B-2016-1348 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:`B-2016-1348 ,
7503 KINGSBURY CT .CUPERTINO,CA 95014-5043(362 29 025) (BAYHILL HEAT&
AIR)
SAN MATEO,CA 94402-
1835
OWNER'S NAME: MENEZES EUSEBIO F AND EUNICE TRUSTEE DATE ISSUED:02/11/2016
OWNER'S PHONE:4089961472 PHONE NO:6502127600
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC-20 Lic.# 19 7996
Contractor(BAYHILL HEAT&AIR 1 Date 2/11/2016 X BLDG —ELECT —PLUMB
X 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:
REMOVE(E)A/C UNIT AND REPLACE WITH(N)2 TON A/C UNIT,
I hereby affirm under penalty of perjury one of the following two declarations: SAME LOCATION;REMOVE(E)AND REPLACE WITH(N)FORCED
1. 1 have and will maintain a certificate of consent to self-insure for Worker's AIR FURNACE,SAME LOCATION
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
x! I have and will maintain Worker's Compensation Insurance,as provided for
by Section 3700 of the Labor Code,for the performanceof the work for which
this permit is issued. Sq.Ft Floor Area: Valuation:$8000.00
APPLICANT CERTIFICATION
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 6229 025
Number: Occupancy Type:
362
ordinances and state laws relating to building construction,and hereby 3
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 witky all/hon-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.
.:Code,Se on 9.18.
Issued by:PAUL O'SULLIVAN
Signatur Date 2/11/2016 Date:2/11/2016 �Jl �
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 first obtaining an inspection,I agree to remove all new materials for
1. 1,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(Sce.7044,Business&Professions Cade) Signature of Applicant:
2. I,as owner of the property,am exclusively contracting with licensed Date:2/11/2016
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. 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.
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 ay Area Air Quality Management District I
will maintain compliance wiyhjtoltino Municipal Code,Chapter 9.12 and
Worker's Compensation laws of California. If,after making this certificate of the Health&Safetions 25505 ,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:2/11/2016
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 ARCHITECT'S DECLARATION
consequence of the granting of this permit. Additionally,the applicant I understand my plans shall be used as public records.
understands and will comply with all non-point source regulations per the
Cupertino Municipal Code,Section 9.18.
Licensed
Professional
Signature Date 2111/2016
GENERAL PERMIT APPLICATION Dn ( - - MEP
ELI] COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingP-cupertino.orq misc
CUPERTIN€3
❑PLUMBING MECHANICAL [:]ELECTRICAL y(/� (�L❑MISCELLANEOUS
PROJECT ADDRESS-I.T Ii.�iy cao APN#36A DC I 001)5
OWNERNAME U)b) E7N QVZ 0 fpf( EMAILEEVIv (/�iCi(flUO!
STREET ADDRESS n CI& � _6 G"ry/7 CIS1%I FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE„ZIP FAX
❑.OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR KCONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME IL x n LICE E LICENSEE BUS.LIC
C MPANYN??AME ! ' E-MAIL r: FAX
iPO W1 LL 1rd. MG1Ua 6) 1 hey fi r. e 5o 2/2- 7vo
STREET ADDRESSITY,STATE,ZIP PHONE
1 S00-11t cL�� M o r cT" §F P A XID , c/-)-
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OFSFygD or DUPLEX ❑. MULTI-FAMILY PROJECT INWtLAND [3 YES PROJECT IN ❑YES IS THE BLDG AN El YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE ❑NO EICHLER HOME? I5QNO
DESCRIPTION OF WORK
U-PtIRCI C-) F>03114b A/G AN b. RY-NA& OMT
FUP-N f-L6- = q-s',00i)
l� = 2� sV OtJ I--.
TOTAL VALUATION: Y[( Ta RECEIVED BY
By my signature below,I certify'o each f the f wings I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have oxide collect. I have read th cscription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ildin ti . la ho ' e e r iv of Cupertino to enter the a/ v I e eIV
pffo spection purposes.
