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B-2016-1506 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1506 720 STENDHAL IN CUPERTINO,CA 95014-4659(375 40 027) (M B K T CORP) SAN JOSE,CA 95131 OWNER'S NAME: Michelle Skogle DATE ISSUED:03/11/2016 OWNER'S PHONE: PHONE NO:408-202-8812 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic.#B63274 Contractor(MB K T CORP)Date X BLDG X ELECT —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: ELECTRICAL SERVICE UPGRADE 200 AMP I hereby affirm under penalty of perjury one of the following two declarations: 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 performance 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 this permit is issued. Sq.Ft Floor Area: Valuation:$2800.00 APPLICANT CERTIFICATION 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 375 40 027 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 DAYS FROM LAST CALLED INSPECTION. Code,,Section 9.18. Issued by:Phuong Devries Signature Date l Date: 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(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date: 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 this permit is issued. Health&Safety Code,Section 25532(x)should I store or handle hazardous s. 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 s defined by the Bay Area Air Quality Management District I p g au contaminantsthecompliance with the Cupertino Municipal Code,Chapter 9.12 and will maintain compliance Worker's Compensation laws of California. If,after making this certificate ofHealth&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 be deemed revoked. Owner uthgfiz ed agent, Date:.� 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 Professional Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE"AVENUE•CUPERTINO,CA 95014-3255 mm- A CUPERT[NC7 S�c (408)777-3228• FAX(408)777-3333•buildingQ-cupertino.org I ElPLuj,4BING ❑MECHANICAL ECTRICAL Q MISCELLANEOUS PROJECT AD S— F- I p _ ; I APN it V !L4 4 2 ` OWNER N,AN� � � PHONE E-MAIL STREET AD SS CITY, STATE;ZIP FAX CONTACT NAME PHONE E-MAIL _ STREET ADDRES `a^ n CITY,STATE,ZIP FAX QL Vw�x VI ❑ OWNER ❑ Ow NER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ .ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N LICEN 7, LICENS TYPE BUS.LIC COMPANY N E , E- IL ' FAX STREET REZ L n �� CITYSTATE ZIP ts;om/ �� ONE ARCHITECT(ENGIlQEERN E LICENSE NUMBER C COMPANY NAME �� E-MAIL FAX STREET ADDRESS �— CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IA'WILDLAND El YES PROJECT IN El YES I IS THE BLDG AN El YES BL'H:DLNG: f-1COM1,1ERCIAL URBAN INTERFACE AREEAA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: 91100 a By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope ow er's ehal£ 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 ply with all applicable local ordinances and state laws relating to building cons ion. I authorize representatives of Cupertino to enter the above-/enti ed property for inspection purposes. Signature of Applicant/Agent: Date: C � SUPPLEMENTAL INFORMATION REQUIRED „ ., OFFICE IISE OnLI Jy z A[AJOR AIEPAlflscApp 2011.doc revised 06/21/11 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT-'BUILDING DIVISION /E4 CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildingP-cupertino.org �a,,, I (Permit o. ress ��Q LS/�A),0 /&, W, Mir tb QA)(ff_o_f Alarms Smoke—.) rCar ob n M&n_oxidF { PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE ;r HAS BEEN s ED AND RETURNED TO THE BUILDING DIVISION 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 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 alarms 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 California Residential Codes.The alarms have been tested and are operational,as of the date signed below. 1 have read and agree to comply with the terms and conditions of this statement Owner(orOw�gent ss)-Name: F (si na ure .. ....:........ ........r.. .............Date)... t .. (Con rac or _arise: ( i na ure).................................................................1,L"ic.#)..........._.................._.......(Date ................... Smoke and CO form.doc revised 03118114 19 omrzR ctR**icATE oF compuANce CW.MUMTy DEIEL REN DEPARTMENT-BUILD1NC'DiVISION CUPERTINO 1�?3tJ1 TORRE.AVERl1E-OtJsPERTI-NO CA95014-3255 �—� F l '(4.09)777-33228-•FAX(40�777-3333 o building, uoerbno org ' 1 OwnerNamal &i! fF4J---P vSJ<CG,C IE, PermitNo i �® � o Address Cal 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-conceiving 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 forth and sign bottom of form. ' 19 No Go to Question 3. 3. Is water service perirartently disconnected for your building? W(❑ Yes CivilCade 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, 199-4? No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 thrduglr 110.1.&do not apply. Skip the rest of the form and sign bottom of form. gg 19'Yes My real property is built and available for use or occupancy on or before January 1,.199'4. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of forth.. 5. PI ase check ONTE of the fallowing: " a Mr ; UPI&identidreaPfVSee Civil_Code Section 1101.4. On and,after January 1, 2014,building alterations or improvements shall require all nait-compliant&mibing,fixtures to be replaced with water=conserving plurtibmg fixtures throughout the building.Ori ar before January 1,2017,all non- compliant plumbing fixtures shall be replaced with water-conserving ptumbtrig fixtures (regardless of whether property-andergaes alterations or i rnprolvetrterits): ❑ Mv,y .plopertyis a.mt rettifamt y residential read property. See Civil Code S'eetiori.110+1.5 On and after January 1,.20-14,specified!btlYlding alterations or improve itents sha?,regjirenon compliant plumbing,fixtures to be rcplacediwith,wafer congervirig plumbing fixtures. On.or before 7anuary 1,2919;,a11;non-eomphanl.plumb'i rg i tUre 9hatt b--replaced with water- conservingPhu'ibing,fixtures throughout thte building(regardless of,whethrr property im lergoes alterations or inig roveme-Rts)k Ell 1vlypropertyis:acorxr>ycerciab realpropeity: See Civil Code Section 1101.5. Cn ands after Jamuary 1,2aP4,.specified`burldiiig alterat%©ns or improvements shad reqrilre non-compliant plumbing factures to}be replayed w%tliwater conse'rving p�luinbing fixtures. On or before:Jaauaty Ti„ 2019i,, all non compliant plu-nabing fixtures: shad be reRfauedi with waftr conserving, plum hi ig fixtures fifiiiro�igl one th e.building.(regard`fess of whether•property undergoes alterations or,irnproveinents)! I,as the owner or owaer;'s agent of this property,,certify under penalty,ofperlury that not-compliiant plumbinrig fixtures.will+be replfacedtplior to date',specithedt above w%th water-conserving plumbing fixtures in accordance with.Civil Code Sections 1101.1 tlu+ough 110=11,,the currenfi C'alrfornia Plnimbing Code and California Green Building.Standar f'+Code,and'manufaeturer's instasllatrotr requizerncnts,and that.the:water=conserving plumbing fixtures comply with;the.requirements as indicated in•the table on tl�,frJllowiii.: page. Owner or OWner Agpntts.Stggature LTpony Gompletiilg and signing,this,Ceititf eate,please return.it to,the Building Division in order to:finaI,your buil .mg.permit% SR407 2-0)15:doc revised 08/2-6/15