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15120001TL_ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10540 N PORTAL AVE CONTRACTOR: CLEAR DRAIN PERMIT NO: 15120001 PLUMBING OWNER'S NAME: GUINN ORVAL C JR AND WANDA W PO BOX 826 DATE ISSUED: 12/01/2015 OWNER'S PHONE: 4082570685 LOS GATOS, CA 95031 PHONE NO: (408)358-3242 �0 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ dp Q ? Q License Class Lic.#� Q .7 � U C, INSTALL (N) PROPERTY LINE CLEANOUT ContractDat O I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000 of Division 3 of the Business & Professions' ( g ) t T'i Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: r� 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: $2500 &ave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31632010.00 Occupancy Type: 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 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 AS LED 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 Z granting of this permit. Additionally, the applicant understands and will comply e e: with all non -point source regulations er tlne Cupertino Municipal Code, Section 9.18. j ` RE -ROOFS: Signatuge D e®D2 "' `` 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. 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 Cupc n Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of tine Labor Code, for the performance of tine work for which this the Health &Safety Code, Sections 2 .05, 3, nd �" 34. Owner or autho•ized ageiyt� Da 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, tine applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUP ERTIN 0 - GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPIdiENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 5501A-3255 (408) 777-3228 • FAX (408) 777-3333 • build ina(C cuoertino.orq 00 M I '5nPLU'hEBNG ❑MECHANICAL ❑SLECTRiCAL ❑MESCELLA1\�OUS PROJERCT ADDP.ESS i , j (/ APN y �t�7 OCvTiRITA�✓' Ry.Vv�- P PH T� `1 V i -Z� � 95' �]✓-�L J VV L V i Yll1 f STREET ADDRESS q, , II / r CITY, STATE, ZIP I FAX (/4 COA"TACT N t;�E (0 40 �) 13 - 7 g L 3 E I✓LA JL CITY STATE, Z-1?�� FAX °K�-? 1 l ��`�J✓r ► �C4� j os'r CA ❑ Oti ❑ OV11.yR-3UT1 D=R ❑ Oti.WMAGTT ❑ CONM4,CTORO'`'TRACTORAG2— �T ❑ ARC--ITZECT ❑ Ev0W=R2 ❑ DEVELOPS ❑ i_k.S]-T CONI PL CTOR I1.A.I,i T .El' E'S'L ER c� �� Z LIC SE TYPE BUS. LIC ) _730 b C01,12ANY 1\AIa't-l�iAIL I FAX STREETADDRESS CITY, 4T.4T- ZIP U ba I v J ` P�30'�jr� _ c-0 / 5 q ARCI�TECTF_NG��ER T.} T,E LICENSE Nb!' ILBER BUS. LIC CON3ANY N AhS E-IJL�T F aX ST=.4DDRESS CITY, STATE, ZJP I PHONE USE OF ❑ SFD, o,DL'PJ X ❑ ),rULTI-F.U,'jLY PROTECT N'ri'IITT)LA-\M ❑ Y: -:s ??.OT-- CT -N ❑ YiS IS i E BLDG AN ❑ 7 Zs BuT PIG: ❑CO1'G.C�t " UR3AN1L)\Tic72.'rACEA?.EA ❑ NO FLOODZOI\3 ❑ xo =ICi?LERHON,E7 ❑ x-0 DESCP,IFTI07\' OF \VO.RiC TOTAL VALUATION: 5y my signature below, I certify to each of the following: I am the property owner or authorized agent to a:operty owner's behalf. I have read this application and the infor ation I have provided is cosec have read the Description of 'Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatir!g to build'�Q stiction. =' e represents 'v `o enter the abojve-identifcd prop �} for ins lion purposes. :gent: Siyaa:re ofA.pplicanJ Date: SUTPPL E I riI L\ r OR D Q - wRgqgt,r � ODER TiiE COL'�TER,' r .� -'+eJ . S.:r .lr. ,4E.�•>J?,�EJ�' 75.n.E.�R .',��. .<»' k AIEP?disc,4Dp_2011.doe revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: 10540 N PORTAL AVE DATE: 12/01/2015 REVIEWED BY: MELISSA APN: 31632010 BP#: *VALUATION: 1$2,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: ;,,... ;,<..., f; PENTAMATION 1 RPSS I PERMIT TYPE: WORK INSTALL N PROPERTY LINE CLEANOUT SCOPE APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check0.0 hrs $0.00 QTY UNITS BP FEES 12L', FF Sewer, Sanitary 1 PRSEWER ;,,... ;,<..., f; 1 # $25 . Lj PME Unit Fee: $25.00 PME Permit Fee: $48.00 KIA", F7 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (D No $0.00 ? "'Vk111 TOTALS: Travel Documentation Fee: ITRAVDOC $48.00 $25.00 $0.50 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 Ureliminary information available and are onlv an estimate. Contact the Dept for arldn'I info. FEE ITEMpS (Fee Resolution 11-053 .E . ?/1/13) FEE Plumb. Plan Check0.0 hrs $0.00 MISC ITEMS Permit Fee: 1 PPERMIT 12L', FF Other Plumb Insp. 0.0 hrs $48.00 ;,,... ;,<..., f; PME Plan Check: $0.00 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 Ureliminary information available and are onlv an estimate. Contact the Dept for arldn'I info. FEE ITEMpS (Fee Resolution 11-053 .E . ?/1/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 . Lj PME Unit Fee: $25.00 PME Permit Fee: $48.00 KIA", F7 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (D No $0.00 ? "'Vk111 Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $167.50 $0.00 TOTAL FEE:F $167.50 Revised: 10/01/2015 C- 4101 ®rvAi C. Jr, a•4z tvati4o__ w. u7umn SMOKE i CARBON MONOXIDE ALAR IS OWNER CERTIFICATE OF COMPLIANCE F IgoL;- COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(a.cupertino.org � ] n ��ISlzooC) l ill i-ess PERMIT CANNOT BE FL\T kLED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN , C,NED AND RETURNED TO THE BUILDING 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 su-igle-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: h -i 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 agreete-compN with the terms and conditions of this statement Zv n (ot c1:tijner Ages tis) Na ie W rrAA 18v 4 ........................................................ Gar�lr�ier Name: Ll Signafufe. - - ... Lic# .J. v ..-.Dafe:`�.....L....... Smoke and CO.form.doc remised 03/18/14 'WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION FRO E CUPERTI(i O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 6 � �.0 (408) 777-3228 - FAX (408) 777-3333 • building aAcupertino.om Owner Name 6V i Irl 6 OVA V a L �' � `, o-v�c� k&)Cl ��►err>�.No r Address 1 0 S t— G ji PG✓ Tr,, \ 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. R 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 pluinber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. 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. R 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. A 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. 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 undergo es 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 shalt 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 plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1.1.01.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -co nservin lumbing fixtures comply with the requirements as indicated in the table on the followine Dage. ter., _ -----------� Owner or Owner Agent's SignatOt,�13 "'" Date;=�;-� Z Upon completing and signing this Certifi e, rn it to the Buildinr? Division in order to final vnur h,,;lrl;no „P,,,,;+ SB407 2015.doc revised 08/26/15