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15120050 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 921 MILLER AVE CONTRACTOR:TATS INC DBA MR PERMIT NO: 15120050 ROOTER PLUMBING OWNER'S NAME: BRADBURY MARGARET TRUSTEE 2827 AIELLO DR DATE ISSUED: 12/07/2015 OWNER'S PHONE: 4082307676 SAN JOSE,CA 95111 PHONE NO:(408)227-1630 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL F] DUPLEX UNITS#921 &#923-INSTALL(N) PROPERTY License Class C�,Ce Lie.# ��� z� LINE CLEANOUT; (N) BUILDING CLEANOUT AND 1k.�+nn {ti �� REPLACE Contractor (Vk� ' i�k1? '? '� Date 25' OF TRENCHLESS SEWERLINE **CUPERTINO I hereby affirm that I am licensed under th provisions of&apter 9 SANITARY** (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: 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. Sq.Ft Floor Area: Valuation:$16500 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 APN Number:36919047.00 Occupancy Type: permit is issued. 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 YS FROM LAST CALLED INSPECT O indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the �{ ' Q granting of this permit. Additionally,the applicant understands and will comply Issued by: ' i�°�® Date: I� with all non-point source regulations per the ertino Municipal Code,Section 9.18. RE-ROOFS: Signature7=1 Date 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the stricture is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE constrict the project(Sce.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I 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(x)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 the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and i have and will maintain Worker's Compensation insurance,as provided for by the Health&Safety Code,Sections 25505,2F33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this *AAA 2 'l permit is issued. Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's 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 APPLICANT CERTIFICATION Lender's Address 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, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date GENERAL PERMIT APPLICATION MEP 1 COMMUNITY DEVELOPMiENT DEPARTMENT-BUILDING DIVISION 10300 T ORRE AVENUE• CUPERTINO, CA 9501^—.-3255 (408)777-3228 • FAX(4,08)777-3333 • buildina(a cuoeriino.org CUPERTINO- m I ❑1,ECH12,ICAI ❑ELECTRICA-L ❑MISCELLANEOUS PROT-ECTADDRESS Cl 7�5 ��Ve_ = fIIII OS'vTiR1�/1✓E v\ (A g)g taf I PiIOT f� IJgtZ STREET ADDR SS ,A n\ 1� -AV n I CITY, STATZ,ZIP ( ' �oC n I FAX CO.NIACT �`;`�1 IV V� ��]-(� PHONE STREET dDDP SS "` `j\V� / 321lIN CITY,STATE, ZAP Sj�K (JZ C"A C,G-I 1) F x ❑ OV,---a ❑ OR 1.c?-3U Ti Det ❑ 0\n t AGENT VC01TP.0.CTOR ❑CO ZP ACTOR AG?T 'kC CT ❑E?vG =`R ❑ I)EIELOPER ❑ i_?e,�7 CONTRACTORKAJ\rr.. LICHNSENUA0ER �� I LICi=.nSETYPT7 I BUS.LIC .' r NA-Q&Ae\P—P6V%ARi#M ze COMPANY NP'aB E-NyS1L I FAX 7 1P. STREET ADDRESS -CITY,STATE,ZIP PHONE X21 S,�rJ�S-z c� a\�i,I I--- .A-R=T-rCT/EX-Gj-KE:7ER Kkh? E LICENSE NU.%GER BUS.LIC R COIdPaNYNAIJE. I E-M"k. FAX STREET ADDRESS I CITY,STATE,ZIP I PHONi USE OF C3'�7 Dr DUPLEX ❑ M ULTI-iAb,zLY PROTECT LN WZDLAND ❑ YES PROT--CT IN ❑ YES IS THE BLDG AN ❑ 1=S B=NG: ❑COAO,=CIAI UI2.31-2.'LNrI=E ACE AREA p xo FLOOD MINE ©1I0 ❑ No DESCP.IPTION OF R'ORiC --1W'A TOTALV?.LUATION: lu\P300 By my signature below,I certify to each of the following: lam the property owner or authorized agent to act on the property owner's behal . ave read this application and the infor_nation 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 ordinances and state laws relati-!g to builging constrction. I authorize representatives of Cupertino to enter the above-identified propel ty for inspection purposes. Signa re ofA.pplican/"-.gent: Date: 2 1� S PLE"IN7ENT -ENVIR-MATJONREQULRF,D ys zDFFSGELSE OLl fi, W ti Ol'E£THE COi�TER^ 4 , KM NIN .