B-2016-2002 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2002
20313 NORTHCOVE SQ CUPERTINO,CA 95014-0507(316 41 066) SUPER ELECTRIC
VALLEJO,CA 94590
OWNER'S NAME: SPROWLS DAVID V DATE ISSUED:5/23/2016
OWNER'S PHONE:408-446-1727 PHONE NO:(707)648-3333
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC-10 Lic.#8290 5
Contractor SUPER ELECTRIC Date 12/31/201'1_ X BLDG X ELECT _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 MAIN PANEL(125 AMP);SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
z. I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perforuance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$2500.00
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 16 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 316 41 066
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUA CE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CA DE S TION.
Signature `�" Date 5/23/2016 Issued by:ALEX VALLELUNGA J
Date:5/23/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. 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)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.'1044,Business&Professions Code). Date:5/23/2016
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. I 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 equipment 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 Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 1
Owner or authorized agent:
APPLICANT CERTIFICATION Date:5/23/2016
1 certify that I have read this application and state that the above information is CONSTRUCTION TION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(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
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 5/23/2016 Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
CUPERTIMO (408)777-3228• FAX(408)777-3333•buildlnq(d-CUDertlno.Orq
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❑PLUMMINIG ❑16ECRANICAL LECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS a��►3 t�ar-��h�Ov1J S I APN n
O\RERNAME v1V�C�1TC�`S I PHONE( ��1(}Z{ _ a E-NiAII l/L�lX
STREETADDRESS CZW CITY, STATE,ZIP r- %014 F.A3
CONTACT NAME PHONE
STREET.ADDRESS 1^t CC) CITY,STATE,ZIP ,f q - FAx
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❑ OR'A`ER ❑ OwNmR-BUILDER ❑ MER AGENT ONMACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TEN.ANT
CONTRACTOR NAME S-'fjti �' C I LICENSE NTU11BER c2, qtr 5 LIC TYPE I BUS.LIC O Fz--Q
COMPATYNAME NIS� �o,C71�is E-MAIL SUNY-QA C't G� OlQ I. CGryi I FAX (7-(5q)
STREET.ADDRESS v�[ r (n �� p ?�`a( CITY,STATE,ZIP yo,
r I cj `T 1 9 ec/o PHONE -r
ARCMTECT/ENGIN,EER NA-1,E LICENSE NUMBER BUS.LIC
COMPAI\Y NA4E E-TLML FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT LN WILDLAND ❑ 5-.S PROJECT IN ❑1'7ES IS THE BLDG AN ❑ N-ES
BUILDING: ❑C01,SIERCLAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOT.E? ❑ NO
DESCRIPTION OF WORK
paq1'^ f�ryl FV, _n -{.d I_.�C4
TOTAL VALUATION: RECEIVED Bl
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the ope , owner' 'ehal£ I have read this
application and the information 1 have provided is collect. I have read the Description of'Work and verily it is accurate. I agree to comply Nvith 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 of Applicantrkgent: � _ Date: �D -f3
SUPPLE-NIENTAL INFORA4ATION REQUIRED \` .z OFtZCE L1SE:01\Ll ;
OVER=TkE OU\TER;;
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SMOKE I CARBON MONJUXIDE ALA 6OWNER Ct"MAf
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COMMUNITY DEVELOPMENT DEPARTMENT. BUILDING DIVISION
V�T10300 TO:RRE AVENUE• CUPERTINO,CA 95014-3255
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(408)777-3228FAX(4'08)777-3M33► buildingcupertino.org
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FURPOSIE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for �
compliance with 2013 CRC Section 8314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections ate required.
1
GEINMA L INEORMA7[I ON
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 {
$1.000'.001 CIBC Section R,314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoamide Alarms be installed in the following locations:
AREA
SMOKE ALARM CO ALARM
r0g-rntitevery
side of each separate sleeping area in the immediate vicinity of the X X
room(s-
level.of a dwellin unit including basements X X
h each sleeping in room
Carbon Mionoxide alarms are not required rn dwellings which do not containf uel-burning appliances and that
do nut l�a}ve =;,,attael ed garage'. Carbon rino oxide alarms combuned with smoke alarms shall comply with
CBC Section 420.6 and sluff be approved by the Office of the State Fire Marshal.
Power Supply:ha dwelling units with no comm ewial power supply,alarm(s),may be solely battery operated.
In existing dwelling t outs, alarms are permitted to b,e solely battery operated where repairs or alterations deo
not result ino the removal of wall and ceiling finis-Ices or there is no access by means of attPc, asernent or crawl
space.Refer to CRC Section R314 and CBC Sections 90.7.2.11.4 and 4201.6.2.An electrical per<<it is required for
alarms wh ch,must he coiulected top the building wiriing.
As owner of the above-refereznced p operty,Illereby certify that the alarm-(s),referenced above hasfhave been
installed in,accordance with the manufacturer's instructions and un compliance with.the Calnfoxnia,Buil li-ag
and Caltfonn'a Residential.Codes.The alarms have been tested and are operational,as of the date signed
below.
have ready andi agree,fa co m- r . a.nd c ndrtions.of this statement
____ ,.fit hatUf�;y!:° .............. ... .... ... ........ ......... �,.:..... ....... f..
Y -- I Sgnat te. Lac Date ..................ii
I
WATER-CONSERVING PLUMBING FIXTURES MF LL
OWNER CERTIFICATE OF COMPLIANCE1 {
COMMUNITY DEVELOPMENT DEPARTMENT•'BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408 777-3228•F (408)777-3333-building(a?cupertino org -
wnerName IGS--V M— ( Perini#No.
1. Is your real property a registered historical site?
❑/es Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. j
Ob 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 riot 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.
O No Go to Question 3.
3. Is water service permanently disconnected for your building?
V❑ ' s 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?
i
El
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.
YesMy real property is built and available for use or occupancy on or before January1, 1994.
LJ Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. 1Pl,ese check ONE of the following:
CP" 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).
El' 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).:
CI 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 110 1.1
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 age. ,.
Owner or Owner Agent's Signature Date
Upon completing and signing this Certificate,please r rn it e Building Division in order to final your building permit.
SB407 2015.doe revised 08126115