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1511002271 DO' R ow '':C CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:; 10322 N STELLING RD CONTRACTOR: LA ROCA BUILDERS PERMIT NO: 15110022 7.1 OWNER'S NAME-I:MERCHIA AMBIKESHAWAR. R AND SUNITA C 3465 CHARING CROSS IN DATE ISSUED: 11/04/2015 OWNER'S HONEu-, 4089166135 SAN JOSE, CA 95132 PHONE NO: (408) 835-5160 E3 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIALE] Install 28 (N) Recessed IC Rated Lights; Install 5 (N) Ceiling Fans; Install (N) 50 Amp Licerise Class Lic'.-# Sub -panel Contractor Date I hereby affirm thit'l-am licensed under the provisions of Chapter 9 (commencing with §iction 7000) of Division 3 of the Business & Professions Code :and :that my license is in;full force and effect. I heXeby AM up eF pen ,y.of perjury one of the following two declarations: irmJ d alt andwill maintain a certificate of consent to self -insure for Worker's Compensatiofi; as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $5000 performance 6f the.Work;for:which this permit is issued. I have a4wilfiriaiiiiain WAer!s Compensation Insurance, as provided for by ' - . , '' 11 ; !,l: j, j--.,-,- - Secti; n' .3 9 1b6 of the ]LAdf C dieJor the performance of the work for which this - APN Number: 32630089.00 Occupancy Type: permit is issued. .-;t-1;: CERTIFICATION ..APPLICANT I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED coffe6t.J agree to,comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,' and hereby authorize representatives of this city to enter upon the above mentioned pr'bperty for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and k ; e , dp! 4 i a , rmles's ' the City of Cupertino against liabilities, judgments, costs; and expensies4fiichifia' accrue against said City in consequence of the Date: [114,160 15, ­;,., . Additionally, granting of this permit: Additionally, the applicant understands and will comply Issued by: with alFfion-p6ini.s6uice regulations per the Cupertino Municipal Code, Section gn'; Date Signature RE -ROOFS: roofing material being installed. If a roof is All roofs shall be inspected prior to any roof installed without first obtaining an inspection, I agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION I hereby affirin'thatl am: exempt from the Contractor's License Law for one of Signature of Applicant:_ Date: the following two" -reasons - ALL ROOVCJMRINGS TO BE uLASS "A" OR BETTER 1, as owner of thelproperty,, drimy employees with wages as their sole compensation, will,do Work7'-afiid,he'stru' ct'uI re isnot intended or offered for sale (Sec.7044, 'the': Busiftes '&ProfessibnsCdde•):� i 1, as owner of the-pr6p.efty,'irn exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE , ns,''i6.704,, Business & Professions Code). construct the protect I have read the hazardous materials requirements under Chapter 6.95 of the I hercl5y'affirinimder 'penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations-"- Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and` -will miaintain� a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation; as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the wWork'for'which this permit is issued. will maintain compliance with the C ertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Sectio,p*13.700 4 the� L-abor'Cbde,, for the of the work for which this .yCode,Sectio 505,25!5!33,�and- the Health & Safet c iol 1114115 . ;-- I I I I -il ` t, I , :..1, �, , I., , performance permit is*'i's's;ue4&,,i",', Owner or authorized agent: Date: I certify in the performance. of the work for which this permit is issued, I shall not employ;any personemploy; inmariner so as to become subject to the Worker's om ensationjaw's of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 'u' *e fto. the k beco''esWor, Compensation provisions of the Labor Code, I must �j c I hereby affirm that there is a construction lending agency for the performance of forthwith ,comp iy'wit.h such, provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name ;0.. -,[v APPLICANT CERTIFICATION I certify thatJ hav6.iead this, application and state that the above information is Lender's Address corrept,J:6greeIo: comply with all city and county ordinances and state laws relating to building coqs",ori,:�andhereby l authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ., , , , I, I " i , . . in&mnif��afid ke�p1armlesstthe City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, an d 6p�t6s'�Ikhich may accrue against said City in consequence of the I understand my plans shall be used as public records. granting dthis! jpeimiit. Additiofiiilly, the applicant understands and will comply ' .. with'all non -point source ieg6lat6s per the Cupertino Municipal Code, Section ��P " Licensed Professional 9.18. ,: ;, zq; I it !,Jij, i I* Signature Date ,t J �e CUPERTINO Ph GENERAL PERMIT APPLICATION 1511 00ag- `l COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 015014-3255 (408) 777-3228 - FAX (408) 777-3333 • build! no(d)cu Dertino.org, ❑ PLU'B NG ❑ MECKA.NTICAL. ELECTRICAL ❑ 3,411SCELLA-NEOUS PROI~CT ADDRESS l 1 -C 1 �lI (- lt%""'I, v. - ... �© bg OZkTiRNAJIIIZ v 1 ffr' " I PHVO 0^ 011661,7f- E.I,/,4jL STREET A-DDRESS CITY, STATE, ZIP I FAX CONTACT N.SMF i` P i0 vE E-?vL<IL STREET ADDRESS CITY ST.Ait, Z?P FAX (d�L< ❑ OtiR.