� Ri ,,, x15'.F h .i. ��;'^ �-❑ 3+ZAJDRhr;mss ''� � 1�1EPh!isc.4pp_20II.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 921 Miller Ave DATE: 12/07/2015 REVIEWED BY: PAUL APN: 369 19 047 BP#: 'EVALUATION: 1$16,500 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPSSA WORK Duplex Units#921 &#923 - Install N Property line Cleanout N Building Cleanout and Replace 25' of SCOPE trenchless sewerline APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $25 Sewer, Sanitary 1PRSEWER 1 # $25 TOTALS: $50.00 s ec . 1 lon€">;i?i'.. Plumb.Plan Check 0.0 hrs $0.00 Lircr;..'enni=Fee,. Plumb.Permit Fee: IPPERMIT c>:e:._erinh;1 CJazIz>c`5'r. hrs=. Other Plumb Insp. 0.0 1 hrs $48.9,0- L Ptrc>r lr.. :'lech. iii/.1"e.'t.`. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District, etc. . These.fees are based on the prelimina in.formation available and are only an estimate. Contact the Dept./or addi2'l info, FEE ITEMS (free Resolution 1.1-053 y!L 7,%1/13) FEE QTY/FEE MISC ITEMS T r PME Plan Check: $0.00 r>..... PME Unit Fee: $50.00 PMEpp Permit Flee: $48.00 -T Administrative Fee: IADMIN $45.00 Work Without Permit? Yes (F) No $0.00 .rf, L1.7'cc';sI.i'l!1'?j't7r:?./`f'G',S: Travel Documentation Fee: ITRA VDOC $48.00 A Strong Motion Fee: IBSEISMICR $2.15 / Select an Administrative Item Bld�T Stds Commission Fee: IBCBSC $1.00 "SIJ13T0TALS $194.15 $0.00 ` :TOTAUFEE. $194.15 Revised: 10/01/2015 SMOKE d CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE FI-E COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CVPERTMO 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255 (408)777-3228^ FAX(408)777-3333 o building(a.cupertino.ong f _ s �� 0 .�ca � Ire: t1ide: PERMIT CANNOT DE 1<'INALED AND CO.PL,ETED IINTH,THIS CERTIFICATE Z DFE. N t' l AN1)BML "I+� I'1gE BUr ,i3ii"NG 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 INIFORMATION 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 Califonaia Residential Codes. The alarms have been tested and are operational, as of the date signed below. �14I have read and a ree to comp f with the terms.and conditions of this statement Owc� r 'h' ecRgen[=5Z4�arne 41A V �Ov 1 S.i'"iiatfre. Gl...� Cc?# '✓ �`'�� Da:ti � J Smoke and GO form,doc revised 03/1'8/14 'WATER-CONSERVMG PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE OW _ & ECOMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPfEFB{f&V�i® (�L (408777-3228®FAX(408)777=3335, •building&-cupertino.om Owner Name L `V t G i Permit No. 0 Address Q2,1 (n/� (��Qi Poe 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 fonn. ffl[/Ao 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 plu bing,installation of water-conserving plumbing fixtures is not technically feasible? es Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. E�4Skip the rest of the fonn and sign bottom of form. Go to Question 3. 3. Is water service permanently disconnected for your building? 61❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the fonn and sign bottom of form. N0 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. �1�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. 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 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). 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 11.01.8,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 age. Owner or Owner Agent's Signatur�gr r� G�, Date; ;:�% Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08/26/15