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B-2016-1411 CITY OF CUPERTINO BUILDING PERMIT BUIhDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-1411 10481 JOHNSON AVE CUPERTINO,CA 95014-3862(375 17 047) (DRAIN GO PLUMBING SUNNYVALE,CA 94089 OWNER'S NAME: KUSHNERANNEDORE DATE ISSUED:02/22/2016 OWNER'S PHONE:650-704-6220 PHONE N0:408-892-5192 r rrFNSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: j License Class CC-36 Lic.#982301 X_BLDG —ELECT X PLUMB Contractor(DRAIN GO PLUMBING)Date 02/22/2016 MECH X RESIDENTIAL_COMMERCIAL i — — 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 PROPERTY LINE CLEAN OUT-*SUNNYVALE SANITARY I hereby'affirm under penalty of perjury one of the following two declarations: DISTRICT r. 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 performance of the work for which this permit is issued. 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:$1000.00 APPLICANTCATION 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 375 17 047 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 harmless the City of Cupertino against liabilities,judgments,costs,and PERMIT EXPIRES IFWORK 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 FROM LAST CALLED INSPECTION. Code,Section 9.18. Issued by:ABBY AYENDE Signature Date 02/22/2016 Date:02/22/2016 i_ OWNER-BUILDER DECLARATION RF-ROOFS: 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 stalled without first obtaining an inspection,I agree to remove all new materials for following two reasons: inspection. i. 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 for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date:02/22/2016 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: 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. material. Additionally,should I use equipment or devices which emit hazardous s., I 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 Worker's Compensation laws of California. If,after making this certificate of the Health&Safety.Code,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 agent' be deemed revoked. Date:02/22/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 say indemnify and keep harmless the City of Cupertino against liabilities, judgrrlents,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 02/22/2016 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10481 JOHNSON AVE DATE: 02/2212016 REVIEWED BY: ABBY APN: 37517047 BP#: 'VALUATION: j$1,000 rPERMIT TYPE: Plumbing PermitAN j'PLCHECK TYPE: Alteration /Addition / Repair TION PRIMARY PENTAMA 1 RPSS USE: SFD or Duplex PERMIT TYPE: WORK - SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $25 i $25.00 TOTALS: :.. 777 Plumb.:PlaTnCheck 0.0 hrs $0.00 r`-E �,- _ '_ E.ec mb,Permit Fee: 1PPERMIT Via. . , Other Plumb Insp. 0.0 hrs $48.00 o, . S ",:;�E I E.F i.�r.`e`: t�E➢s ri.IfL)Ci,s`i'x;. � ..f. [VOTE. 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 preliminary information available and are only an estimate. Contact the De t far addn'l info. FEE ITEMS 61 ee Resolution.11 ; 7, -053 E 7!13 FEE QTY/FEE MISC ITEMS 1x' PME Plan Check: $0.00 >> l< d <�f�}r1l Pee; PME Unit Fee: $25.00 PME Permit Fee: $48.00 t:r)11tE,t .r.r3 f.ttt. Administrative Fee: IADMz1V $45.00 Work Without Permit? 0 Yes (F) No $0,00 Travel Documentation Fee: ITRAVDOC $48.00 Stroaation Fee: IBSEISMICR $0.50 Select an Administrative Item Eldj Stds Commission Fee: IBCBSC $1.00 SUBT©YACs: $167.50 $0.00 . TOTA>E,FEE: $167.50 Revised: 01/01/2016 GENERAL PERMIT ,4PRL(GAT(Otd MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333•building (5)cupertino.org misc CUPERTIN4 /PLUMBING []MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS ®y ®��4� APN# i PHONTE a ® -AMAIL. OWNERNAME ylY®Qi` - .� . STREET ADDRESS CITY,STATE,ZIP �1 `���p5 I FAX -. CONTACT NAME PH AEE-MAIL Gam ,' "�� a$- j STREET ADDRESS CITY,STATE,ZIP FAX 1 7V ,� , � , yds ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBE r p LICENSE TYPE BUS.LIC n Fry.- COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STAT,ZIP PHONE ARCHITECT/ENGINEERNRME LICENSE NUMBER (' BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF 2�SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES 15 THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FI:OOD ZONE ❑NO EICHLERHOME?. - El NO DESCRIPTION OF WORK r f 77777777777, l IJV RECEIVED TOTAL VALUATION: �� �- BY` By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owners b half I have read this application and the infonnation 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 relating to building construction. I authorize representatives of Cupertino to enter the abovedentified property for inspection purposes.. Signature of Applicant/Agent: Date: ,Gds SUPPLEME FORMATION REQUIRED ai rzc us7777777777777 E oivr t%zI co„i7n�I x, 5 �t F” Y .5 s � D MAJOR -AIEPMiscApp_201 Ldoc revised 06/21/11 0 A E ERTIFICATEOF COMPLIANCE WN R CE COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION F511 CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333 v buildlnq(a�cupertino.orq 2 o) OE L.