B-2016-1954 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1954
21691 LOMITAAVE CUPERTINO,CA 95014-5910(357 17 023) ALTERNATIVE
POWERAND
ELECTRIC
BOULDER CREEK,CA
95006 `
OWNER'S NAME: MAYHEW STEVEN AND JEANETTE DATE ISSUED:05/16/2016
OWNER'S PHONE:408-605-3084 PHONE NO:(408)605-3084
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ELECTRICAL Lic.#639615
Contractor ALTERNATIVE POWER AND ELECTRIC Date 03/31/2018 X BLDG X ELECT —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:
REPLACE MAIN ELECTRIC PANEL(200 AMP)
I hereby affirm under penalty of perjury one of the following two 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.
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. Sq.Ft Floor Area: Valuation:$1000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 357 17 023
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 pe upe i Municipal Code,Section 9.18. 180 DAYS FR LED INSPECTION.
Signature Date 05/16/2016 Issue A N
Date:05/16/2016
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
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 ofApplicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:05/16/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
z. 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 M ' ipal de,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Section 5 5,2 d 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:05/16/2016
I 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 05/16/2016
GENERAL PERMIT APPLICATION MEP
ELI] COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MISC
(408)777-3228• FAX(408)777-3333•buildingPcupert!no.org
Cl.1PER'1"INC3 (3 r ��
❑
PLUMBING
1' P ❑MECHANICAL [:]ELECTRICAL ❑MISCELLANEO
PROJECT ADDRESS Z
OWNERNAMc I L 1 ••1 PHO / E-MAIL (�
STREETADD$FS; ; � (\y p CITY&AT IP FAX
CONTACT NAME
r` ' PCRI {�, b0
STREET
r E-MAIL.
STREET ADDRESS CITY,STATE,ZIP / J" —1 FAt_
❑OwNER ❑ OwNER-BUHAER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER El TENANT
CONTRACTOR NAME ` � LIC E It g LICEI�ySE TYP ) BUS.LIC AZ 7e7
COMPANYA1�,\t `t�Je S D ,nA „I t E-MAIL (� c�C
STREET DRES ''`"'1 C L� nn �l II CITS��6TAT-E.1ZIP� r �
ARCHITECT/EN ER NAME w �! LIC ENSENUMBER v1G{[�I /( ` BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN W ILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBANINTERFACEAREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
i
By my signature below,I certify to each of the following: I am the property owner or authorized ad nt to a on the per ner's behalf. I have read this
application and the information I have provided is correct. I have read th De of Work and verify it is a agree to comply with all applicable local
ordinances and state laws relating to building constructG . I on
eprese ves o Cupertino to enter the above-identifiedpropertyfor inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENT INFORMATION REQUIRED y OFFICE USE ONLY
W D OVER-THE-COUNTER
_ EXPRESS
U
STANDARD
LARGE
1EPMiscApp_2011.doc revised 06/21111
SMOKE I CARBON MON OXIDE ALARMS
�.
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
C'U'PER TINI10 10300 TORRE:AVENUE: CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333 buildinp(@cupertino.org
Ave 2o 10
I"URPOSI
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.
GVNMAII,INFORMATION
Bxistiing single-family and multi-family dwellings shallbe provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions,alterations,or repairs to existing dwelling units exceeds
r
$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 X
bed r-orn(sl
On every~level of"a d'tiv61tfhg,.unit including basements X j
Within each sleeping roam X
Carbon Monoxide alarms are not required m dwellings which do not contain€zel-burning appliances and that `
do not Have an attached gar.age. 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 com -�ercial power supply,alarm(s)may be solely battery operated.
In existing dwelling units; alarms ar.e permitted to be solely battery operated where repairs or alteratioxs 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 R3I4 and CBC Sections 907.2.11.4 and 420•.6.2.An electrical pernut is required for
alarins wlticll must be connected to the building wiring.
As owner of the above-referenced property,Ihereby certify that the alarm(s)referenced above hasfhavebeen,
installed in accordance with the manufacturers instructions and in compliance with the California Building,
and Ca z E fo k iia Residential.Codes. t h e alarms leave been tested and are operational, as of the date signed
below.
it have read and a rea to coni l with tf e t and conditions of this sfafemenf
W AFiC
....... t:,Dae _5:..
S q`nafure .......... ................
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3 28•FAX(408)777-3333•building(a�cupertino.otq I
Owner Name f e,_)c ✓ CcA/, Permit No. '20/6
Address'!al G q 1
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply.: Skip the rest of the,form and sign bottom of form.
,, tK 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?
El 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.
K 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 of the form and sign bottom of form.:
W No Go to Question 4. '
4. Is your real property built and available foryse 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-.-
vil Cade.Sections-1-101:1--through-1101.8"apply. Check one of the three following statements and sign
_ ~ Cibottom of form..
5. . Please check ONE of the following:
�kb 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,"Al on-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures t9oughout the building(regardless of whether property undergoes alterations or
irnprovements).
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 CivilCodeSections 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-cons plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature:% Date:
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB40 7 2015.doc revised 08/26/15