B-2016-1263CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1263
21584 LA PLAYACT CUPERTINO, CA 95014-4802 (356 23 014)
( MIKE COUNSIL
PLUMBING INC )
SAN JOSE, CA 95131
OWNER'S NAME: PANG BO AND CHEN HONGYU
DATE ISSUED: 01/26/2016
OWNER'S PHONE: 408-702-7347
PHONE NO: 408-2724900
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC36 Lic. #679261
Contractor ( MIKE COUNSIL PLUMBING INC) Date 01/26/2016
X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL _ COMMERCLAL
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.
JOB DESCRIPTION:
INSTALL 2 (N) DEDICATED GAS LINES FROM METER TO DRYER &
I hereby affirm under penalty of perjury one of the following two declarations:
OVEN/STOVE
1. 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.
�7 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
Sq. Ft Floor Area:
Valuation: $3300.00
this permit is issued.
J
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county
356 23 014
356
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, costs, and
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS FROM LAS ECTION.
Code, Section 9.18.
Issued by: MELISSA _
Signature Date 01/26/2016
Date: 01/26/2016 -
OWNER -BUILDER D ARATIO
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 01/26/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
ALL, ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
t. 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
this permit is issued.
e. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Sections 25505, 25533, and 25534.
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
Owner or authorized agent:,�P
be deemed revoked.
Date: 01/26/2016
APPLICANT CERTIFICATION
CONSTRUCTION L ING A EN
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construe n lendin ncy for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is is d S 97, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address .
judgments, costs, and expenses which may accrue against said City in
ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date 01/26/2016
+CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingCa)-cupertino.org
t3_ 1,0 (6 -
MEP
MISC
Z 6 3
❑///PLUMBING
❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS '
L�G ` APN # 0 _ o `
ej
OWNER NAMEPHONE
O n
n G -' -
E-MAIL
p �+en AQ
STREET ADDRESS
Af
CITY, STATE, ZIP C
e �I
FAX
CONTACT NAME
r 1
PHONE
E -M IL /
nl�
�C 2
G r
��� G Ifiw n fa
STREET ADDRESS
."120 fa wafv
CI STAT ZIP
40S c 64-
FAX
�//
❑ OWNER ElOwNER-BUHAER 1:1 OWNER AGENT ElCONTRAC" OR U CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR AME r
n
LICEN BER
02
LICENSE TYP
BUS. LIC #
3 14
COMPANY NA (
l
E-
FAX
STREET /
l [
CITY, STAT , ZIP
PHONE
61a �A W - 4f,7 co
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF Dor DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WnDLAND ❑ YES
URBAN INTERFACE AREA i/AO
PROJECT IN ❑
FLOOD ZONE NO
IS THE BLDG AN El YES
EICHLER HOME? 4.I115-
DESCRIPTION OF WORK 1
,6
-
`f �oh� i!1 C - e— e /+
.,d 00 G
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner ora orized agent to act on the prope ave readthis
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
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:
Date:_ f�i7 16
SUP LEMEN
FORMATION REQUIRED
ocE usE oNLY
w
4. .
OVER THE -COUNTER•
❑ `EXPRESS
❑ STANDARD ='•
U
0.
LARGE
❑ MAJOR
MEPMiscApp_201Ldoe revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21584 LA PLAYA CT
DATE: 01/26/2016
REVIEWED BY: MELISSA
APN: 356 23 014
BP#: B-2016- 126 ?
*VALUATION:
1$3,300 I
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 RPGAS
PERMIT TYPE: 9d
WORK
INSTALL 2 (N) DEDICATED GAS LINES FROM METER TO DRYER & OVEN/STOVE
SCOPE
TOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schooi
District, etc.). These fees are based on the preliminary information. available and are only an estimate. (;ontactthe Dept joraaan'lmf
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
Plumb. Plan Check 1 0.0 1 hrs $0.00
Plon
A'Iectl' ilernn;'.Vee:
Plumb. Permit Fee: IPPERMIT
-i;s
.0 e'ee.
fA4'hev 'k-�cb.
Other Plumb Insp. 0.0 $48.00
F
h"lec. ir'sp. Fee:
TOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schooi
District, etc.). These fees are based on the preliminary information. available and are only an estimate. (;ontactthe Dept joraaan'lmf
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check P'ee"
Supp.
F
PME Plan Check:
$0.00
permit.!-"ee:
-T
PME Unit Fee:
$72.00
PW Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
'A
Travel Documentation Fee: I TRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
—1
Bldg Stds Commission Fee: IBCBSC
$1.00
TOTAL FEE
$214.501 $0.00 $214,50]
S BTOTA
Revised: 01/01/2016
CUPERTINO
MOKE / CARBON MONOXIDE ALARM
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 m FAX (408) 777-3333 o building(a.cupertino.org
215g`f LA 7JA
PURPOSE
6 2 0 ) fo 12.x&_
Cr.
PERMIT CANNOT BE FlfNALED AND COMPLETED UNTIL TINS CERTIFICATE
WkS BEEN S QN AND'LTTEP �T�i LD1 D� 4��SIO.i'u'
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
SMOKEALARM
COALARM
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 manufacturers instructions and in compliance with the California Building
and Calif orinia Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
t have read and agree to comply with the. terms. and conditions of this stntpmpnt
Si nafure .........::................... Dafe.� t .�....
...................................................... 2
Sigr]at ire:_ Lic° ;. � at, j p°aie`? / t b, I
Smoke and: CO foam. dbc remised 03,11,8/1'4,
CUPERTINO
Owner N
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 a building(&cupertino.org
J 01-4CQ, Permit No,
Address &T.
&- 2-014, 12-63_
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 form.
jb M No Go to Question 2.
2. Does your real properly 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 form and sign bottom of form.
,M 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.
Q 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 propertyis 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.
p 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:
OF 1] 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 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 -conserving plumbing fixtures comply with the requirements as indicated in the
table on the following age.
Owner or Owner Agent's Signature_J_�, -�--� pati, `j i /27/1 F;
upon completing and signing this C;ertiticate, please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15