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15020082CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10392 SCENIC CIR CONTRACTOR: KWAN KATHERINE I PERMIT NO: 15020082 OWNER'S NAME: KWAN KATHERINE I 10392 SCENIC CIR DATE ISSUED: 10/28/2015 OWNER'S PHONE: 4089963896 CUPERTINO, CA 195014 PHONE NO: ® LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL CONVERT PATIO INTO HABITABLE ADDITION (607 SQ FT); License Class Lic. # BATHROOM REMODEL (50 SQ FT); INTERIOR REMODEL (264 SQ FT); CONVERT (FAMILY ROOM INTO GUEST BEDROOM. Contractor Date 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: i. I haveand will maintain a certificate of consent to self -insure for Worker's Sq. Ft Floor Area.' Valuation: $80000 Compensation, as provided for by Section 3700 of the Labor Code, for the APN Number: 357,07023.00 Occupancy Type: performance of the work for which this permit is issued. 2. 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 i permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION I certify that I have read this application and state that the above information. is WITHIN! � 180 DAYS OF PERMIT ISSUANCE OR 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 180 DAY S FROM LAST CALLED INSPECTION. e indemnify and keep harmless the City of Cupertino against liabilities, judgments, Issued by:Tg� i, Date: 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. RE -ROOFS:. Signature Date 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. OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2 1, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the onstruct the project (Sec.7044, Business & Professions Code). California Health � Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air i. I have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliaolcc with the Cupertino Municipal Code, Chapter 9.12 and the performance of the work for which this permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. 2. 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 Ow a •ora thoritied agent: f '` "� Date: I f permit is issued. _ 3. 1 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 i CONSTRUCTION LENDING AGENCY I hereby affirm thatthere is a construction lending agency for the performance of work°s become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) must forthwith comply with such provisions or this permit shall be deemed Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information isARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional 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. Signature Date t l CONSTRUCTION PERMIT APPL[CA,TION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 UPERTtt C (408) 777-3228 FAX (408) 777-3333 • buiidino noupertino.org TI " REVISION /DEFERRED PROJECT ADDRESSAPN N .—C 2 OV TNER NAME�j yr PHONE( g > r - 'gyp I/ a�J Q•@(� - I " \ E-MAIL STREET ADDRESS g^ CITY, STATE, ZIP �g FAX �_.... ` C'•1 -O 0\ CONTACT NAME` PHONE i� E -MOIL > (t '-' � '. c (x 0.1 STREET ADDRESSp 1 r7Z�g j> f CITY, STATE, ZIP , _ � c-r/'t r; �rVia, �t FAX 1:3OVNTER 0 OWNER-BLMMER ❑ OWNER AGENT � CONTRACTOR. ❑ CONITRACTORAGENT, - 'ARCHITECT rl NGINEEK ❑ DEVELOPER I] TENANT CONTRACTOR NAME I LICENSE NTUMBER o LICENSE TYPE I BUS. LIC 9 COMPANY NAME E --MAIL I FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGLNEER NAME q t p LICENSE NU114BER �7 r V, l.. � (� -74' P 4' BUS. LIC � COMPANY NAME ^ � � � � .e � E MP3L � 1M� T. C IGH �rS5 FAX G t-��U a cVf a' STREET ADDRESS CITY STATE, ZIP `D v, G� f rn;�a c� , Ce ' � PHONE (�09)cr:te---%�fc4 DESCRIPTION OF WORK t o _ 1 A� t KF ( �i 0 �n kj l •P. �a G,_®� .. Y 6fi sv, �... l�-r �c is C� t� ... �c�.C� �e � Ir !/ ®i3a h EXISTING USE PROPOSED USECONSTR. TYPE - ( STORIES USE I TYPE OCC. SQ.FT. I VALUATION (S) EXISTG AREA NEW FLOOR DEMO AREA ®% AREA .G Q � TOTAL 3 2 -4 1 NET AREA �k BATHROOM KrtCF3tN l OTHER REMODEL:AREA REMODELAREA RET40DEL AREA PORCHARECK.AREA - TOTALDECK/PORCHAREA GARAGE AREA: D AC 1=�r5i n DWELLINGUNRS IS ASECOND UNIT YES BEING ADDED? N0 SECOND STORY DYES ADDITION? '0 I PRF -APPLICATION ❑ YES IF YES, PROVIDE COPY OF LETTER Is THE BLDG AN ❑ I EICHLERHOn4E? �..NO X K TOTAL VALUATION: •`��`�� '�'�- r� � Imo_ PLANNING APPL 9 ❑NO PLANNING APPROVAL -- - "��._ By my signature below, I certify to each of the following: I am the property ov ner or authorized agent to act on the property mvner's behalf. I nave read ung application and the information 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.Q Date I authorize representatives of Cupertino to enter the above-identifiedabove-identifiedproperty for inspection purposes. I Signature of Applicant/Agent: —` � d INFORMA New SFD or Multifamily dNvellings: Apply for demolition permit for existing building(S). Demolition permit is required prior to issuance of building permit for new building. _ Commercial BIdgs: Provide a completed Hazardous Materials Disclosure To—nn if any Hazardous Materials are being used as part of this project. — Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. &IdgApp_2611.doc remised 66/21/11 CITY OF CUPERTINO FFF F QTII%4 A TnR — RITYL-nING' DIVISION ADDRESS: 10392 Scenic Circle Iml DATE: 0211212016 REVIEWED BY: Sean APN: BP#: /J�� C�- cp-1 *VALUATION: E6,666 --- rPERMIT TYPE: Building Permit PLAN CHECK TYPE. Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes (D No I OTC., 0 Yes (E) No PEN AMATION IR3SFDADD PERMIT TYPE: 'A woRy, Convert atio into habitable addition (607 sq ft); bathroom remodel (50 sq ft); interior remodel (264 sq SCOPE ft); convert family room into guest bedroom. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA 01.1 PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,lV,V-B 607 $2,664.00 IR3PLNCK $1,666.00 JR3INSP PME Plan Check: $0.004" s. $431.001 Remodel, Other IREMRESOTH Permit Fee: $1,666.00 Suppl, Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME U . nit Fee: $0.00 PNM Permit Fee: $0.00 TOTALS: 607 $2,64. 0 � . $1,666.00[ ATech. Ilan Check I I:Meeh. Permit Fee: Oihcr.Wech. Inv I'luillb. Nan Ched., Pluinb. Perinit I , , 'ee: 01hei. Plim-lb Imp Elec.1"Ian Check FIec. Perniii Fee: oillel, Elec. Insp. ilcrl> jnsFee I I'lunib. hisp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning,; Public Works, Fire, Sanitary Sewer District, School ,u1strict,ete-j. ineserees are vasea on mepre"fruff"r FEE ITEMS (Fee Resolution 11-053 Eff 7/111.3) FEE QTY/FEE. MISC ITEMS Plan Check Fee: $2,654.00 50 s.t - $645.00 Remodel, Bath (<=300 sf) IREMRESBAT I Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.004" s. $431.001 Remodel, Other IREMRESOTH Permit Fee: $1,666.00 Suppl, Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 PME U . nit Fee: $0.00 PNM Permit Fee: $0.00 -.onstrucrim.7ax:, ' J.j Work Without Permit? o Yes 0 No Advanced PlgRning-Fee- IPLLONGR $0.00 $84.98 Select a Non -Residential Building or Structure 0 0 'l-rai,el i)oeuynewat.iort Flees: Strong Motion Fee: IBSEISMICR $10.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 $4,419.381$1,076.00 Z $5,495.38 1 OWNER -BUILDER DISCLOSURE FORM VA COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ZEN (408) 777-3228 • FAX (408) 777-3333 • build ina(51cuoertino.org CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: T/fJl y SITE ADDRESS 2 SCEM i L .. 0 _.. APN.35q- OR 093BP OWNER NAME WUR_ ADDRESS t DESCRIPTION OF WORK: 76M(m. KW -00 - We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) �Lf , 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. . I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. ��. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family NCi.�� residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for nyina fncial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 L9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents, I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or v✓ww.cslb.ca.gov for more information about licensed contractors. 4(1). I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. Sapplicable 1. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by laws and requirements that govern Owner -Builders as well as employers, �2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated bylaws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint, .Your only remedy against unlicensed Contractors may be in civil court. It is also important for you -to understand that if an unlicensed Contractor, or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signaiufe. - Property Owner's Signature: f<� L ---t Date: 10 "2A 2 0r/� 1 ------------- &I ---- -- ---- t 10�%i�-=---------------------------------------------------- ------ NOTE: The following Authoriz ion Form is required fo be completed by the property owner only when designating an ( 9 agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owners driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/19/10 POST THIS CARD NEAR FRONT OF BUILDING PERMIT NUMBER CITY OF CUPERTINO 16300 � INSPECTION DIVISION JOB INSPECTION RECORD PERMIT EXPIRATION UNIT# _LOT# JOB ADDRESS -` 7��'-'`- -- PERMIT EXPIRES IF WORK CONTRACTOR IS NOT STARTED WITHIN OWNER r =-'^ - 180 DAYS OF PERMIT ISSU• INSPECTION DATE INSPECTOR INSPECTION RECORD gNCE OR 180 DAYS FROM FOUNDATION NOTE: LAST CALLED INSPECTION. UFER ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE .APPROVED PLANS AND CITY OF PER'''T ALiDAT"' PREGUNITE CUPERTINO STANDARDS. GARAGESLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING A ELECTRICAL MECHANICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED WOOD FLOOR PLUMBING MECHANICAL ELECTRICAL FRAMING INSULATION PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED ISSUANCE DATE SO FT FLOOR AREA BLDG ELECT PLG MECH DIAPHRAGM BUILDING USE HESIND CON PB Olnr ❑ ❑ ❑ ❑ ❑ ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION ASSE SSORS PARCE L NO t� AL UAT ICN SIFT 0i3 SAN.