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B-2016-1759CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: I CONTRACTOR: PERMIT NO: B-2016-1759 10184 CARMEN RD CUPERTINO, CA 95014-2784 (357 09 013) DELUXE AIR WOODLAND, CA 95776 OWNER'S NAME: BJELETICH JOHN G AND NANCY J TRUSTEE OWNER'S PHONE: 408-253-2139 LICENSED CONTRACTOR'S DECLARATION License Class CC=20 Lic. #994539 Contractor DELUXE AIR Date 07131/2016 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. 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. J2. 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. 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 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 expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the #plicant understands and will comply with all non -point source regulatioffi the Cuper i i al Code, Section 9.18. Date'''�/� that I am exempt from the Contractor's License Law for one of the .wo reasons: 1, 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 2. 1 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. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of 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. 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 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 4o save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in 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. DATE ISSUED: 04/13/2016 PHONE NO: (530) 662-5008 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: FURNACE REPLACEMENT IN SAME LOCATION. Sq. Ft Floor Area: J Valuation:: $9518:08 APN Number: Occupancy Type: 357 09 013 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Phuong Devries Date: 04/13/2016 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all: new materials for inspection. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 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 hazardous air contaminants as defined by the Bay Area Air Quality ement District I will maintain compliance with the ertino Mumu Code Chap 12 and the Health & Safety CodSections 2550;2 , 25533, and 25534. Owner or ✓aw, Ltel - f b ST I hereby affirm that there is of work's for which this per Lender's Name Lender's Address istruction lending agency f issued (Sec. 3097, Civ C.) I understand my plans shall be used as public records. Licensed Signature Date Professic GENERAL PERMIT APPL(CAT GN COMMUNITY DEVELOPMENT DEPARTMENT + BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 7773228 FAX (408) 777-3333 building(cDcupertino.org UPERTIN0 PROJECT ADDRESS I a �U, ( �� APN n Aevnie�lOWNER NAME � ` •.T' � ` PH E-MAIL MEP miscV- -,I /I IL y STREET ADDRESS CITY, S E, Z FAX t a STREET I&DDRESlu S ,- `L 1 T CONTACT NAME Z�P® 1 t t a PHONE HON E-MAIL STREET ADDRESS LIC Ei\iSENUMBER CITY, STATE, ZIP BUS. LIC It FAX ❑ OWNER ❑ OWNER -BUILDER ❑ 'OWNER AGENT 0 CONTRACTOR ❑ CONTRACTORAGEN*T " ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM LICENSE NUMBS LICE -N BUS. LIC COMPANY NAME r E-MAIL. USE OF ❑ SFD or DUPLEX ' BUILDING: ❑COMMERCIAL. R MULTI -FAMILY F TOTAL VALUATION: �� _ "� I RECEIVED By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on blerty owner' behalf. I have read this application and the information I have ovided is correct. I have read the Description of -Work and verify it is accura . `I agree to Amply with all applicable local ordinances and state laws relating to b Iding constructi . a e representatives of Cupertino to enter the above -i e - property for inspection purposes. Signature of Applicant/Agent: _ ®— AL INFORMATION REQUIRED MEPMiscApp 2011.doc revised 06/21/11 t a STREET I&DDRESlu S ,- `L 1 T CITY; ATE Z�P® 1 t t a -5 HON ARCHiTECT/ENGINEERNAME LIC Ei\iSENUMBER BUS. LIC It COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ' BUILDING: ❑COMMERCIAL. R MULTI -FAMILY PROJECT IN WtLAND URBAyN�ATER^rACEAREA ❑ YES ❑ NO PROJECT IN FLOOD ZONE ❑ YES ❑ NO IS'TBE BLDG AN ❑ YES EICHLERHOME? ❑ NO DESCRIPTION OF WORK '!— ry / „/ TOTAL VALUATION: �� _ "� I RECEIVED By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on blerty owner' behalf. I have read this application and the information I have ovided is correct. I have read the Description of -Work and verify it is accura . `I agree to Amply with all applicable local ordinances and state laws relating to b Iding constructi . a e representatives of Cupertino to enter the above -i e - property for inspection purposes. Signature of Applicant/Agent: _ ®— AL INFORMATION REQUIRED MEPMiscApp 2011.doc revised 06/21/11 Address PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building 6dicupertino.org ermft No. 13 -q ? 5 �' te r— 7,21 # of Alarms Smoke: b CaftaMortoxide: PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE um F -w toii 1i1 1 r1:► 1 1 1 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 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 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. I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: Signature................................ ............................................................................ Date:................... Contractor Name: �• q9(f si nature...... ...:.................................... Lic. ............ Date:.. rs.. I CUPERTINO Owner N Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 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. IR 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. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. [A No Go to Question 3. 3. 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. 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 1101.8 do not apply. Skip the rest of the form and sign bottom of form. I Yes My real property is built and available for use or occupancy on or before January 1, 1994. I 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: 1 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). ❑ 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 nate. — n „ 111 Owner or Owner Agent's Signature: 'LIJ&kCMDate: '7� i, -Sl- I ] I Upon completing and signing this Certificate, J 1 ase Mum it to the Building Division in order to final your building permit. SB407 2015. doe revised 08126115