B-2016-2019CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2019
23500 CRISTO REY DR CUPERTINO, CA 95014-6527 (342 54 999) BAYAREA
ENTERPRISE
SAN JOSE; CA 95148
OWNER'S NAME:: ROBERT WORCHESTER I I DATE ISSUED: 05/26/2016
OWNER'S PHONE: I I PHONE NO: (408) 238-5043
LICENSED CONTRACTOR'S DECLARATION
License Class GENERAL BUILDING CONTRACTOR Lic. # 18 7817
Contractor BAY AREA ENTERPRISE Date 03/31/2017
1 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 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
r performance of the work for which this permit is issued.
2 I have and will maintain Worker's Compensation Insurance, as provided for by
i� Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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 sai, City in consequence of the granting of this permit.
Additionally, the appli an understands and will comply with all non -point
source regulations per h tipertino`Municipal Code, Section 9.18.
,'.Signatu
Date 512512015
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, 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)
2. 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (See.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
r. 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. 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.
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 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 revolted.
BUILDING PERMIT INFO:
X_ BLDG ELECT —PLUMB
— MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION'.
UNIT 330E - REPLACE SHOWER PAN, WALLS AND VALVE WITH
PLASTIC AND FIBER GLASS SET.
Ft Floor Area: f Valuation: $3500.00
APN Number:I Occupancy Type:
342 54 999
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 applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature Date 5/25/2016
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: AbbyAyende
RF -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 Applicant:
Date: 5/25/2016
ALL ROOF COVERINGS TO BE CLASS "A"
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 equi em or devices which emit hazardous
air contaminants as defined by the B A a Air Quality Management District I
will maintain compliance with the C rtin Municipal Cod ,fChapter 9.12 and
P
the Health & Safety Code ctions 5505, 25533 and 25534.
r or authorized agent:
5/25/2Q16
I hereby affirm that there is a construction len ' g a ency for the performance
of work's for which this permit is issued (Sec. 3Q27,JCiv C.)
Lender's Name
Lender's Address
ARC'HITECT'S DECLARATION
understand my plans shall be used as public records.
Licensed
Professional
x,.,11
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE , CUPERTINO, CA 95014-3255
(408) 77-3228 FAX (408) 777-3333 ®building aC-.cupertino.org
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11 OWNER ❑ OWNER-BUIIAER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT 11 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME f *� q LICENSE NUMBER LICENSE TYPE BUS. LIC#
COMPANY NAMEq C(g� E-MAIL FAX
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STREET ADDRESS CITY, STATE, ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
FSCRE TION OF WORK C fy 'j �. o i,
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USE TYPE OCG, SQ:FT. VALUATION ($)
EXISTG NEWFLOOR DEMO TOTAL
AREA AREA': AREA NETAREA
BATHROOM - KITCHEN OTHER _
REMODEL AREA REMODEL AREA REMODEL AREA
BEINGADDED?- []NO ADDITION? ONO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF ISTHE BLP" ❑YES TLY� '' �" :" ' TOTAL VALUATION:
PLANNINGAPPL# ONO PLANNING APPROVAL .LETTER EI _ A ? ONO
By my signature below, I certify to each of the'0110 a
g: I am �zr ertyowner or authorized agent o act on a property owner's behalf have read this
application and the information I have provided is ect. I have he Description ofWork and verify it is accurate. I gree to comply with all applicable local
ordinances and state laws relating to building co tion. I aut rrepresentatives of Cupertino to enter the abova4d tified pro for inspec on purposes.
Signature of Applicant/Agent: Date:
New SFD or Multifamily dwellings: Apply for de4nolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Orm if any HazardousMaterials are being used as part of this project.
J Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BldgApp 2011.doc revised 06121111
SMOKE l CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
CUE$E Ik`fl ci 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - buildingocup4ariino.org
CPermitNo.g�6G �i
Address �: a d yr �j # of Alarms Smoke:.. Carbon Monoxide-)
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 8314 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 eve level of a dweHing 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 9072.11.4 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.
Smoke and CO form.doc revised 03118114
WATER -CONSERVING PLUMBING FIXTURES
its OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
11 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
C-PPERTIN(
(408) 777-3228 FAX (408) 777-3333 • huildinctecupertino.org
Owner Name t u "� � Permit No.. ?-0 b Z®f %
Address F) � � ��LJ ..�'� Y c � � �a, s�v'" 4�a— -- S 3
1. Is your real property a registered historical site?
❑ Y' Civil Code Sections 1101.1 through 1101.8 da not apply. Skip the rest of the form and sign bottom of form.
Xo 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
1"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 sof the form and sign bottom of form.
2"Wo. 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 l; 1994.
ter' Civil Code Sections 1101.1 through 1101.8 `do not apply. Skip the rest of the form and sign bottom of form.
2e Yes My real property is bunt and available for use or occupancy on or before January 1, 1494.
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:
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 Mures 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).
1, as the owner or owner's agent of this property, certify under penalty oferl� that non-compliant plumbing fixtures will be
replaced prior to date specified above with water -conserving plumbm es, in accordance with Civil Code Sections 1101.1
through 1101.8, the current Califoinia Plumbing Code a4&aliforui Gr en Building Standards Code, and manufacturer's
installation requirpnents, and that the water-conservinglurrribing es comply with the requirements as indicated in the
table on the fallwin Pag, e.
Owner or Owner gent' Signature: Date:
Upon compl t5gAd signing this Certificate, please re ��e Building Division in order to final your building permit.
SB407 2015.doc remised 08126115