B-2016-1264 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1264
10785 CARVER RD CUPERTINO,CA 95014(375 35 016) (MIKE COUNSIL
PLUMBING INC)
SAN JOSE,CA 95131
OWNER'S NAME: LUTHERAN CHURCH OF OUR SAVIOR CUPERTINO DATE ISSUED:01/26/2016
OWNER'S PHONE:408-334-9190 PHONE NO:408-272-4900
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC=36 Lic.#6Z9261
Contractor(MIKE COUNSIL PLUMBING INC 1 Date 01/26/2016 X BLDG —ELECT X PLUMB
MECH X RESIDENTIAL_COMMERCUL
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:
REPLACE(E)WATER HEATER,SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
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
A
formance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as provided for
Section 3700 of the Labor Code,for the performance of the work for which
is permit is issued. Sq.Ft Floor Area: Valuation:$2500.00
APPLICANT CERTIFICATION
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 75 Number: Occupancy Type:
3
ordinances and state laws relating to building construction,and hereby 375 35 016
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 LA SPECTION.
Code,Section 9.18.
Issued by:MELI SA NA S
Signatur Date 01/26/2016 Date:01/26/2016
OWNER-BUILDER DE ARATI RR-ROOFS:
I hereby affirm tha�eptm theContractor'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 reas installed without first obtaining an inspection,I agree to remove all new materials for
t. 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).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 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
this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous
s. 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
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
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 25505,255 ,and-253"4
S .-___
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 ageryt.
be deemed revoked. Date:01/26/2016
APPLICANT CERTIFICATION CONSTRUCTION L.N..G AGE
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction nding 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 issued ec. 7,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
consequence of the granting of this permit. Additionally,the applicant ARCHITECT'S DECLARATION
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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinclCaD-cupertino.org M I S
CUPERT[NO 0r � ZQ Z6 ,� f 2
PLUMBING OMECHANICAL [:]ELECTRICAL ❑MISCELLANEOUS l
PROJECT ADDRESS a I APN# , �: - - !�
OWNER NAMEL(/ PHONE E-MAIL I
41170 . rr—
STREET ADDRESSFAX
a CGS nJ &- e�+ SSG i
CONTACT NAME PHONE E-MAIL
w r I GA7
STREET ADDRESS ` CI STATE ZIP AX
❑OWNER ❑ OWNER—BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CON CTO NAME AU,41 LICEN E MBER LICENS TYPE BU LIC#
COMPA NA / E- FAX
7 C ( C✓.� / /� / c
STREET MS5L CI STATI,ZIP PHONE
o r e 2 �tAG
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
r
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
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK �
r e Cid ^
1 n '
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the p owner'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
ordinances and state laws relating to building construction. I authorize re resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMEN ORMATION REQUIRED ori'E usE olvLY : ,
W ERThE-COUNTER`
❑ EXPRESS.
V
STANDARD
LARGE
R,
MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10785 CARVER DR DATE: 01/26/2016 REVIEWED BY: MELISSA
APN: 375 35 016 BP#: B-2016-1264 VALUATION: $2,500
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARYSFD or Duplex PENTAMATION PRWHEAT
USE: PERMIT TYPE:
WORK REPLACE E WATER HEATER SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $29
TOTALS: $29.00111.1
Aiech I'l-a p(,'heck Plumb.Plan Check 0.0 hrs $0.00 V`,e,. Plan Cliec
FCC" Plumb.Permit Fee: IPPERMIT Elec.per";1if Fee:
Other Plumb Insp. 0.0 hrs $48.00 C111cie'. t,„°1.
f.it`C. h7sp. Fee:
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 preliminar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/131 FEE QTY/FEE7 MISC ITEMS
I Pin (.."I'leck 1:7ee,
&tqt pL PC.1 7Ole
PME Plan Check: $0.00
1'3€'rinit.l"ee"
Supl.)/. Ins”)l-e(t
PME Unit Fee: $29.00
PNM Permit Fee: $48.00
-T(`tl�f:�i`3°uction :l ifx:
Administrative Fee: 1ADMIN $45.00
Work Without Permit? 0 Yes =:•:.- No $0.00
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS $171.50 $0.00 TOTAL" FEE: $171.50
Revised: 01/01/2016
SMOKE f CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
&u
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
A 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255
CUPEPtTINQ
(408)777-3228- FAX (408) 777-3333- buildingQcuperflno.orq
&mum
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL TELLS CERTIFICATE
WkS:RE EN MNjj ',L)ANS,HL'TjjTjhLRD TO T HE B
UJILUING 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 Pe,
Within each sleeping room X
Carbon Monoxide alarms are not required h-i 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 acturer's instructions and in compliance with the California Building
and Calif onua Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
I have read and a Ur e to Com.l with the tiairm.ws,and conditions of this statement
W
0. ........./.A.04�4 .......... ....................................................
.... ........... ........... .. ....
/-"(GA Sigggwre:.... . .......... ..... ............ .......................... .................... Dat
Smoke and CO for revised 031118114,
WATER-CONSERVING PLUMBING FIXTURES -r,,�M
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERT MO 10300 TORRE AVENUE o CUPERTINO,CA 95014-3255
(408)777-3228 o FAX(408)777-3333 a building(a�cupertino.org
Owner Name eAC Clrs ,, ¢ o�� Sly , syr Permit NoA Gt
Address AA _e4 G/Al
1. Is your real property a registered historical site?
�❑ YY Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
l!�e 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 110 1.1 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.
LJ'No Go to Question 3.
3. Is water service permanently disconnected for your building?
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
LFAIN
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
L�f 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 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).
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 page.
9 g r....
Owner or Owner Agent's s Si nature:i�.- Da — 7
Upon completing and signing this Certificate,p ase re n it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15