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B-2016-1885CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1885 21174 LAURETTA DR CUPERTINO, CA 95014-1657 (326 54 020) PAYLESS WATER HEATERS& PLUMBING INC VALENCIA, CA 91355 OWNER'S NAME: WONG ROBERT C AND JUDY C TRUSTEE DATE ISSUED: 05/04/2016 OWNER'S PHONE: 408-705-5035 PHONE NO: (661) 775-2979 LICENSED CONTRA((CpQTOR'S DECLARATION BUILDING PERMIT INFO: License Class PLUMBING Lic. #836216 Contractor PAYI FSS WATER HEATERS & PLUMBING INC Date 08/31/2016 X BLDG —ELECT X 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 50 GAL WATER HEATER, SAME LOCATION (GARAGE) ; 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: $2000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 326 32654 020 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agre save indemnify and keep harmless the City of Cupertino against liabiliti s judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED nsequence of the granting of this permit. may accrue against saidCity i Jands WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant and r and will comply with all non -point INSPECTION. source regulations per the Cu ino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED i g at Date 05/04/2016 Issued by: MELISSA NAMES Date: 05/04/2016 ON OWNER-BUILDERDECL I hereby affirm that I am exem t from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofmg material being installed. If a roof is following two reasons: 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: 05/04/2016 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. 1 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 material. Additionally, should I use equ' ent or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay A ea Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of wiR maintain compliance with the Cu e . o Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code a tions 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorize APPLICANT CERTIFICA'T'ION I certify that I have read this application and state that the above information is Da ' ON TRUC LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a co st tion lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is i d (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 05/04/2016 professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • build inaQcupertino oM Isc ® PLUMBINGT3_ Zo l c — C M ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS,' N APN # , 2 / � � — n C) OWNER NAME O ��y PHO a��—+3� E-MAIL STREET ADDRESSC�'j If 7 wy' S��,ZIP,., rr) /) A FAX MEPMiscApp 2011.doc J-evised 06121111 -....� `-►� � • -- Irl / J � CONTACT NAME "PHO r ' 3d 253271 E-MAIL STREET ADDRESS ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OIANTTERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CNT TOR NA LICENSE NUMBER ?;3& LIC�ENSaE YPE BUS. L C Q �I (: SCJ COMPANY NAME _ r �j E I l e/S •G�yy FAX STREET ADDRESS oZ 7 ( 0 Y, STATE, ZIP � Cc C.iK 13Ss 77S—d-jZ I M-77 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC � COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF �R 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 EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATION: dav Q i .,.; 44 By my signature below, I certify to each of the following: 6the property owner or authorized agent to act on the f. pro a I have read this application and the information I have provided is correc have read the Description of «pork and verify it is accurate. I ordinances and state laws relating to building constructi agree to comply with all applicable local I authorize representatives Of Cupertino to enter the above -]X10 tifi d property for inspection purposes. Signature of Applicant/Agent: s �% Date: SUPPLEMENT INFORMATION REQUIRED ` „r ;; .OFFICE USE ONLY , PER THE CO[JATER ....: X 3 � h `'❑ STAATDARD '�� ` �, � ;y � v "`, . � y r � xz x > D nzAJOR �, MEPMiscApp 2011.doc J-evised 06121111 SMOKE / CARBON MONOXIDE ALARMS �6 OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d.cupertino.org Address 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 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.inthe removal of -wall and ceiling finishes or therP-is�no access -by --me ans, of- attic,_basement or--.crawl-,--.-- space. r.crawl_.__,_.v._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 haves sari and aaree to comply with the terms and conditions of this statement Owner (oar Agent's) Name: JOwner Si nature ......... .... ............... Date: Contractor N Signature...................................................................Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03118114 CUPERTINO Owner Name Utlkl Address V 114 L WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 • FAX (408) 777-3333 , building@cupertitio.org Perm 4. 54MY-7 r=-1 6" q,"---61 Vj 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. .,/,K 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 futures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. El The licensed plumber's certification has been provided to the Building Division. of the fm -n bnd'sign botta- -ort'-forth: ✓ •kNo Go to Question 3. 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. 11/* 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. 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.. 5. Please check ONE of the following: Al"I 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). CJ My property is a multifamily residential real properly. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing -fix -turps 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 futures throughout the building (regardless of whether property undergoes alterations or improvements). El 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 futures comply with the requirements as indicated in the table on the following page. a _ a a Owner or Owner Agent's Signature:Date: �; l—�� k0 i completing and signing this it to the Building Division in order to final your building permit. tia SB4072015.doc revised 08/26115