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15110033 CITY OF CUPERTINO BUILDING PERMIT BUILDIr G ADDRESS::2194.5 HYANNISPORT DR CONTRACTOR:AMERICAN PERMIT NO: 15110033 RESIDENTIAL SERVICES OF CA • OWNER'S NAME:`RAWikRAYMOND F AND SANDY L 965 RIDGE LAKE BLVD STE 201 DATE ISSUED: 11/05/2015 OWNER'S PHUNE'4082534342'� MEMPHIS,TN 38120 PHONE NO:(408)982-0405 �,1 ""• ` JOB DESCRIPTION:RESIDENTIAL E] COMMERCIALE] YNJ c;� .','q;LICENSED CONTRACTOR'S DECLARATION LicenseyGlass Install(N)property line cleanout Contractor::` Q'A K�}DS t l 51 I hereby,affirm,that!I.ani;licens,ed under the provisions of Chapter 9 (commencing wifh'ISection 7000)of Division 3 of the Business&Professions Code and that my license;is:l-n.full force and effect. %SANITARy I hereby affirm under penaltyof perjury one of the following two declarations: I have and:will�maintain a,certificate of consent to self-insure for Worker's Compensation;as provided for bySection3700 of the Labor Code,for the performaiice'of the;work for'.which this'permit is issued. Sq.Ft Floor Area: Valuation:$1140 `I have and-will;maii}ta n Work'er's Compensation Insurance,as provided for by Section 3700.6f the'labor Code,'for the performance of the work for which this permit is issued;';. ':i .'. .' APN Number:35608002.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this�application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I 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•property'for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemn'ifyranill &p1harmless'tlie City of Cupertino against liabilities,judgments, Costs ,ai►d;expenses'.which.may'acorue against said City in consequence of the Date: granting ofthis pernlrit.-Additionally,,the applicant understands and will comply Issued by: with.' .1.non-point,source,regulations per the Cupertino Municipal Code,Section 9.18 00't . ... RE-ROOFS: Sigriatur .. ..I. Date All roofs shall be inspected prior to any roofing material being installed.If a roof is r it LL Iinstalled without first obtaining an inspection,I agree to remove all new materials for !, inspection. ❑ oj;,OWNER-BUILDER DECLARATION Signature Applicant: Date: ffir I hereby aiii''thif.I am'eiempt'from the Contractor's License Law for one of g the ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as6ownei:of the'property ioi my'employees with wages as their sole compensation, will do,the.woi�,iand';the'stQ`tuie is not intended or offered for sale(Sec.7044, Business;&'Pr`ofessions Code)' l! •'a " HAZARDOUS MATERIALS DISCLOSURE I,as owner of tlie'property,am exclusively contracting with licensed contractors to construct the pro3ect'(Sec.7044J3usiness&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three 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 maintain 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,tlie'work�for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and - the Health&Safe Code,Sections 25505,25533,and 25534. I have'and.will'inai tairryJ�orker's Compensation Insurance,as provided for by Safety I. Section 3700rof the'iC,abor Code,ifor the performance of the work for which this � Owner or authorized ag'�ent: Date: 1 S permit is-issuedJi 'i; �,6 I certify ihat'in�the performance of the work for which this permit is issued,I shall not employ:anyperson;in;any manner so as to become subject to the Worker's I CONSTRUCTION LENDING AGENCY Compensation li�vs;o£,Califonra. If,after making this certificate of exemption,I become subject'to„tlie,. ol Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply;with such'provisions'or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name ! h'APPILICANT CERTIFICATION Lender's Address I ceitify'that'I have;{gad'`.this.application and:state that the above information is co:rrect;"I°agree!to cgmply,witfi;ai.city and county ordinances and state laws relating to building c n'structron;and Hereby authoriie representatives of this city to enter upon,the above,me�tinned property:for inspection purposes.(We)agree to save + ARCHITECT'S DECLARATION indeipnify�anil'keep;harmies's-tlie City of Cupertino against liabilities,judgments, costs;;and;bxpenses!iwHich,may;accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit,.Additionally,i the applicant understands and will comply with all non-po'T.splirce regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18.: h:, t} . ,, •, Signature f r f! 4 , +t l' ", ' Date GENERAL PERMIT APPLICATIONM EP COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION ME, vtl- 10300 T ORRE AVENUE• CUPERTINO, CA 55014-3255 (408)777-3228• FAX(4,08)777-3333 • buildina(a)cuoertino.org CUPERT[ti0 m I LU,431NG ❑MECHANICAL ❑ELF-C-1-PLICAL ❑], 1SCELLA-NT•OUS I D©`— 3 PROJECTADDP SS 2rC\ CZ 1 .yx� I P�N' OWNERNAME PFONE �j 122ci C-tOk- 2 C-1 STREET A DDRESSCITY, STATE,-71PF u X I l @1 u � Q � 171' I G t,� r�r>19 � CONTACT NA.IJ-\ � PHONBE E-I ZAII U CAW goclo 12t%'Z-.0(4 01S- [n 'C a GLi Uw STREET ADDRESS CI �T.4in, ZIP FAX LJ Y- L 1"t"--c �QvN—zk ❑ OR'1ER-ETj .D? ❑ OWNTER4GD\T ❑ CDNTtiCTOR ❑CONFPACTORAGM:T ❑ :SRCIMECT ❑ ENGINEER ❑ D��LOp ❑ !