B-2016-1998 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1998
20213 NORTHCREST SQ CUPERTINO,CA 95014-0511(316 37 006) GLEN GILBERT
SAN JOSE,CA 95154
OWNER'S NAME: YUE LIN DATE ISSUED:05/23/2016
OWNER'S PHONE:408-996-3737 PHONE NO:(408)377-9990
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-42 Lic.#677475
Contractor GLEN GILBERT Date 09/30/2017 X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
PROPERTY LINE CLEAN OUT REPAIR OFF-SET AT POINT OF
I hereby affirm under penalty of perjury one of the following two declarations: CONNECTION APPROX Y FROM CLEAN OUT AREA-CUPERTINO
1. I have and will maintain a certificate of consent to self-insure for Worker's SANITARY
Compensation,as provided for by Section 3700 of the Labor Code,for the
5 Ci 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 perfonnance 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 37 006
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 ISSUANCE 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 CALLED INSPECTION.
Signature Date 5/23/2016 Issued by:Abby yende
Date:05/23/2016
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)
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: 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
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
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. 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 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
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 5/23/2016 professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(g cupertino.org MISU
CUPERTf NO (p
❑PLUTABMIIG ❑MECHAMCAL [:]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESSf APN n
ki 14
O\\RvERNA?4E PHONE Q 31 E MiAM co
in
STREET ADDRESS 52
= I I
l Vd S st s CITY, STATE,ZIP Cl FAX
CONTACT NAME V L p-VPHONE E-ZAH
STREET ADDRESSU - CITY,Sian. O f (A �� FAk
1 ` y r
❑ OWNER ll OWNER-BUILDER ❑ OWNERAGE.'T jd CON'T'RACTOR ❑cON`TRACTORAGENT El ARCHITECT 13 ENGINEER ❑(J DEVELOPER ❑ TE.ANrr
CONTRACTOR NAM 4LICgSE LICIEETYP BUS ICS �/� -
COMP.AA'Y NAME E-MAIL F !+/
!W Zod
STREET D SC Y,S ATE,ZIPS C / I PHOA D
Lr 9'FP PLT
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC'
COI\IPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND' ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BLIMDING: ❑COMMERCIAL URBANI INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
rl r �[��Thr 15- .t/ 'r
Gr r� 0 A fi (= 07fd
CID 11\
TOTAL VALUATION: RECEIV0 Bl c
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property 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 epresentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: ��2 3
SUPPLEMENTAL INFORMATION REQUIRED
C
':...:.r•.:. D..,EaPRESS e° �;r `` �� � :;
1 {(`3'A
Ui
< '
�. x� J•1AJOR
A1EPA1iscApp_2011.doc remised 06121111
Northpoint Homeouuners Association 10880 Northpoint way,Cupertino,CA 95015
May 19,2016
Donovan Lazaro Planning Intern
City of Cupertino Community Development
10300 Torre Avenue,Cupertino,CA 95014
RE:20213 Northcrest Square,Cupertino,CA 95014
Dear Mr. Lazaro;
Please disregard the letter sent by Maribel Cervantes as-it was sent in error due to a misunderstanding.
Northpoint HOA grants Able-Septic to move forward with obtaining a permit to perform repairs at 20213
Northcrest Square,Cupertino,CA 95014. Please forward copies of the permit for our records,thank
you.
On behalf of the Northpoint HOA,
Zayra Yves,General Manager
Northpoint HOA
10880 Northpoint Way
Cupertino, CA 95014
Office:408-996-3734
Fax:408-996-0226
email: manaser(@northpointhoa.com
10800 Northpoint Way;Cupertino,CA 95015
nianager(a northpointhoaxom
Ii
SMOKE I CARBON MONOXIDE ALARMS HLE
OWNER CERTIFICATE OF COMPLIANC �1
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333-buildina(a)-cupertino.org
1
Acv j Permit No. -ZOO,- 1 etoo/
Address #of Alarms Smoke: Carbon Monoxide. "
PE T CA�TOT`BE F'111NALED ,, CONI%%TED TNTIL TH1�' CERTI 'TGATE
S BE - A RETURNED TO THE$U " 1NG 1VISION
k ti
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and C on Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
i
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 X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X J
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- urning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke arms 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 wher 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 wi the California Building
and California Residential Codes.The alarms have been tested and are operational, as of the date signed
below. a
have read and a rea to comp!2 with the terms and conditions of thi statement
Owner(or Owner Agenfs)Name:
i.� $, � ��1.� ® Si nature........ .j............ .......................................................................................Date: .
Contractor Name`.
Sinature..................................................................:Lic.#.....................................Date: ...................
Sm ke and CO fonn.doc revised 03118114
i
WATER-CONSERVING PLUMBING FIXTURES FIL
OWNER CERTIFICATE OF COMPLIANCE , &AE
]Ebmc I
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
DUPER It 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333• buildingPcupertino.org
Owner Name s_f LA Permit No. �qr
Address 3 t47`r Lr T
I. 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.
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?
❑ 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.
No 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 indsignbottomof form.
No Go to Question 4.
i
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.
d Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form d sign bottom of form.
Yes My real property is builtand 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 follow' g 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- ompltant 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 on-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 w ater-
conserving plumbing fixtures throughout the building(regardless of whether property unde goes 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 r on-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 alteral ions or improvements).
1,as the owner or owner's agent of this property,certify under penalty of perjury that non-com pliant 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 rec uirements as indicated in the
table on the following page. ® !
Owner or Owner Agent's Signature: Date: i
Upon completing and signing this Certifica e,please return it to the Building Division in order to final your building permit.
SB40 7 2015.doc revised 08126115