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B-2016-2034CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2034 11342 CANYON VIEW CIR CUPERTINO, CA 95014-4838 (356 27 019) RESIDENTIAL OWNER'S NAME: LOT'); RONALD M AND KAREN TRUSTEE 'S PHONE: 408-981-3333 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #705554 Contractor RESIDENTIAL HEATING AND AIR CONDITIONING INCDate 04/30/2017 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 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 Xierformance of the work for which this permit is issued. ave 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 applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code,Aection 9.18. Date 5/26/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: i. 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. I, 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. 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 1 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 5/26/2016 HEATING AND AIR CONDITIONING INC CAMPBELL, CA 95008 DATE ISSUED: 05/26/2016 PHONE NO: (408) 377.4073 BUILDING PERMIT INFO: X BLDG ELECT —PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE FURNACE AND AC SAME LOCATION Sq. Ft Floor Area: Valuation: $11000.00 APN Number: Occupancy Type: 356 27 019 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM Issued by: CTION, 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: 5/26/2016 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 edit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 255005, 25533, and 25534. Owner or authorized agent: M Y Dade: .5126/2016 _-- CONSTRUCTION LADING o AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION 4 AL-mR ATTow / TT ❑ RRVMTO1 J / TIRFTRRFTT 2—o ILe—oM (1DT(_TkTAT 'MDTATT 4 PROJECTADDRESS . 1 3 3 ,l2Can VI^C� (r1 e APN# 356 2 � 0'1 OWNER NAME /'�y��n � O I % , Lott p� (� PHONE t�1.1B ( � 2 E-MAIL STREET ADDRESS 113+ 2. bn o� V� ,w Circle CITY, STATE, ZIP a t�no Cid so► FAX CONTACT NAME Coon I /p PHONE li(Tf E-MAIL } � ekF�6 STREETADDRESSSt j � �(�� CITY, STATE, ZIP =CjK CA q S ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR IJ CONTRACTOR AGENT ❑ ARCHITECT 0 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME C / +i_ 146tI r ^ LICENSE NUMBER C LICENSE TYPE BUS. LIC # 2 1 1 d ,, 1 COMPANY NAMEe s 1 1 � ► I' i a I ' I afi lJ E-MAIL kL l I �U 1 I 1 r %r.CO FAX q o 6_ 31 ! _89 18 9� STREET ADDRESS C�5 CriSftt Lane CITY, STATE, ZIP aYYI e(1 C stt $ PHONE Iirk -377-073 `# ARCHITECT/ENGLNEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ., d I o cin f�yno ce, and / - ' same location EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES - USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL _ AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODEL AREA REMODEL AREA REMODEL AREA PORCH. AREA - I DECK AR111 TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH. _ # DWELLING UNITS: A SECOND UNIT ❑YES SECONDSTORY I-] YES - - - BEING ADDED? []NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESRECEIVED $ TOTAL VALUATION: PLANNINGAPPL# ❑NO. PLANNING APPROVAL LETTER EICHLERHOME? E] NO // f,_)75 By my signature below, I certify to each of the following: I am the property owner or authorized age to a ton t6dproperty owner's behalf. I have read this 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. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature Applicant/Agent: Date: of SUPPLEMENTAL INVORMATION REQUIRED PLAN CHEM-HEM IfOEPIINYrsIIP s R-.rHE-CaiaN°rEk ❑ BUILDih G PLAT RT UEw _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ PREss ...... g PLANlNLAi17REVIEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑sTA A>2D ❑ PUBLICIWORKS form if any Hazardous Materials are being used as part of this project. 