :
3y my signature below,I certify to each of the following: I am the property owner or authorized agent the ner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of\V rk 'erify i a�ee to comply with all applicable local
ordinances and state laws relating to building nstructi a representatives of C in r th p `` ( urposes.
Sika re of-.pplicart!�.reat v —� t \
SUPPLEb4ENTAL D\TFOR-MATION REQULRED OFFICE USEONLY
❑ OVER-TIIE-COUNTER
EXPRESS
❑ TA'-D P D
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❑ L.%RGE
MEPA,fiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10225 ANTHONY PL DATE: 09/21/2015 REVIEWED BY: MELISSA
APN: 342 12 075 BP#: "VALUATION: 1$5,700
PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 REAP 2
WORK UPGRADE E 100 AMP PANEL TON 200 AMP PANEL SAME LOCATION
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 100 Amps $48
TOTALS: $48.00
i'hnnla. Plaa Flec. Plan Check 0.0 1 hrs $0.00
Plumb. Periiiit Fee Elec. Permit Fee: IEPERMIT
Other Pluuh Inv). Li Other Elec. Insp. 0.0 hrs $48.00
NOTE. This estimate does not include fees due to other Departments(i.e. Planning, Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the reliminar information available and are only an estimate. Contact the De t or addh7 info.
FEE ITEMS (Fee Resolution I1-053 E_([: 717113) FEE QTY/FEE MISC ITEMS
r'1r1 � 'hc •k 1 •
PME Plan Check: $0.00
/'erinit I pec-.
.Si;ll/,l. his/) I(',
PME Unit Fee: $48.00
PME Permit Fee: $48.00
( 'oll.s Irm.1ion ]M'.' F
Administrative Fee: !ADMIN $45.00
Work Without Permit? O Yes (E) No $0.00
.4c1v-nnc-e(1 Plunnin,g Fees:
Travel Documentation Fee: ITRA VDOC $48.00
i
Strong Motion Fee: IBSEISMICR $0.74 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.001 1
SUBTOTALS: $190.74 $0.00 TOTAL FEE: 1 $190.74
Revised: 07/02/2015
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUIPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(c-cuperlino.org
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Address 1422.�'_AA f 1 (. Cr-71+ VTC#ofAtaruis Siaioke: <G rba�l2ouo`�crd�:; Z
PERMIT CANNOT BE F'INALED AND COMPLETED UNTIL THIS CERTIFICATE
BEEN SI I ,,a " B M TO THE BUILDING DIVISION
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 X X
bedroom(s)
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
iristalled 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.
I have read and allree to comply with the terms and conditions of this statement
oWaer(.0rSOwner✓Agenf s)-Name_
D^+� /
LJ 1 v Si natu`r4111-izrx��... ......... ...............
_Cantrfdtor.Name:
Stnature.............. ....................Lic#................................ ....,Date ..................
Smoke and CO form...loc revised 03/18/14
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a.cupertino.org
Owner Name DAVI z) Permit No.- /M7
Address _
A -0.
�g.4e . ,
I ozz '00,
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.
-� NTo 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.I.through 1101.8 do not apply. Skip the rest of the fonn 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. Phase check ONE of the following:
C 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 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
improvements).
❑ My property is a commercial real property. See Civil Code Section l 1p.5.
On and after January 1,2014,specified building alterations or unprovements 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 peljury 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. --
Owner or Owner Agent's Signature `Date: k
Upon completing and signing this Certificate,pl ase retu i o the Building Division in order to final your building permit.
SB4072015.doc revised 08126/15