B-2016-1688 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1688
20116 LAS ONDAS CT CUPERTINO,CA 95014-3106 AAA ELECTRIC
(369 30 038) SAN JOSE,CA 95121
OWNER'S NAME: PATELMANISHKUMAR C AND DATE ISSUED:04/04/2016
KAYURI H TRUSTEE
OWNER'S PHONE:408-253-8777 PHONE NO:(408)557-8899
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class—11 Q Lie.#741024 X_BLDG X ELECT —PLUMB
ContractorAAA ELECTRIC Date 10/31/2017 MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions JOB DESCRIPTION:
C
of Chapter 9(commencing with Section ode (E 125 AMP MAIN PANEL TO 200 AMP.SAME LOCATION.of REPLACE
Division 3 of the Business&Professions Code and.that
my license is in full force and effect.
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
iSq.Ft Floor Area: Valuation:$2000.00
Compensation,as provided for by Section
37 of the Labor Code,for the performance
of the work for which this permit is issued. APN Number: Occupancy Type:
I have and will maintain Worker's 369 30 038
Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the
f e
performance of the work for which this permit
is issued. PERMIT EXPIRES IF WORK IS, NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION 180 DAYS FROM LAST CALLED INSPECTION.
I certify that I have read this application and
state that the above information is correct.I Issued by:Abby A e {`;)
agree to comply with all city and county
ordinances and state laws relating to building Date:04/04/2016 1
construction,and hereby authorize
representatives of this city to enter upon the RE-ROOFS:
above mentioned property for inspection All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without fust obtaining an
purposes. (We)agree to save Indemnify and inspection,I agree to remove all new materials for inspection.
keep harmless the City of Cupertino against
liabilities,judgments,costs,and expenses
which may accrue against said City in Signature of Applicant
consequence of the granting of this permit. Date:4/4/2016
Additi*a,pplicaa understands and
will cooint source ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
regulaertino Mu icipal Code,
SectioHAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,
SignaSections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter
9.12 and the Health&Safety Code,Section 25532(a should I store or handle hazardous material. Additionally,
should I use equipment or devices which emit ardous air contaminants as defined by the Bay Area Air
OWNER-BUILDER DECLARATION Quality Management District I will m 'n ai co iance with the Cupertino Municipal Code,Chapter 9.12 and
the Health& ions 25505,25533,and 25534.
I hereby affirm that I am exempt from the
Contractor's License Law for one of the following two
reasons: Owner or authorized agent:
n. I,as owner of the property,or my employees 'Date:4/4/2016
with wages as their sole compensation,will do CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's,for which this
the work,and the structure is not intended or permit is issued(Sec.3097,Civ C.)
offered for sale(Sec.7044,Business& Lender's Name
Professions Code)
2. 1,as owner of the property,am exclusively Lender's Address
contracting with licensed contractors to
construct the project(Sec.7044,Business& ARCHITECT'S DECLARATION
Professions Code). I understand my plans shall be used as public records.
I hereby affirm under penalty of perjury one of the Licensed Professional
following three declarations:
r. 1 have and will maintain a Certificate of
Consent to self-insure for Worker's
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(Dcupertino.orgCUPERTINO: misc
❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS �-Zalu— 1'u
PROJECT ADDRESS / / T APN# ® ` 0
OWNERNAME t� � c- ( PHO jiyi s � vv2d E-MAIL
STREET ADDRESS r t J ® t,,�_ CITY'EAT , FAX
CONTACT NAME- PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OwNER-BUILDER ❑ OwNERAGENT ❑ CONTRACTORS ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME r�1 � � / `Q r ,(7 LICENS NU EIt� LICENSE TYPb I Q BUS.LIC# y�
q'7-7
COMPANY NAME A rQ-A � ( W '�,`/a' t\c E-MAIL ( (� FAX U
STREET ADDRESS /�. ��C?�✓'��-� (_"' .STAT[ / PHTQ
ARCHITECT/ENGINEER NAME LICENSE NUMBER C BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑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 EICHLERHOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: 2 RECEIVED BY:'t
By my signature below,I certify to each of ollothe prop owner or authorized agent to act on the pro e o er' beh If. I bave read this
application and the information I have pro d d isjAe read Description of Work and verify itis accura . I gree omply with all applicable local
ordinances and state laws relating to b i din coho" e resentatives of Cupertino to enter the abo i I o e for inspection purposes.
Signature of Apphcant/Agent: Date:
UPPLEMENTAL INFORMAT O REQUIREDUSE ONLY,
w-. ❑>OVER T -COUNTER
�.. EXPR7•;SS
,isTJ
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MEPMiscApp_2011.doc revised 06121/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
+CUPERTINO 10300 TORRE AVENUE•CUPERTINO,'CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(a)cupertino.org
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PFRMT CANNOT BE F.'y.l 1 EIDE A W COAlPLET '.AJ TIL,T ,CE'R-T'. KATE 3
HAS BEEN SIGN'tl) 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)maybe 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.
i have read and agree to comply with the terms and conditions of this statement
(wneT ii'Pwnf Agpnrs)Name:__
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-Confracl4r_Name:
;Si naEuFe '. ................................................. .......sL1c .................... .,Daft:
Smoke and CO form.doc revised 03118114
WATER-CONSERVING PLUMBING FIXTURES F1
7*-
OWNER CERTIFICATE OF COMPLIANCE 16.
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �]
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
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Is
A-Is your real property a registered historical site?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
V 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?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
D The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
9 No Go to Question 3.
Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
V No Go to Question 4.
Is your real property built and available for use or occupancy on or before January 1, 1994?
0 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.
C/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..
Please check ONE of the following:
C/ 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).
0 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).
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, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless ofwhether 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 following page.
Pwn�er or Owner gem's i`gna ure; (Da rY�l Ze 16
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB40'7 2015.doe revised 08126115