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B-2016-1367 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS CONTRACTOR: PERMIT NO:B-2016-1367 11583 UPLAND WAY CUPERTINO,CA 95014-5105(366 03 065) (A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC) MEMPHIS,TN 38120 OWNER'S NAME: SHU DAREN AND LEE-YING TRUSTEE DATE ISSUED:02/16/2016 OWNER'S PHONE:408-515-0567 PHONE NO:408-982-0405 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C36 Lic.#765155 Contractor(A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA X BLDG —ELECT X PLUMB 1.NG1 Date 2/16116 _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 JOB DESCRIPTION: license is in full force and effect. Installation of building clean out. I hereby affirm under penalty of perjury one of the following two declarations: r. 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 ,44 performance of the work for which this permit is issued. F / 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 Sq.Ft Floor Area: Valuation:$2400.00 this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct.I agree to comply with all city and county 366 03 065 ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep PERMIT EXPIRES IF WORK IS NOT STARTED harmless the City of Cupertino against liabilities,judgments,costs,and 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 180 DAYS FROM LAS_ T CALLED INSPECTION. comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by:d�21 Date:2/16/16 Signature / Date 2/16/16 RE-ROOFS: OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of the installed without first obtaining an inspection,I agree to remove all new materials for following two reasons: inspection. 1. I,as owner of the property;or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered Signature of Applicant: for sale(Sec.7044,Business&Professions Code) Date:2/16/16 2. 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this.permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will 2. I have and will maintain Worker's Compensation Insurance,as provided for maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the by Section,3700 of the Labor Code,for the performance of the work for which Health&Safety Code,Section 25532(a)should I store or handle hazardous this permit is issued. material. Additionally,should I use equipment or devices which emit hazardous 3. 1 certify that in the performance of the work for which this permit is issued,I 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 the Health&Safety Code,Sections 25505,25533,and 25534. Worker's Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the/ " Owner Labor Code,I must forthwith comply with such provisions or this permit shall.- 1 authorized agent: Date:211 ti/16 be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance I certify that I have read this application and state that the above information is of work's for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws Lender's Name relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION I understand my plans shall be used as public records. consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333-building(�cupertino.org CUPERTINO , misc z�)1 ,lea 7 IS PLUMBING ❑MECHANICAL [:]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# 3 OWNER NAME g ey� �^ t�•Rit V' PH �+ �J E-MAIL STREETADDRESSd� � B ® B CITY, STATE,ZIPA q„ +� FAX CONTACT'NAME 1 PHONE I E-MAIL,( STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OwNER-BUIIAER ❑ OWNER AGE,,T 171CONTRACToR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPERS ❑ TENANT CONTRACTOR NAME LICENSE NUMBERFLO;& ICENSE TYPE BUS.LIC 4S el G5'I SS CL(2 4 Z COMPANY NAME f,�C^s- � E-MAIL � fre 5 c ­�` �'1 FAX STREET ADDRESS CITY,STATE;ZIP E ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF -D or DUPLEX ElElElMULTI-FAMILY PROJECT IN WILDLAND YES PROJECT IN YES IS THE BLDG AN ❑ITS BUH iJING: t]COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZOAIE NO EICHLER HOME? NO DESCRIPTION OF WORK a b TOTAL VALUATION: RECEIVID DY _ti By my signature below,I certify to each of the following: 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 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 rel ti to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent t7 Date: _./ SUPPLEMENTAL INFORMATION REQUIRED OFFICE'USE OIv� "v �r j ❑ MAJOR � s R7EPMisc4pp_2011.doe revised 06121111 r a 5S+#tt7.1t 20863 STEVENS CREEK BOULEVARD,SUITE 100 CUPERTINO,CALIFORNIA 95014-2154 PHONE(408)253-7071 FAX(408)253-5173 4 www.cuportinosanitarydistriet.org `rzrsxEB 4Di ' Receipt of Fees Receipt#: 