B-2016-1989CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1989
21450 COLUMBUS AVE CUPERTINO, CA 95014-4971 (362 05 003) WATER HEATERS
ONLY INC
GRASS VALLEY, CA
95945
OWNER'S NAME: NATARAJAN BANGALORE RAND PADMINI DATE ISSUED: 05/20/2016
OWNER'S PHONE: 408-202-7322 PHONE NO: (800) 835-8345
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC -36 Lic. #374573
Contractor WATER HEATERS ONLY INC Date 05/31/2017 X BLDG —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:
WATER HEATHER REPLACEMENT (48 GALLONS) - OUTSIDE
I hereby affirm under penalty of perjury one of the following two declarations:
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.
z: 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.
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 liabi' ies, judgments, costs, and expenses which
may accrue against said Citypp consequence of the granting of this permit.
Additionally, the applicant uriqbrstands and will comply with all non -point
source regulations per the pertinjo Municipal Code, Section 9.18.
Date 5/20/2016
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)
z. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
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.
z. 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 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 5/20/2016
Sq. Ft Floor Area: I Valuation: $1500.00
"N Number: Occupancy Type:
362 05 003
t
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALL D MPECTION.
Issued by: Alex Vallelunea
Date: 05/20/2016
RE -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: 5/20/201
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 equip nt or devices which emit hazardous
air contaminants as defined by the Bay Ar Av Quality Management District I
will maintain compliance with the Cuper Municipal Code, Chapter 9.12 and
the Health & Safety Code, S& &U05505,25533, and 25534.
Owner or authorized agent:
Date: 5/20/2016
CONSTRUCTION I
I hereby affirm that there is a constructi
of work's for which this permit is issued
Lender's Name
Lender's Address
lending agency for the performance
ac. 3097, Civ C.)
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
40300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC
CVPrRTIPl07 (408) 777-3228 • FAX (408) 777-3333 • building aC)cupertino.org'a--2olb--IC4-f
❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ki�&�(4 �--�,4,12Z
LICENSE NUMBER3 7'-t!9-7
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CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND El
URBAN INTERFACE AREA ❑ NO
PROJECT IN ElYES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: ' V
RECEIVED BY:
By my signature below, I certify to each of the following: I a he property owner or authorized agent to act on the prope own 's b have read this
application and the information I have provided is correct. I e 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. uthorize representatives of Cupertino to enter the above ified °roperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTA F RMATION REQUIRED
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MEPMiscApp_2011.doc revised 06/21/11
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SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE.
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(a)cupertino.org
f �-a 1Lf-
Address 2 { 9 (0 LU11413 6'S C&'PC0t1V# of Alarn
5-2—C&-/�Sj
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 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
bedroom(s)
X
X
On every level of a dwelling 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 42-0.6 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,c`rawl
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 with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
+h +ate +ar,,v mnr1rnnr1h ns of this statement
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Owner (or Owner Agent's) Name:
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Si nature ..... ............ ......... ...Date`f'.Ae!/l"�'.
Contractor Name:
Signature....................................._............................. UG.# ...................................... Date: ...................
Smoke and CO form.doe revised 03118114,
WATER -CONS'ERV'ING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
12 COMMUNITYDEVELOPMENT DEPARTMENT •'BUILDING DIVISION
CUPERTINO 10300TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 - building(o-cuoertino org ,,,,_,,_� 3
Varve ___ �1 �, �0)°E AJA-T A PA-r-A,iv�' Permit No.----
A�ess `` 2f L S b "L V `�3
1. 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.
ED ! ' 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.
Z 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.
M No 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 1, 1994.'
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
Ej 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. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
1 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 properly undergoes alterations or
improvements).
El My property is a commercial real properly. 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 page.
owner or Owner Agent's Signature: t 1 ` ' ' ` `v — rate: v r
UDon com>7leting and sinning this Certificate, pleas return it to t& Building Division in order to final your building permit.
SE4072015.doe revised 08126115