B-2016-1289 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1289
10924 BARRANCA DR CUPERTINO,CA 95014-0102(326 02 002) (COMET PLUMBING
AND SEWER COMPANY
SUNNYVALE,CA 94088
OWNER'S NAME: LUCAS BRIAN ET AL DATE ISSUED:02/01/2016
OWNER'S PHONE:408-735-0367 PHONE NO:408-502-0432
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#951887
Contractor(COMET PLUMBING AND SEWER COMPANY)Date 02/01/2016 X BLDG —ELECT X PLUMB
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:
INSTALL(N)'PROPERTY LINE CLEANOUT
Ieby 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
a;-fperformance of the work for which this permit is issued.
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 SANITARY
this permit is issued. Sq.Ft Floor Area: Valuation:$3500.00
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 APN Number: Occupancy Type:
ordinances and state laws relating to building construction,and hereby 326 02 002
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 DANSPECTION.
Code,Section 9.1 .
I Issued by:M=
Signatur �'/'I c?-�i� Date 02/01/2016 Date:02/01/2016
V
OWNER-BUILDER DECLARATION 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 fust 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:02/01/2016
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
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
z. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. 1 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
3. 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 Cod 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 agen
be deemed revoked. Date:02/01/2016
APPLICANT CERTIFICATION CONSTRUCTION LENDING 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
Signature Date 02/01/2016 Professional
GENERAL PERMIT APPLICATION
MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228! FAX(408)777-3333•build ing(a)-cupertino.org misc
CUPERTINO
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN#
l 2 4 A P,_At-j. c,^ -o44
OWNER NAME 3 c PHONE a E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
l o � /1cgk)Ua (OR CV_2�� Gam}
CONTACT NAME PHONE E-MAIL
AN" /,,&(.j �he®�,s S - 50 Z— 2192
STREET ADDRESS CITY,STATE,ZIP FFA�j
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT VCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME .�l ipl e.-o LICENSE NUMBER F77SETYPEC_3( BUS.LIC�
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONjt
ARCHITECT/ENGINEER 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 =FLOOD
❑ YES IS THE BLDG AN El YES
BUILDING: El COMMERCIAL URBAN INTERFACE AREA ❑ NO ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
-1 o
TOTAL VALUATION: �S-�CJ D
By my signature below,I certify to er of following: I am the property owner or authorized agent to act on the e s ehalf. I have read this
application and the information I ha roviddd is correct. I have read the Description of Work and verify it is ace e. I agree to comply with all applicable local
ordinances and state laws relating t it ing Lonstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: t 2
LEMENTAL INFORMATION REQUIRED oICE ilsE oxLY
'OVERTHE-COUNTER-
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MEPMiscApp_201 Ldoc revised 06121/11
CITY OF CUPERTINO
11 FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10924 Barranca Dr DATE: 02/01/2016 REVIEWED BY: MELISSA
APN: 326 02 002 BP#: *VALUATION: $3,500 1 zzh
°PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du lex PENTAMATION 1 RPSS
USE: p PERMIT TYPE: A
WORK INSTALL N PROPERTY LINE CLEANOUT
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWE.R 1 # $25
TOTALS: $25.00
>,; /::••- Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: 1PPERMIT
C1rr:;;; •r. r'r. t�: ,. Other Plumb Insp. 0.0 hrs
z
I?hinib.;i'Z,S;1: .x`cc'. ]',>£'::.;d,,ti'J•: t-';'£':
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District, etc). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'l info.
FEE ITEMS (Fee Resolution.1.1-053 F,fl: 7/11131 FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $25.00
PME Permit Fee: $48.00
Administrative Fee: ]ADMIN $45.00
Work Without Permit? 0 Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldc Stds Commission Fee: IBCBSC $1.00
SUBTOTAL S: $167.50 $0.00 TOTAL FEE:, $167.50
Revised: 01/01/2016
E LA,
SMOKE, I CARBON MONOXID A _'RMS
OWRE R CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333-building(ftupertino.om
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PERN11T CAI%1NOT ME FTPS ALtib AND COMPLEETM UNTIL THIS CERTIFICATE
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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:AILARM
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 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 420k 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,dwell.mg,units, alarms are permitted to be solely battery operated where repairs or alterations do,
not result in,the removal,of wall, and ceilingf'mishes,or, there is no access by means of attic,basement,
1 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-referertced property,I hereby certify that the alarm(s)referenced above has/havebeen,
installed iin, accordance with the manufacturer's mistruic tions,and ina compliance with the California,Buillding,
andl Califflo nmiia Resi-dent-al Codes.The alarms have been testeda nd are operational,as,of the datesigned
b-e-111ow
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Sino'ke,and,C0jjbirm.,.db.c revised.,'0311,?&1145
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMEWDEPARTMENT-BUILDING DIVISION
C`UPERT'INO 10300 TORRE,AVENUE*CUPE'aRTINO,CA 98014-325
1408)777-3228.FAX(408)777-3333•building(a)cuoertino.or_Q
Owner Name Permit N o
Address ! 2 jaip_ wt, 4 C yF_Z-T(Q)r
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 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.
El 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?
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 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.
I ,ElCivil 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. PI ase check ONE of the following:
MY property Y is a single-family residential real property.3• 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 pluinbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements):
❑ Myproperty 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.
Owner or Owner-Agent's Signature-.` 4 Da i
Upon completing and signing this Certificate,please return it to the Building Division in order to final:your building permit.
SB407 2015.doc revised 08126115