Signature ofApplcant/Agent: Date: // 1±
SUPPLEMENTAL INFORMATION REQUIRED 1 oFzc 'usE ons ,
R=THE�AUN7r
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tem ' i
❑sI�9RGE` �� �,, z
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7503 KINGSBURY GT DATE: 02/11/2016 REVIEWED BY: PAUL
APN: 362 29 025 BP#: `VALUATION: 1$8,000
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
SFD or Duplex FURN/AG
USE: PERMIT TYPE:
WORK REMOVE E A/C UNIT AND REPLACE WITH N 2 TON A/C UNIT SAME LOCATION; REMOVE
SCOPE AND REPLACE FORCED AIR FURNACE, SAME LOCATION
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=1 OK cfm) 1BRE MAIR 1 # $72
Furnace, Forced-Air 1MFR=<100 1 # $143
TOTALS: $215.00
Mech.Plan Cheok 0.0 hrs $0.00 P" PA .{.
Mech,Permit Fee: IMPERMIT 1',.. " ,•#f 1. ;r3 I
Other Mech.Insp.' 0.0 hrs $48.00 £lane,-Ph F r,
ukcls t,T,.Pee. Pluuwb.r .•t.. Vis`£'; .� C ;.',':7,{F t:�C';
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the prelimina information available and are only-an estimate. Contact the De t or addn l info.
FEE ITEMS (Fee Resolution 11-053 Lf: 7 113) FEE QTY/FEE MISC ITEMS
IX iW9, 1 zrr
PME Plan Check: $0.00
leer nr ,
)IV fl,.Sp 'ee
PME Unit Fee: $215.00
PME Permit Fee: $48.00
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes (j) No $0.00
Travel Documentation Fee: ITRAVDOC $48.00'
Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
STBT3ALS $358.04 $0.00
TOTAL SEE: $358.04
Revised:
SM .K I'GARBGNMONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
FSI- COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION IL
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 /?
CUPERTINO (408)777-3228-FAX(408)777-3333.building(a-)cupertino.onq
7 3Q ^j fl--/ Cr do P,:5;z r/wo F-M�, �"--
dke.: 9,-
PERMIT CANNOT BF,FINALE-D ANI)CoMPLFTE:P UNTIL THIS CEIRTIFICATE,
AAS Dr-IFIN BlomMRT
T Arl L
I NIX-0 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.
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 in the following locations:
AREA SMOKE A1-ARM
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 X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
dc,not have anattached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 4207.6 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 &
not result in,,the removal of wall and ceiling,finishes or there is no access by means of attic,basement e ment.or, crawl
dra ,i
space..Refer tcp CRC Section R,314 and CBC Sections 907.2.11.4 and 42.0.6.2..An electrical permit is required for,
alanns 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
instaffiedin accordance with,the.mmanufactuxiez's instr uctions an-d in,compliance with,the California Build m tg-.
and Califunnilia,Residential,Codes.The alarms,have,been,tested a nd are operational, as,o=f the date sigTted:
blow.
1 hia.va read'and'
_E;Ef,�L&Wcam' lyw �'Ahqter imsa,,ndfcondi,ti.onsofithl,,sstatement
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Shzoke and'COfibmi,.dbc revised,,0311f8lP4i
'WATER-CONSERVINGPLUMBING IXTUR
OWNER CERTIFICATE OF COMPLIANCE �! L
COMMUNITY Y :BUfl.DING D1V151OP3
CUPERTINlA
10300 TORRE AVENUE CUPS iTINO,CA 950'14-3255
(408)777-3228,FAX 44087 777-3333 p buHdiUg@ggperUno ory
Owner Nam �vf t sr=iia �Ai Gc �?Eey S Permit No.& 01 i3 Ll-I?
Address 7503 k tM Gs uee'1 or r �1�pE iC%Ty/V D '9c a 1
1. Is your real property a registered historical site?
El 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?
El Yes Civil Code Sections 1101.1 through 11`01.8 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.
4 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.
Ml 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:
Cx� Myproperty 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-multifamilyresidential real propeity.. 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-compliantplumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).-
0: 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, 20.19, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements):.
1,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 110 .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 requirementsas indicated in the
table on the following page.
Owner or 0wnerAgenfi's.Signature ' i��cv�r�GT,o p�� DatA,; a—lZ,p.5 0
Upon completing and signing this Certificate,please return it to the Building Division in order to-final your building penni.t.
SB4072015.doc revised'08126115