( PFR-MITCkN.NOTB!Fr'INA�l,r',IDANS-COMPLFTEDUNT)tTTIHSC1CPTIFtCATE .,U ATOTRY ,P!,N 1$1 N 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. GVEN,ERAL IN FORMATION Existing single-family and multi-family dw0lings 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: AX-tA SMOR V,ALARM CO A,t AR M Outside of,each separate sleeping area in the immediate vicinity of the X X bedroom(s) Onevery level,of dwelling unit including basements X X Within each 91 eeping,room rX Carbon,Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and donot Dave anattached garage. Carbon monoxide alarms com�,,bimiiedwith smoke alarms shall comply wit-irt, CBC Section 4-20f.6-,and shall,,,be approved,by the Office,of the State Fire Marshal!. Power-Sup :Indwelling:units wifl-L,no conmercial power sup battery ply,alimmm,(s), nay, y be solely ba i' ery operate L In existing dwell btig, alarms are permitted to be solely battery operated where repairs,or alterations, d 0 not result the removal of wall,and ceiling finishes or there is.no access1by mneairts of attic,basement or crawl. space.Defer to CTICS'ection R3114 and CBC Sections%7.2.11.4-and,4291.62.An electrical permit Uit is required fox a-T,,aTins,wlrt-ich,,m,,rzs,t'b,e,colillin_-ect,'ed,,tathe b---Uzldiitgwiring. 'As,uwner o4thite ab-ov-e--refereiicedp.ro,,pe-rty,lhereby above has/haveb-eel.11, immstalTedt in,auzrdamvewiffi the manufacturer's instructions anidlin,e&mmp)Run-,'ce an,,dC'airiT,onrLiaRzesid',en,f ail Coes.The alarms hia�vebeeintestedamd!almoperafioxak as,olf they date sjg�jedj jD .0ithei fkiw s,and!un,&W.6 njs.off thi§, I t 'mir n, al"IR-Oire.................... ...... . . ....................................... II .................................Day............. .................... Smoke and7CO)fbmt dbe revise&0311211:41 ` T�, € LUUMNG FIXTURES EMR ' CER .ATE COMPU C. 'I MMUf W1 , DEIELO' U--,,W BEPARTl18 NT*BUILDING DIVISION CIJp° 4 $I;P� 1030)), TORRE.AVENUE-M RTIN0,CA 95014-3255 1(4:08)77,Z 3228•.FAXMR-, 777-3333 c buildiggawpertino oTg Owner NV S;1+N E <. 1'errnit NA, zot L Address It l oq l ?®hh 5o,4 Ave, _ —H o r I. Is your real properly a registered historical site? ❑ Yes Civil Cade Sections 1101.1 through 1101:8 do not apply. Skip the rest sof 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 ofwater-conserving pluri�bing 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. 13-1 No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do riot 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. Civil Code Sections 1101.1 through 110'1.8 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.110l..8 apply. Check one of the three following statements and sign bottom-of form.. 5. Please cheek 010E of the following: ' lvlypropertyis as rrg.Fe faririkresidentlal real p7©perty. See Civil Code Section 1101.4. On and after January 1, 2014,,building alterations or irnprovements shall require all non=compliant plumbing:fixtures to be replaced with.water-conserving plumbing,fixtures throughout the building.Ont of before January 1,2017,all non- compliant plumbing fixtures shall be replaced withwater-conserving pluinbnrig fixtures (regardless of whether property undergoes alterations or.irnprovermnts} Mypropertyis a.rr tiltifamtFy reside7itial real proei-ty, See Civil Code Section 11,01.5. On and after January 1,20'14,specified bttizlding at>erafro rs or immzovernents skull require non-compliant plumbing fixtures to,he replace-d with wafer consoiving plumbing:fixtures. On or before January 1,.M, alt`non-compliantplumhirig.fixtures shalt be replaced with:water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alteration's or improvements).- ❑ My property is a commercial rent property. See:Civil.Code Section 1101.5. 0'in and after January 1,20.14,specified building,alteraniorns or improvements shall,require non-compliant purnbimg fixtures to be replaced'.with wafer conserving pluinbirng fixtures. Om or before.January 1, 2916„ all non compliant plumbing fixtures shall be replaced with water--conservin+g plurnbirrg fixtures Qxougfiont the bu'ildhng(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-com,pliant plumbing fixtures willbe replacedprior to�date speciFf e'd above:with water-conserving plumbing fixtures in accordance withx Civit Code Sections 1101.1 through k 10t1?.S,the current Cahfomia Plumbing Code and;California Green Building Standark&Code,and;manufacturer's: installation requirements,.and thatthe.water-conserving plumbing fixtures comply with the requirements asindicated is the table on time following.page, , Owner or,ON m rl'9 t t?s Si nature d 2-414 Ugoa comp'etiiig^and signing,this Centikficate,please retami it toy the Building Dyvision,in,order to'final:your building;permrf. SS40.7 2015.doc nevi=sec&0812,6115