5569 Recieved From: Rescue Rooter 2/16/2016 9:42:OOAM Address: Phone: 408-982-0405 Check/Property Information Check No. 8128007385 ABA# Bank: Bank ofAmerica Amount: Two Hundred,Fifty Dollars&00/100xxx Permit Over the Counter APN# 366-03-065 Tract No: Lot No: Property: 11583 UPLAND WAY,Cupertino,CA 95014 Bldng/Apt RECEIVED FOR PURPOSE OF: Connection Fees: Zone: Reimbursement Agreement Acreage: Cost/AC: Account Number Amount: (410.10) 0.00 Front Footage: Cost/Foot: g y (415.10) Add.Dwelling: Cost/Ea: (420.10) 0.00 Add.Commllnd/Gal Cost/Gal: m_e i (425.10) { 0.00 Special Benefit Zone: j j 0.00 t 9 Plan Check/inspection Fee: r (430.10) i 250.00 Inspection Fee-Replace existing P/L C/O i Additional Fee 1: s 0.00 i Comment/Additional Fee i i 0.00 i District Staff / Total: I 250.00 fmartinezyl { All fees are non-refundable,unless an installers'agreement is required and executed for the development project. Page:1 SMOKE 0,CAR130'N MONOXIDE ALARMS WN' R CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION CUPERT INO 10300 TORRE AVENUE,CUPERTINO,CA 95014-3255 (408)777-.3228.FAX(408)777-3333• building(a.cupertino.ong WLAOp 6) . kir nuke. CarbolrQnoYce: 2. PERlVffT CANNOT BE FINALE D ANIS COMPLETED UNTIL THIS CERTIFICATE t :L,ELUKMAl!E� 7.4���N���� [DN 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 $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On every level of a dwelling unit including basements X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply:In dwelling units with no commercial power supply,alarm(s)may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for alar ns which must be connected to the building.wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building, and Califonua Residential Codes.The alarms have been tested and are operational,as of the date signed below. t have read_and,agree,to,com,ply with;the terms anal conditions of this statement Qyi renCla �F$tl i natJre., ... .......... ... . .... :..... �t ............... ' Conifa�for�Nam er A nE r A05 ... A _ � �31f� Smoke and COfiw,ni..d6c rrevise'03,08114 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COA1liUil.NiTY D.EVELO W:i lDEPARTMEW+:BUILDIN t©1`ViS:iON �ll 1� 6tt l N tp 10300 TO RR E AVENUE—G RER. .0,CA 95014-325;5 (408)777-3228'-,FAX{403)777-3333 a building guaertir obib Owner Nam Vhwv-4 Std Permit No, -Z(bEF0- ►3(�` Address 11583 WAY CVPEF--nt4o,C,R c(5ojL1 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. 0 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? ❑ Yes Civil Code Sections 110 1.1 through.110 1.8 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 I, 1994? No My real property is built and avallable for use or occupancy after January 1, 1984. Civil Code S ections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. es My real property is built and available for use or occupancy on or before January1, 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 fa-Inily residential real property. See Civil Code Section,1101.4. On and after January. 1, 2014,building alterations or improvements shall require all non-compliant plumbingfixtures 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 futures (regardless of whether property undergoes alterations or improvements). ❑ My propertyis a mafltifain ly residential real propye Civil Code Section I10i1.5. u ert . Se On and after January 1,2014,specified buildings 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 fxtare&shall tie replaced with water- conserving:phiimbing fixtures throughout the bundling(regardless of whetherproperly=dergoes alterations or improvements). ❑ My property is a commercial real.property. See Civil Code Section 1104.5. On and atter 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, 20119, all non-compliant plumbing, fixtures shall be replaced with water- conserving. plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvemeuts)i. I,as,the owner or owner's agent.of this property,certify under penalty of perjurythat non comp p g fixtures wish be leant lumbin replaced prior to datespecified above with water.-conserving plumbing fixtures in:accordance with Crvi1 Code Sections 1101.1 through 1 LO%1.8,the. current California Plumbing Code andC'altforna Green.Building.Standards Code,and.manufacturer's installations requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table-on the followin .page. Owner or.Own;erAgen.ft,Signature �:� Date, ���ZOfo Upon completing and signing this"Celitifizate,please return it to the Building Divisions in order to final:your building.permit. SB-4,07 2015.doc revised 08/26115