=R ❑ OVT2\tR-BUIIDEFt ❑ ow,.traAciExT �CO)"MACTOR ❑ CONIKACTORAGLTT ❑ ARM= CT ❑ ENG I== ❑ DnFLOPEZ ❑ i_? ShT CONTRAC T OR NAI,r r LICENSE NUhBER LICENSE W' I BUS. LIC 1 � COMPANY NAME E-MAIL I FAX STREET ADDRESS CITY, STATE, ZIP PHONE AR CIE TECTrNGD\TEER TAI`4E LICENSE 1\'U? BER BUS. LIC r• CO3,12A �v'Y :\'.AI ,JE E-NUzIL I FAX STREET.4DDRESS CITY, STATE, ZIP PiiO1�B USE OF ❑ SFD or DUPLEX ❑ 1✓rULTI-FAhffi.Y PROTECT IN WILJL ND ❑ YES PROj%CT IN ❑ YES IS TI- BLDG AN ❑ 1 _S B MDL\'G: ❑ COJaMCIAL I URBAN P\'TIItFA.CE AREA ❑ NO FLOOD ZONE ❑ 1\70 EICITLER HOME? ❑ 1\'0 DESCP.IPTION OF R'0. 2 c.1 �� C•C !� TOT IVA.LUATIO':\T: RECEI EDB1 �? y = By my signature below, I certify to each of the following: I an the property owner or authorized agent to act on the property owner's behalf. I have read this application and the Lnfonnation I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local - ordinances aad state laws relating to buildina cons tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/.Agent: Date: OMATION REQUIDSUP _EA TAL I\' �:<-=:_'a i v r �,�;,� h:'_ �'❑ Ov''ER"Ti�E-COU'NT'ER:� , �' 'E�REaS'n KX 'a..L:t..x AxaLS� x'5z�'�i72Dr� w 4' � fav Y gg -, s:. iN AfEPA47SCA4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO� IC FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10322 N. Stelling Rd DATE: 11/04/2015 REVIEWED BY: PAUL APN:% , BP#: *VALUATION: 1$5,000 *PERMIT TYPE:. Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 REAP11 USE:. p PERMIT TYPE: WORK I Install 28 N Recessed IC Rated Lights; Install 5 N Ceiling Fans; Install N 50 Amp Sub -panel SCOPE 7?lCh . 4.1i/ie./iiIl, IFlumb, Permit }f/wr 13hinib insp. Almwb, bap, Fee: Elec. Plan Check 0.0 1 hrs $0.00 Elec. Permit Fee: 1EPERMIT Other Elec. Insp. 0.0 hrs$48.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, -Public worics, tire, mmiary 6'ewer Liszrici, acnooc District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE' ITEMS (Fee Resohition 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS &t ppL PC ` :1* ee PME'Plan Check: $0.00 Permit 1f"ee: ,S'up/3l. Insp .bee . PM Unit Fee: $198.00 PME Permit Fee: $48.00 Administrative Fee: lADMIN $45.00 Work Without Permit? O Yes •> No $0.00 ,�c/�=rxtzc�ill'lcrnni��,�,p f �rT�a�: Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item Bldg Std§ Commission Fee: IBCBSC $1.00 x SUBTOTALS $340.65 $0.00 TOTAL FEE Revised: 10/01/2015 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE / COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION / 10300 TORRE AVENUE • CUPERTINO CA 95014-3255 vvv • CUPERTINO IkL) J (f08) 777-3228 • FAX (408) 777-3333 • buildin-gAcupertino.org `I• Owner Name ��LkA ��'i�C ,' .9 Permit No. S_// O 0 712r_ Address LO 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn. �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. G� 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. V�-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. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. �Ple7se 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 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 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). I, 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 plurnbing fixtures in accordance with Civil Code Sections 1101.1 through 110 1.8, the current California Plumbing -Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the waterJ�on ing plumbing fixtures comply with the requirements as indicated in the table on the followinp- pace. 1 /1 i Owner or Owner Agent's Signature: �' Date: I I /Zv / f � 1 Upon completing and signing this Certificate, please return it to the Buildine Division in order to final vour huild n� nf nPrR,it SB407 2015.doc revised 08/26/15 CUPERTINO Address ( 6) 'S 22 PURPOSE 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(acupertino.org f �lll - Stab %I\ - LS 11�•�� Permit No. f% 002-2— Carbon 022Carbon Monoxide: S' PERMIT CANNOT BE FINALF,D AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RFTI RN- D TO THE BUILDING DIVISION 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. have read and agree tq,6mply with the terms and conditions of this statement Owner (or Ovq& Agents) Name Sinature ............................................................................................................ Date: ....... .. Contractor Name: Signature...................................................................Lie.#...................................... Date: ................... Smoke and CO form.doc revised 03/18/14 OL -rG t2o14 Sc COMPy".UNI`Y D` 'ELO�MENT DEPART MENT BUILDING t ivI vN - CUPERTINO a i c c� s ! i ,'T be kept at the This sit of plans and s; •2 ifi «tion v.lJ� � - �en • _ jo!j cii0 j� _ nq CCnSii L C'tlGil. it IS Llilia�'.�iUi to I"ii i:e any (4pEL �r Cil -:i-)e or alt-rc ioCls Oil same-, or to de:•viaib therefrom, without ap :3roval from the Building Official. 1' SHALL NOT L'F is s& ( The sl..-mping of this pi .n and specifications � e k� - r bo held to p,-,rmit Or t ) be iai 2pprOval of iil') vlotatiM��-G� A isions of e I,y City OrciinGr ce�OZILa v. ID IP. at !�`t SCJ -4N\ n1 �-> F- ITJ, PER -1,11T N6. ® ; ZcP#14 � Zc Odaa -Lc Ajq -rc Acte -j- C Atje Ce4q .: kF9 15a 1 o 0 p Amp fi o lel4,-M21 Alar\ry -I -LZ 30-1 9 510IJ 0 L5-vj^d, -2.1 6 FEW E4. 7X ey2.Ve/ r�o) ZcP1,c-- 77c12.- Leq cY2.q ,/ Took : i �j s4e-111'q3 PC cu P-- ¢, �� C r4 7s Oil V1 py�vj-: l Ua� ,u ji:le7 F s CUPERTINO Building Department NM . 4 2015 EWED FOR CODE COMPLIANCE Reviewed By. 3 NP -W -6 YL-)