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B-2016-1746r. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1746 22535 SALEM AVE CUPERTINO, CA 95014-5648 (342 12 097) HOLDER INC SANTA CLARA, CA 95054 OWNER'S NAME: ONORATO STEVEN J DATE ISSUED: 04/12/2016 OWNER'S PHONE: 415-305-3269 PHONE NO: (408) 496-9960 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B. 0-17 Lic. #690918 Contractor HOLDER INC Date 04/30/2017 X BLDG —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: REPLACE 19 (E) WINDOWS 1 STAND 2ND FLOOR, LIKE FOR LIKE 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 Sq. Ft Floor Area: Valuation: $19750.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 42 342 12 097 3 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 expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulatio er the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ignature Date 4/12/2016 Issued by: Abby Ayende (N D • n ,� Date: 04/12/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 4/12/2016 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety,Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code tions 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall do be deemed revoked. ner or authorized agent: APPLICANT CERTIFICATION bate: 4/12/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 4/12/2016 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I _ 10300 TORRE AVENUE • CUPERTINO, CA 950143255 CllPERTINO (408) 777-3228 • FAX (408) 777-3333 • build inaCCDcupertino.org I S C I—I PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ]MISCELLANEOUS PROJECT ADDRESS � Se - 1 -P q r— , j'] }'j U APN # 2>41 O\VNERNAMES C` V t o N o re4 PH �� I o - z,./T7MAIL STREET ADDRESSq „ „ CITY, STATE, ZIP FAX CONTACT NAME / _ to PHONE4 /0� 1 ��,• // b EMAIL 6 49 STREET ADDRESS !W jb i1 ( o0 T/ j CITY,�AT� ZIP C �� FAX ❑ OWNER ❑ 00 --BUIIDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONT TOR NAME X� D� A w 61G ��/_ /t f� (T (� LIC SE 9 0 R --MAIL LICENSE TYPE BUS. LIaaL a (/ 37 COMPANY NAME EE FAX STREET ADjqV A-` ^ O AVT c CITY,AT tI I l V, (�� 7 NE PH 1^j� / ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMH.Y BUILDING: ❑ COMMERCIAL PROJECT A WIIALAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN FLOOD ZONE ❑ YES ❑ IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO % DESCRIPTION OF RK C, r) / . , i N e! dw r I le t � l ke_ eN l 1 vV G� (tet gN�O' -p C"+/I Nc/ _ J TOTAL VALUATION: s 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 provide orrect. 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 ct' I authorize representatives of Cupertino to enter the �above-identified property for inspection purposes. Signature of ApplicanUAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED k ' OFit'ICEUSE:OAL1r ❑ O\'ERzTHE COUi\TER f" ❑ EaPRESS k ` a t ❑ LARGE r � ` � ❑ NL470R \ MF,PMiscApp_2011.doc revised 06/21/11 a STW e QfJ017+TD J-AMr Z 2 X31' SAC Pm . Cuee -mv o ` 04-1- . 957/V (ft) -3 or- -7 2 .6- q ------------ 9 ace X d ®wf Pig N42w 14'4ke OffAJ Pffj >r n I'IV, �3 o" ((Q (Kr t 'rv'0'Dn &Nc WIPW �'k 1"611-3 0 full t 5 ,Floa( 110 r n S� COMMUNITY DEVELOPMENT:.DEPART ' NT BUILDING DIVISION - CUPERTINO APPROVED This set of plans ar d specifications MUST be kept at the job site during co struction. It is unlawful to make any changes or alt rations on same, or to deviate the.refrom,.withou approval from the Building Official. .The Stamping of th - plan and specifications SHALL NOT be. held to permit or to be an approval of the violaer��ar of -any. provisions f a y City OrdinanceJr State � DATE RERMLT-k; f - 1-1%4(..o BY Is IN pi l i vl� &► '410 0 er r/ o &`�� fW P g—. r".LAN-SCHEGKED BY DATE 44 PLANNING DEPT CUPERTINO. 5 TAVC 01J6,1A ZZs S4-(C144ve. GuP f 04 . QS -b ! V (*v 3o.-- 3 1,,c q 44,010, gAje 601 IApfc�tbe lk0ow a4 r w f�- mets Lr,�� Y� N 'a y � ¢•�nx3'0 'p'x?'® o ��p'X�•0 �raoM c576IK 'aj (t O�'s 3or '�X`f Ali 3`Q'�x1�o+� A\rc"e Tiv :k,0(aWL6jr- P� N CHECK�:� °° L:: ,, DATE � PL',NNI C DEPT SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPE'RTINO,'CA'95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.ong x ddress-- -2 Aj-,Em Avr PURPOSE - 206-17q6 n --us 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 bedroom(s) X X 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 I 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 wl-lich must be cormected to the building wirmlg. 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. l,have read and agree to comply with the terms and conditions of this statement "Her dor Owner Ageni slName`4 S V E Y NO RA� 8i nature Dale: ,.. -�obfra�9xN�iae: � r 2'NC �y4 Si Hato€e } ............,.......... Lrc#....1�4�j'l� ...........'Date'fi1� N(, h( Smoke and CO form.doc revised 03/18/14 IN MATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CU INO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 ,0408) 777-3228 • FAX (408) 777-3333 • buildingCa7cupertino.org i a 17q6 owner ame; i G V �3 o 9th` b Mini, o '®� 1 7 r2 L --+S 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? p Yes Civil Code Sections 1101.1 through 1101.8 do not apply. The licensed plumber's certification has been provided to the Building Division. MINSkipthe rest of the form and sign bottom of form. No Go to Question 3. L 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. VNo Go to Question 4. C4) 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. Lam" 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; V 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 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). • 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 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-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. Tnnn cmmnlettina and sianinp, this Certilficate. please return it to the Building Division in order to final your building permit. SB40'72015.doe revised 08126115