B-2016-1255 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1255
1212 YORKSHIRE DR CUPERTINO,CA 95014-4918(362 10 017) (DIRECT HOME
REMODELING INC)
SAN JOSE,CA 95112
OWNER'S NAME: HIBBERT DAVID LAND GAYLA C DATE ISSUED:01/25/2016
OWNER'S PHONE: PHONE NO:855-388-6695
LICENSEDCONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#992696 X BLDG X ELECT —PLUMB
Contractor(DIRECT HOME REMODELING INC)Date 01/25/2016 —
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL-COMMERCIAL
—
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
MASTER BATH-REPLACE(E)FAN,ADD 1 (N)RECESSED LIGHT
I hereby affirm under penalty of perjury one of the following two declarations: AND INSTALL M TILE FLOOR
1. 1 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.
;MO 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 permit is issued. Sq.Ft Floor Area: Valuation:$4000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN
information is correct.I agree to comply with all city and county Number: Occupancy Type:
362
ordinances and state laws relating to building construction,and hereby 362 10 017
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 WORD 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 CALLED INSPECTION.
Code,Section 9.18 — --
Issu-
Signatur Date 01/25/2016 Date•01/25/20
O R-BUIR DECLARATION RF-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. 1,as owner of the property,am exclusively contracting with licensed Date:01/25/2016
contractors to construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALLROOF COVERINGS TO BE CLASS"A"OR BETTER
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 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. 1 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
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 505,25533,and 25534.
exemption,I become subject to the Worker's Compensation provisions of the I
Labor Code,I must forthwith comply with such provisions or this permit shall Owner or authorized agent
be deemed revoked. Date:01/25/2016
APPLICANT CERTIFICATION CO TR CTI N LEND AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency 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(Sec.3097,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 01/25/2016
CONSTRUCTION PERMIT APPLICATION
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CITY OF CUPERTINO
JAAPNFEE ESTIMATOR-BUILDING DIVISION
:
DDRESS: 1212 YORKSHIRE DR DATE: 01/25/2016 REVIEWED BY: MELISSA
362 10 017 BP#: VALUATION: 1$4,000
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 REAP1
USE: PERMIT TYPE: A
WORK MASTER BATH- REPLACE E FAN ADD 1 N RECESSED LIGHT AND INSTALL N TILE FLOOR
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixtures, Lighting 1BREMFIXT 1 # $72
Appliances 1ERESAPP 1 # $25
TOTALS: F77771:1 $97.00
I.,
i
" 't'e Elec. Check 0.0 hrs $0.00
•;`a<,h'1 errn�`Fee: t'i t}n:.i.]' r•nii]' a: Elec.Permit Fee: ]EPERMIT
Oily;r'1'hoi,b hs,,,,. Other Elea Insp. 0.0 1 hrs $48.00
he's).
NOTE: This estimate does not include fees due to other Departments(i.e.Planninb Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee.Resolution 1.1-053.F1 7/1/132 FEE QTY/FEE7 MISC ITEMS
PME Plan Check: $0.00
Permit PE:c::
P'�sP.1,"e
PME Unit Fee: $97.00
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes (E) No $0.00
Travel Documentation Fee: ITRA VDOC $48.00 A
Strong Motion Fee: IBSEISMICR $0.52 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $239.52 $0.00 TOTAL FEE: $239.52
Revised: 01/01/2016
SMOKE /CARBON MONOXIDE ALARM`
OWNERCERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPFERTINO 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228 e FAX(408)777-3333•buildin4(a.cupertino.orq
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PERMIT
HAS
RE I"INAIXI)AND COMPr�L.FTED UNT�r�YYysy�T`IHSS CERTIFICATE
.Cl t S LI E° iL"�1 ,,,.._. T� .,_��,,�.'l. 7M BU,A3,7i1,f�1";F U.i`11
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 X
Within each sleeping room J(
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bumirig 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 tliat the alarm(s)referenced above has/have been
installed in accordance with the m-anufacturer's instructions and u compliance with the California Build' ,
and Cal fo=ntia Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
t have,read_and_a,ree to,,corppjy cornwith the terrms and conditioyfs of l7is statement
Y1 .c nate� " ,, int.
Gontraefor Name: i
sjwwM ..,. L .... ....Date
Smoke a i i d C Gfib,nn1.6c rel iised'03/1!&/,]!4+
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNIT- Y DEVE'LOPh4EWT DEPAaTMENT BUILDING DIVISION
+CUPERTIN O 10300 TORRE AVENUE CUPE'RT]NO,Cry 95014-3255
(408)77.7-3228•FAX X408)777-3333 m building(a7cupertino org
Owner Name . L.A-, ,�—-o3— Permit Nod '
f3 /� 1
Address L 1.2
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.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of thero e
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?El p P rtS'or its
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.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
- El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
kr R1, 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.
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:
Myproperty is asingle family residential realroPertY� See Civil Code Section 1101.4.
P
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 fixture s e ply ith the requirementsasindicated in fhe
table on the following.pa e.
Owner or Owner Agent's Signature ; Date `
Upon completing and signing this Certificate,please return it to the Building Division in order to final your bui ding pjklit
SB40'7 2015.doc revised 08126115