B-2016-1286CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1286
22406 SALEM AVE CUPERTINO, CA 95014-0958 (326 15 018)
(BATH FITTER
NORTHERN
CALIFORNIA)
SACRAMENTO, CA
95834
OWNER'S NAME: WEST DENNIS LAND BARBARA
DATE ISSUED: 02/01/2016
OWNER'S PHONE: 408-981-0801
PHONE NO: 408-834-1111
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CC36 Lic. #988525
Contractor (BATH FITTER NORTHERN CALIFORNIA) Date 02/01/2016
X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL COMMERCIAL
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 R VALVE IN MASTER BATH SHOWER
I hereby affirm oder penalty of perjury one of the following two declarations:
1. I e and will maintain a certificate of consent to self-insure for Worker's
mpensation, as provided for by Section 3700 of the Labor Code, for the
f
erformance of the work for which this permit is issued.
21I 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: $1000.00
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
Number:
Occupancy Type:
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
326
326 15 018
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 regulatio per the Cupe ' o Municipal
180 DAYS FROM LAS ED INSPECTION.
Code, Section 9.1 .
Issued by: MELISSA
Signature Date 02/01/2016
Date: 02/01/2016
O -BUILDER DECLAR
RE-ROOFS:
I heeby 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: 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
2. 1 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
a. 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 an
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Sec ' s 25505, 25533 255
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
E
Owner or authorized agent: o �
be deemed revoked.
Date: 02/01/2016
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONINSTZCTION
I hereby affirm that there'da a construction lending ,y for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this p rmit is issued (Sec. 309' iv 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
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building&cupertino.org
RIPLUMBING ❑ MECHANICAL ❑ ELECTRICAL
MEP
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❑ MISCELLANEOUS
PROJECT APDRESSk
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CQN2; P,CTORA A
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CITY, STATE, ZIP .
PH
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF J9 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
M5 k3O TAI
-
TOTAL VALUATION: .
RECEIVED B
By my signature below, I certify;to each of the following: I am the property owner or authorized agent to act on t property owner's alf. I liav t is
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agre com all applicable local
ordinances and state laws relating to buil' a con ction. u orize r resentatives of Cupertino to enter the above -identifies property for inspection purposes.
SignatureofApplicant/Agent:
Date: �C ^�/ -0
UPPLEMENTAL eION REQUIRED
FFcEwsE;oNLx '
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OVER THE -COUNTER "
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MEPMiscApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ikADDRESS: 22406 SALEM AVE —7DATE:
02/01/2016
REVIEWED BY: MELISSA
a APN: 326 15 018
BP4:
I
'VALUATION: j$1,000 I
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD Duplex or
USE:. -T
PENTAMATION
PERMIT TYPE: 1 RPFI X
WORK
INSTALL (N) VALVE IN MASTER BATH SHOWER
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture or Trap 1BPFIXTURE 1 # $10
A
TOTALS: $10.00
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 Dreliminary information available and tire only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 LfL7/1113)
Plumb. Plan Check 1 0.0 1 hrs $0.00
QTY/FEE
MISC ITEMS
Plumb. Permit Fee: IPPERMIT
A
Other Plumb Insp. L2.0 J hrs� $48.00
PME Plan Check:
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 Dreliminary information available and tire only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 LfL7/1113)
FEE
QTY/FEE
MISC ITEMS
A
PME Plan Check:
$0.00
h?svf"ee
.1 r
I
PMAE Unit Fee:
$10.00
PME Permit Fee:
$48.00
Administrative Fee: JADAIIIN
$45.00
Work Without Permit? 0 Yes (E) No
$0.00
ees:
Travel Documentation Fee: I TRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS-:
$152.50
$0.00 TOTAL FEE:
$152.501
Revised: 01/01/2016
PURPOSE
SMOKE I CARBON MONOXIDE ALARMS
0� R CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDINGDIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(a.cupertino.ora
. -AMAIN 2 C) i� —1'2O
PVR-VfIT 'CANN'OT RR r' INALEI) AND COMPLETED UNTIL THIS CI' RT IF C, T
.Cl.ti ;�i,. t. A4`V" '� { T ":IIB.iDING
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.
GEN, ERAL 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 u1 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 u1 dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combuZed 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, alarms) 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 cra'wl'
space. Refer to CRC Section R-314 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) referencedabove has/have been
installed in accordance with the manufacturer: `s instructions and in, compliance pliance with the California Building
and Calif nwda Residential Codes. The alarms -have been tested}f ,d are operational, as of the date sin- edl
below.,
f ha.va read a:mt agrea to comfWV i4.rFhr Ther ier, s andf con,dtcans of th is, staYempnt
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Smoke cutd.' CO' for77?t do.c remised' 03%1i8/1.�4j
Owner
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUN#TY DEVELOPMENT DEPARTMENT B11ILgjNG DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
-3228 FAX (4= 777-3333 • buildingCa)-cuperfino.org
I Permit No,
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.
<6 -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 plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
1 o 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.
I/LLN0 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:
❑ 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).
❑ lvlyproperty 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
plumbingfixtures 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 followini? page. 11_� }
Owner or Owner Agent's.
Upon completing and signing this Ceftrficate, please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08126/75