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B-2016-1974 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1974 19936 PEAR TREE IN CUPERTINO,CA 95014-2319(316 31 006) GLEN GILBERT SAN JOSE,CA 95154 OWNER'S NAME: UYEHARA RICHARD S AND DANIELLE TRUSTEE DATE ISSUED:05/18/2016 OWNER'S PHONE:408-252-1296 PHONE NO:(408)377-9990 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class SANITATION SYSTEM 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: i REMOVE&REPLACE(E)PROPERTY LINE CLEAN OUT;AND I hereby affirm under penalty of perjury one of the following two declarations: REPAIR OFFSET ON OUTLET PIPE 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. 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 ermit 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 31 006 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 ainst said City in con quence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additional! the pplicant understa s and ill co ly with all non-point source regulat' p he C, C, i Mu ' ip C Section 9.18. 180 DAYS FROM LAS AL ED SPECTION. Signature Date Issued b :Alex Vallelun a 9 �� Y � Date:05/18/2016 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(See.7044,Business&Professions Code) z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(See.7044,Business&Professions Code). Date:5/18/2016 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 a. 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 device which emit hazardous air contaminants as defined by the Bay Area Air Quali anagement District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the r' Municipa d hapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co ,5e on 2 05, 5 3 nd 53 Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:5/18/2016 1 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 5 181 /� Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinpC�cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/11 ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ` J J R Q� APN# r OWNERNAMEO p -Zs-Z ' STREET ADDRESS Q 2 :dtAwe I a,A CITY�STATE,ZIP CA- 15-0(4 FAX r CONTACT NAMEQ �, v� kr je �f. MI6 PHIL • ^ '�®p O E L �1_ l�• '�4 STREET ADDRESS t -n ST�ATJE,ZII� Q ,0 LLO FAX C ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 0 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOF R 0 = ,-- LICEN �` LICEZ! T BUS ;#40 COMPANYNAMEAVE-MAVe6 �� `I•�R� FA Q/[Q,n' ICO%l STREET ADDRES O V CTE,Z CA- Y "' t c) P c7C1, -I l'Lob Close ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX -V 11 1 1 N I J A f I VIV r 13 STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK rte. • ally' --5 VA EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: DETACH ❑ATTACH N DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY TOT VALU ON: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized agent tollact o the pro erty owner's behalf. I have read this application and the information Mi-aN%provId,cd is correct. hhave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t b ildi ons ctio . auth r eentatives of Cupertino to enter the above-idefn(ttified roperty for inspection purposes. Signature of Applicant/Agent: Date: (�• SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for p OYER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS, ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. LARGE ❑ FHIE DEPT , _Copy of Planning Approval Letter or Meeting with Planning prior to El 'MAJOR- El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp 2011.doc revised 06/21/11 WATER-CONSERVING PLUMBING FIXTURES F OWNER CERTIFICATE OF COMPLIANCE 1 09 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING'DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ( 08)777-3228•F (408)777-3333 buildingc( cuper ino.orq Oivne 4Na re GG(GC �frt t,ta'�= -- ,Permit No. f i 1. Is your real property a registered historical site? OEl Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. L"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 forma L 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 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? ❑ 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. 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: C 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). ❑' Myproperty 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). ❑ 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). 1,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 datespecifred 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 requirements as indicated in the table on the following page. 0 P r Owner or Owner Agent's Signature: Dat 1 l� D l Upon completing and signing this Certificate,please return it to the Building Division in order#oL:_,final our building permit. t—--S-BB407 2015.doc revised 08/26/15