# `Yom• PERMIT TO ELECT. ENERGY TRACT NO STORIES TYPE CONSTR PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED SO FT FLOOR AREA TOTAL ACREAGE ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID DIAPHRAGM BUILDING USE HESIND CON PB Olnr ❑ ❑ ❑ ❑ ❑ ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSE SSORS PARCE L NO ROUGH SAN.# PLUMBING ELECT. ENERGY TRACT NO PARCEL No TUBS & SHOWER PAIN PLUMBING ENERGY MECHANICAL MECH. ENERGY ACC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT, FINAL TEST _ ZONING ENG SITE NO. INSULATION PLUMBING GAS TEST GAS FIRE SPRINK I ❑ N ENERGY T 24 Y ❑ N( MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING FLOOD ZONE Y ❑ N ❑ A L U C Y ❑ N EXTERIOR SHEAR ELECTRICAL INTERIOR SHEAR FIRE DEPT. FEE SUMMARY = SHEETROCK GRADE EXTERIOR LATH BUILDING ^0-sov BUILDING INTERIOR LATH TEMPORARY APPROVALS` N CHECK FEE SCRATCH COAT (ELECTRIC ' GAS SEISMIC FEE. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. ARRANGE FOR INSPECTION BY PHONING 252-4505, ONE WORKING DAY BEFORE REQUIRED INSPECTION. O PLEASE GIVE JOB ADDRESS WHEN PHONING. z• - SEE PERMIT •FOR E;CPiRATION DATE - MICROFILM ELECTRIC PLUMBING MECHANICAL CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE f TOTAL APPLICANTS POSTING COPY C U P� RT�yI O �, _J� �� 3 q � "t CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: - 10.3 47 2– PERMIT # 1 O Z O 3 `- OWNER'S NAME: c PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # OO_ :• ADDRESS: 1.0 e C sv- CITY/ZIPCODE: q,,tS Z) l *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. ,.; NO BUILDING FINAL OR FINAL .00CUPANCY INSPECTION(S) -WILL. BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: - Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRAC'T'OR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing M9sonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal. Sheet Rock Tile r l 6-< Date �;�A,cidress 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 • buildingReupertino org �-PermifNo�� i & o 21 a a 6 2,- PERTHIT CANNOT DE FINALED AND COMPLETED UNTIi, TMS CERTIFICATE HAS BEEN . TCNEp AND BZ `RNTLD TO THE BUILDING DI171SIONT 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 CSC 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 tl}e 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 a ree to com 1v with the terms and conditions of this state S _y!Lr tar Owner-Age€fs)-Name: mer, Cq`niracfor--Name: Si nature bats: .. W 1a` Sio Pure. a .`:�* •a. er°� Lie: r� }'a •� ..Date: . ��. Smoke and CO fonn. doe revised 03118114 'l7 3. i WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO_.. 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (40 8) 777-3228 --FAX (408) 777=3333 bu 1ng(aiCUpertln0 org _ Owner Name Permit No. i, 3 7 Address 1.' Is your real property a registered historical site? 1 '?❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn. 2"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? C 'es Civil Code Sections 1101.1 through .1101.8 do not apply. 11 The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. 3.', Is water service permanently disconnected for your building? - 1' ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.. Skip the rest of the form and sign bottom of form. Wo' Go to Question 4; i 4. Is your real properly 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. M Yes My real property is built and available for use or occupancy on or before January 1, 1994. j Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: f CMyproperty is a single familpy residential real "roe See Civil Code Section 1101.4. '_' property. - 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). El Myproperty 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. Y ur Owner or Owner Agent's Signature, Upon completing and signing this Cerri' icate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08126115 DAVID PERNG,ARCHITECT �� S 10268 Bandley Dr. #102 Cupertino, CA. 95014 Phone: (408) 996-7988; Fax: (408) 996-7809 To: City of Cupertino, Building Department Building Inspector Date: Jun. 20,2016 Job Site: 10392 Scenic Cir.. Reg.: Holdown retrofit observation. Dear Inspector, Per Contractor's request,I have gone to the site to observe the holdowns installation on this site on May 13, 2016. There are total of 13 holdowns at this job. Contractor does clean up the holes and uses epoxy adhesive (set-xp). The installation is proper and per approved drawings. If you have any question,please give me a call. Thank you! David Perng, Architect N F *