0 1AAG iI3E nPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ nfiAab�z SANITAItxSJlwBRpISTIIICP submittal of Building Permit application. ❑ D+NNIRONNTALHEALTH' BIdgApp_2011.doc revised 06/21/11 REMMI V*=fM%VW!'7TrXUf 7-TIUK-AC 3ECUUTT TIMT, wilere no Interior access for inspections are required, GENERAL INVORMATION Existing single-family and multi-fandly dwellings shall be provided with Smoke Alarms and Carbon Mornoxide alarms, When the valuation of additions, alterations, or repairs to existing dwelling units exceeds Monoxide Alarms be installed in the following locations - AREA Outside of each separate sleeping area.in the immediate vicinity of the bedroom(s) VVIQ [mail do not have art attached garage. Carbon monoxide alarms combined with smoke alarms sh.all comply with. CBC Section 420.6 and sliall be approved by the Of fice of the State Fire Marshal - Power Supply. In dwelling -units with no commercial, power supply, alarm(s) may Lie solely fiery 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 arvd ceiling finishes or there is i Lo access by means of attic, base lent of crawl space. Refer to CR -C Section R314 and CBC Sections 9G7.2.11.4 and 4-20.6.21, Art electrical permit is required for alexins which must be connected to the bi&dIng wiring - As owner of the above -referenced property, I hereby certify that the alarm(s) referenced abave has/have been instaHed in- accordance with the manufacturees instructions and h -i compliance with. the Cal ifioniawilding and California Residential Codes. The alaT-ms have been tested and are operational, as of the date sig1jed below, fhave reach anda ee to comply withlbateraz"Odcondifidna; of this statement ............... .. . ...... Y ... In 1 -D ............. WATER-CONSERVING Mi..LUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT ELI _ t TORREz 95014-3265 CUPERTINO hufidin cuaerfino.oM Add Tew, 1. Is your real property a registered historical site 11 Yes Civil Code Sections 1101.1 through 1101,8 do not apply. Skip the rest of the form and sign bottom of form. IN No Go to Question 2. 2. Does your real property have a licensed iunrber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible`? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. C The licensed plumber's certification has been provided to the Building Division. Slip the rest of the form and sign bottom of form. 19 No bio to Question 3. 3. Is water service permanently disconnected for your building`? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Slip the rest of the form and sign, bottom of form. IR No two to Question 4. 4.. Is your real property built and available for use or occupancy on or before January 1, 1994"? D No My real property is built arad 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 forma 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. Cheep one of the three following statements and sign bottom of form.. . Please check ONE of the following: Myproperty is a, i ?c f roily reWdenrlal real property. See Civil Code. Section 1101,=%. On and after January 1, 2014, building alterations or improvements shalt require all non-compliant p1wri ing fixtures to be replaced withwater-conserving plumbing fiures throughout the building. On or before January 1, 2017, all non- compliant plumbing fix=tures shall be replaced avith water -conserving plumbing fbaures (regardless of wherlrer property undergoes alterations or improvements). I My property is a inrildfamily residential real property. See Civil Code Section 1101.5, On and after January 1, 2014, specified building alterations or impro :=ements shall require non- compliant plumbing Mures to be replaced with water -conserving plumbing fu tares. On or before January 1, 2019, all non. -compliant plumbing futures shall be replaced with water - conserving plumbing, fixtures throughout the building (regardless of whether property undergoes alterations or nprovement%). t• My.property is a commercial real property. See Civil Codeec'don 11 01.5. In and after January 1, 24148 specified building alterations or improvements shall require non- compliant plumbing Mures to be replaced with � ater�-conser°vi g Jumbfng factures. On or before January 1, 2€319, all non-compliant pluraabiug fixtures shall be replaced with a�a€ - conserving plumbing fixtures throughout the building (regardless of wl other property undergoes alterations or improvements). Fastheer or owner's agent of this property, certify loader enalty of per�iury that tai-corr�piiant lurrrbi g fixtures ���ill be or to date sp filled above with =ate€«coraserglrrgplumbi€ag fixtures iia accordance ��>it rival Conic Sectia� s 11#11.% 1.8, the current California Plumbing Code. and California Green Building Standards Cade, acrd rnan l'acturer's requirements, and Haat the v aierwconservirag bing­fi%1100,s eomPl}' vvith the requiretrsents as indicated in the table on the followirr a e. - ... Owner or tr caner Agent` Sign tun �' � � �. � � _Mato; Upon completing and signing this Certificate, pleas raturn it to the Butt ding l ivisidn in d d r.tc� kraal dour building permit.