15100061-OLI CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 842 S BLANEY AVE ROOFING AOR: BILL HAMILTON I PERMIT NO: 15100061 I
OWNER'S NAME: KHANNA SHARBARI TRUSTEE 1230 HARRISON AVE i DATE ISSUED: 10/08/2015 1
OWNER'S PHONE: 4084103794 CAMPBELL, CA 95008 PHONE NO: (408)687-2540
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE EXISTING COMPOSITION SHINGLE AND INSTALL
License Class Lic. # NEW COMP SHINGLE GAF ULTRA -21 SQRS
Contractor
Date
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.
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
permit is issued.
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 and state laws relating
to building construction, and hereby authorize 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 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.
Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
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
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three 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
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker'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
must forthwith comply with such provisions or this permit shall be deemed
revoked.
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 and state laws relating
to building construction, and hereby authorize 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 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
Sq. Ft Floor Area: 0 1 Valuation: $6500
APN Number: 36927008.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Ad
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
FILE
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
1 �I CCMIOLNITY DEVELOPMENT DEPARTMENT - BUILDIN_-
CUPERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • nuildino@cunertino_orr,
Permit No.
ff1'
�ddreti. a; _ �'i[ct l,l'cAA �Vlt. Lti yti tw„Z # of Alarms Smoky t_arbon Monoxiuc:
—rte —
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNET) AND RETURNED TO THE B[;ILDING DIVISION
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms i.,i
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior acce4s 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
51000.00, CRC Section R314 and CBC Sections 907.2.11.3 and 420.6 require that Smoke Alarms and/or Carboni
!Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM CO ALARM
Uutstde of each separate sleeping area in the immediate vicinity of theI X
m
bedroos)
_On even level of a dwelling unit including basements
Within each sleeping room
X
X
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances a1111
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall compiv 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 ar
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or craw
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 beer
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 -
I have read and agree to comply with the terms and conditions of this statement
Owner for Owner Agent's) Name:
S H A 1? 8 R 21 K H ML► N A Signature. — - �� ro/9/?a
cto Nar- _ .... mate
—
i3 r't I"�(14�1 l`1Wl UOT tv ' Sigrature. _ Lic.0�� (r�` q rrll �G
i N
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
CUPERTINO
_..tutu rr ,.pert) a registered historical sae'
L :"I Code Sections 1101.1 through l l i,:.b Jo .-ot a�-)i�. ��ip :i:: re -ii _:.i form. _
_.::al propem hate a iicensed plumber ceniSing that. due to the ace or configuration of :he propzm,
_T:;,,-_-,. o: hater -conserving p!umbing fixtures is not tec:vfically fea_ib;c''
:
C;% 11 Code Sections 1101.1 through 1101.8 do not apply.
The licensed plumber's certification has been provided to the Buildme Division
P the rest of the form and sign bots:nn of form.
Question --.
_. ;.-.n : permanently disconnected tor)our buildin_^
1 %d Cole croons 1101 1 through 1101.8 do not apply. Slap the :est of the :urn and sen
:m built and a ails le for use or o_cupancy on or before Januar\ 1, 19941
real propem is ou;a and avaaable for use oroccupanct after Januar 1, 1994.
111 Cede Sections 1101.1 through 1101.8 do not appl\ . Sk'.p the res: of the form a;i :,si_:, c::cr: .
real propem is built and at di'able for use or occupancy on or before Januan1. i 99=.
il Code Sections 1101.1 through 1101.8 apply. Check one of the three following s:a:n^.en'. _._..
+:tom of font..
ciwck LLNE of the following:
pe -:y is a sinlgWamil), rts:dr :::4: real property. See Civil Code Section 1101.4.
;:i,i ; fter January 1. 2014, building alterations or improtements shall require all non-cornpliant p'L.r.hi-
e.i with toter-conser%'ng plumbing fixtures throughout the building. On or before : ar.uan'-
:..:3:: Plumbing fixtures shall be replaced With tater-conserving plumbing ti\:,are.
.-A.-rgoes alterations or improvements.).
ore -,y a n r:!rifanu:r rzsidcttri:! real property. See Civil Code Section 1101.5.
a:;crJanuan 1. 2014, specified building alterations or improvements shall require non- 00 nPliar-t
ng fixtures to be rep'.aced with Mater -conserving plumbing fittures.
Gn m tefore Januar. 1. -1019, all non-compliant p!umbing fixtures shall be replaced with u ster-
c sen irg plumbing fixrures throughout the building (regardless of tthether propert} undergoes aliera:i; is c,
~v is a con:mcr::al -).cal propem. Sec CMI Code Section 1101.5.
=,r Januar} 1, _01-;, specified building alterations or i;nprotements shall require tc ',-
`xrures to be replaced with water -conserving plumbing f xrares.
-glare January 1, 2019, all non-compliant plumbing fixtures shall be replacz:d .:e--
`.xtures throughout the building (regardless of whether property undergoes alteraro:.s or in:-)-; c:
rr or owner's agent of this property, certify under penalty of perjury that non-compliant
:o date specified above with water -conserving plumbing fixtures in accordance ij ::1: C:
S, tae current California PIumbine Code and Cal' fbrtta Green 8 n1'tnL, Stir. ar c
1J I 2e
an;, Cer:.aca-x -)!ease return li :o the 13::!1z;n' D:` kion .n orccr ,.o fl!;:.;_ ... .... _ .- _