_t ��7 CONTRACTOR NAL,L LICENSE hZ..BER LICENSE TYPE LIC �BUS. cos�t (CO2 0 COIJ,PA?,Y N,mZ1 E-MAIL �Sr e� A.. STREET ADDRESS CITY,STATE,ZIP CO PHONE ARCHITECTIENGLNEER NAME LICENSE NUMOER BUS.LIC R COMTA?vYNAM% E-1J Lr I Fey, STREET ADDRESS I CITY,STATE,ZIP I PHONE, USE OF SFD or DUPLEX ❑ MliLTI-F.'U GM-Y _I.PROJECT LN WILDLAND ❑ Y=S PROT=IN ❑ YEs I IS T,=—BLDG AN ❑ 17S BU-T DT NIG: C01,0,- CLQ UP3AN I2N=—A CE AREA ❑ NO FLOOD ZO!3 ❑ NO MCFLER HOME? ❑ NO DESCRIPTION OF WORK ^ vJ TOTAL. A-LUATION: E 1 R0 RrCEIti Dia S r ik J i ` By my signature below,I cce.tiry to each of the following: 1;,m the properly owner or authorized agent to act on the pro r wner's behalf. I have read^this application and the information I have provided is correct. I have read the Description of'Work and verify it is accurate. I agree to comply with all applicable local ordtmances and state laws relati.-!Q to building cons 'ction. I authorize representatives of Cupertino to enter the above-identified property for inspectionpurposes. SigZa'm bfAuulic�ni/Agent: r Date T T T' T I T- >i=�-%s= PP_E_`MN 1 AL LNT ORv1ATIO REQL 1_RED `.,:..;:OFFdCE%LSE O�LI _ OV£R,ThDCOLiiZER s .. z i r STi�J3FiD �1 z� r Y N S A/FPA4isc,4pp_1011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ik ADDRESS: 21945 Hyannisport Dr DATE: 11/05/2015 REVIEWED BY: Phuong APN: 356-08-002 BP#: 'VALUATION: 1$1,140 *PERMIT.TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY.. PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPS WORK Install N) property line cleanout SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $25 TOTALS: $25.00 l�eca�. Plan C'Fieck: .` Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 11ech. Perrin Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee: Other.¢Iech.'InspzLl Other Plumb Insp. hrs $48.00 Other Elec.Insp. 0.0 I-- L i Li .Lteclt.Insp.Fee: Phtnh. Insp. Fee: Elec.Insp.F'ee: ' NOTE:,This estimate,does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etG). These ees are based on the prefinmdina information available and are only an estimate. Contact the De t or addn'1 info. FEE,ITEMS (Fee Resolution 11-053 L . 7/1/13) FEE QTY/FEE MISC ITEMS Plan C'hecft'Fee.- . :Suppl..PC Fee PME Plan Check: $0.00 Pet,rnit Fee:"' .Sztpral:Lnsp F'ee PME Unit Fee: $25.00 PME Permit Fee`. $48.00 (6ust-z1 ' ion Tax: Administrative Fee: IADMIN $45.00 Work Without Permit?,:. 0 Yes E) No $0.00 Advra ee''d Plannink Fees: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item 134dgStds''Commission Fee: IBCBSC $1.00 SUBT®TALS: $167.50 $0.00 TOTAL FEE: $167.50 Revised: 10/01/2015 SHONE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION CVPERTINO 10300 TORRE AVENUE> CUPERTINO,CA 95014-3255 (408)777-3228 o FAX(408)777-3333^ building(a)cupertino.org �Ce:W, MS s n x. PERINUT CANNOT BE EINALEID AND COMPLETED UNTII,THIS CERTIFICATE k- S BEEN S C1_E AND TOT I;L D I w7Cp 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 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 a Lee to come1Z with the terms and conditions of this statement Carr:or ;wcterRcgertf s1 F+tare tQr`_ .. C-. ..................................... CotorA me: Si'cati�re......... ........ ....................................Lict�s:.....................................Dain'''.................. - Srnoke and.CO forin.doc revised 0311811.4 'WATER-CONSERVING PLUMBING MXTURES r"* OWNER CERTIFICATE OF C®MPUANCE �' COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPCERTINO � / (408)777-3228^ FAX(408)777-3333 o building(a)cupertino.ora ��� Owner Name S A-AU 1�-i (� f�y1�L� Permit No �J 6 I Address cl }-t��4✓I��S t��Y'L� 7Vl_ .. 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 fon-n. _.y ❑ 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. U 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. ©'..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 realproperty 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. PIP-se 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 properly 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-cornpliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or irnprovernents). 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 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--conservin lumbing fixtures comply with the requirements as indicated in the table on the following age. Owner or Owner Agent's Signatuw.-.� '' �" ',U• Date". j Upon completing and signing this Certificate,p ease etu it to t_h\e1S r 'ng Division in order to final your building permit. SB407 2015.doe revised 08/26/15