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15120070M CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10397 VISTA KNOLL BLVD CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 15120070 CONDITIONING OWNER'S NAME: MCLAUGHLIN DENNIS Rckeoalt 1,4E 1712 STONE AVE DATE ISSUED: 12/08/2015 OWNER'S PHONE: 40873348195 SAN JOSE, CA 95125 PHONE NO: (408)293-4717 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL REPLACE (E) WATER HEATER, SAME LOCATION License ClasLie. # Contractor Drat 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: 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 Sq. Ft Floor Area: Valuation: $2076 of the work for which this permit is issued. ffiormance ve 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: 32613036.00 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 RMIT 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 D CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Date: granting of this permit. Additionally, the applicant understands and will comply with all non -p in urc regi a ' ns per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: SignaDate l 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 structure 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 construct the project (Sec.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. 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(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, Sectis 25 25533, and 2 Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen Dale: permit is issued. 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 CUPERTINO PIN GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ' (408) 777-3228 - FAX (408) 777-3333 • building(cDcupertino.org �O� sc ❑ C ❑ E ECTRICAL ❑ MISCELLANEOUS AiNI rLumBING MECHAL / V /%, PROJECT ADDRESS 1 0 3q l V I %) � t i� Knoll3 n O l tj M y % APN # 6 13 OWNER NAME Dtar) 7 C M �,L J h Iti PHONE% ��```��'2'' Q�I9 E-MAIL STREET ADDRESS i O � rj o g n o ( J CITY, STATE, ZIP ( I y-� jn D C FAX F / f n /1 / CONTACT NAME AAA PHONE I � ` STREET ADDRESS I I I r�� n I A � / .-#-I CITY, STATE, ZIP 'VA r) FAX 1A ❑ OWNER ❑ 0 WNER-BUII-DER - l OWNER/Q A`IEENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CORACT. -/,t. I� � �I� LICENSE NUMBER � � LENS C2 E BUS. LIC # COMPANY NAMEAAAF / lJ E-MAIL A YYl Ce at). Cb STREET ADDRESS `� 1 /j nt `v l/ CITY, STATE, IP �j (p /'� (�C�-2C U J l (�`, JJ ,J 1 -1' 1 PHONE n 21-14-1 `� AR.CHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES ❑ IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO DESCRIPTION OF WORK A L6c�,rr®,J G I1 5b r 5 u TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorize o act on the pro e e alf. I ead this application and the information I have provided is correct. I have read the Description of Work and verify it is agree to compl I all applicable local ordinances and state laws relating to b iidingc�tionn. I authorize representatives of Cupertino to enter the above -identified pro or inspection purposes. �nsttr Signature of Applicant/Agent: Date: UPPLEMENTAL INFORMATION REQUIRED USE ONLY - OVERTH3+rCOUNTER �r �r,: y: ❑ryiARGE, �-_�, C . _F "max.' .t. _ ; , MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FF.F, F.IRTTMATOR -BUILDING DIVISION 10397 VISTA KNOLL BLVD ia, DATE: 12/08/2015 REVIEWED BY: MELISSA lADDRESS: APN: 326 13 036 1 BP#: *VALUATION: 1$2,076 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR I USE: $29 PERMIT TYPE: A WORK REPLACE (E) WATER HEATER, SAME LOCATION Suppl, fnsp.hee SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $29 TOTALS: $29.00 facet..facet.. Plumb. Plan Check 10.0 1hrs $0.00 1 "" 1 X i,llEC 1kch, llerrnil. *ee: Plumb. Permit Fee: IPPERMIT other L—Other Plumb Insp. 7f, $48.00 otherl.,Iec. bs "p, h1eJi, Insp. "ce: TOTE: This estimate does not include fees due to other Departments (i.e. i-ianning, ruouc worKs, rtre, aunhuryauwer "ottmt, IN-Itum District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact theDept,jor aaan't unto. FEE ITEMS (Fee Resolution 11-053 gff.' �711113 FEE QTY/FEE MISC ITEMS SuppL 11(.`Foe PME Plan Check: $0.00 1'erwit.1-7ee: Suppl, fnsp.hee PMEE Unit Fee: $29.00 PNffi Permit Fee: $48.00 Administrative Fee: 1.4DMIN $45.00 Work Without Permit? Yes (F) No. $0.00 A(,fvance�l Phm ning -ees: Travel Documentation Fee: ITR,4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.001 A S.:: L � SUBTOTALS::; $171.50 1 $0.00 T0TA1L,FEE--.,. $1 Revised: 10/01/2015 G COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - bull ding (acupertino.org P1E1[t1WT CANNOT BE nNALED AND COMPLETED UNTIL TIERS CERT MCATE �� A �THEIBUILD V 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. GIENERAL HN)FORMATION 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 dweIlng 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 manufacturers instructions and in cornpli nce with the California Building and Caillifonnna! Residential Codes. The alarms have been tested and are operational, as of the date signed below. t hake read and agree fa cm, nly uvrAh Nlitaih'Prms; anri! eni nrtltinnq of thi.:e. ,ztatPm. Pnt s Zl - ° Cotit-- torsN7and 5t na ure.. v Sr nature.._��.......... 44....... - .. I=;i.`.lY.v.v.!. I Smoke and C0 fvn7?aloe revised- 0371'871,'41 ' OWNER CERTIFICATE ` F OMPLI ,NCE . a COMMUNITY DEVELOPMENT DEPARTMENT t, BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 �(408) 777-33,33 • _building okup ertino.o ra — Owner Name �� j'�//�j �–, Permit No. Address 1. Is your real property a registered historical site? Q Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn o 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. A 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. C 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. jCivil Code Sections 1101.1 through 1101.8 .do not apply. Skip the rest of the form and sign bottom of form. r� 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: n Myproperty 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 pYumbing 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 improve rnenfs). 0 My property is a m-uhifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specif ed building. alterations or irnproveiments shall require non- compliant plumbing fixtures• to be replaced with water• conserving plumbing fixtures. On or befb= January 1,, 2019,. all non. -compliant plumbing fixtures shall be replaced, with water - conserving pluimbing fixtures throughout the, building (regardless of whether property undergoes alterations or iinproveiments). 0 My. property is a conzanerciali real pi.operty. 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 pluinh- ng fixtures throughout the building (regardless of whether property undergoes alterations or knprovernents). as the owner or, owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replacedl prior to date specified. above with water -conserving plumbing fixtures' in accordance -with Civil Code Sections 1101. l through 116111, the.cunent CalifonuaPlunmbing Code and California Green Building Standard's: Code„ and manufacturer's instad2ation i<equireinents, and that the water -c servin ; lumbing fixtures comply with the requu ements as: indicated' in the table on the ng, page. Owner or Qwner Agent's Signaiturc ° Upon completing and signing this Clertifcate, please return it t wilding Division: in, order to final your bui 'ding p'errnit. SB407 2015.doc revised 08/26/15