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B-2016-2042 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO-B-2016-2042 843 LILY AVE CUPERTINO,CA 95014-4210(359 03 010) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS,TN 38120 OWNER'S NAME: GUPTA SADHANA R TRUSTEE DATE ISSUED:05/27/2016 OWNER'S PHONE:408-253-4586 PHONE NO:(901)271-9700 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL ENGINEERING CONTRACTOR Lic.#765155 Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG _ELECT X PLUMB Date 07/31/2016 _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 JOB DESCRIPTION: license is in full force and effect. BUILDING CLEANOUT 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. I have and will maintain Worker's Compensation Insurance,as provided for by VSection 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2910.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct.I agree to comply with all city and county ordinances 359 03 010 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CALLED INSPECTION. source�egulations per the ertino Municipal Co�Sectflo�n9.18. Issued 5/2 Abby Avende �� t,�Signatur7 Date:05/27/2016 l OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for inspection. r. 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) Signature ofApplicant: i. I,as owner of the property,am exclusively contracting with licensed Date:5/27 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty ofperjury 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the i. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I 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 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety CoC7=— be 4. 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 Owner or authorized agent' deemed revoked. Date: 27 APPLICANT CERTIFICATION CONSTRUCTION LENDING.A ENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION I understand my plans shall be used as public records. and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed GENERAL PERMIT APPLICATION NIEP COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION A = v 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 CUPERTI'hiO (408)777-3228 w FAX(408)777-3333-building(a)cupertino.org Wil S W.; V a0L_ELP2 LUMBn,1G ❑MECEkNICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECTADDRESS �V APN n O WNERNAME L,_\p+0 PHONE oc�� c� L� E-MAIL STREETADDRESS .J V� CITY, STATE,ZIP b G C Sb1 FAX CONTACT NAME PHONE E-MAIL ? STREET ADDRESS )nv) �� 0� 1 CITY,STATE,ZIP --ja vk v c nll > FAX ❑ O"AWER ❑ OWNER-BUILDER ❑ O-MNI'ERAGEN'T CONTRACTOR ❑CONMACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT COINTRAC70R NAMELICENSE NUMBER LICENSE TYPE BUS.LIC 4 ��S – Scc— 7 coC 1 - (2 C Lj 2 A COMPANY NAME E-MAIL FAX CA 0 STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER N I.6E LICENSE NUMBER BUS.LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT N WILDLAND 0 PROJECT IN ❑YES IS THE BLDG AN 0 E BUILDING: ❑COI`B,gRCIAL I URBAN A1TERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORKLA-A,t0tkl TOTAL VALUATION: l RECEIVED �t� l LJ By my signature below,I.certify to each of the following: I am the properly owner or authorized agent to act on the property ownerls 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 representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED s OFFICE USEONLl ? x�F L,z EaPRESS 5 'z. A,fEPA1isc11pp_201].doe revised 06/21/11 SMOKE / CARBON MONOXIDE ALARM E OWNER CERTIFICATE OF COMPLIANCEZ -( COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERT11140 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(a)cupertino.org Address l #of Alarms Smoke: Carbon Mon Dxide: MPLET'ED"IJUNTILT1,H' CERTIF GAT 9AVID G00 } 1 RF k 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 SmokeAlarms and Carb n Monoxide alarms. When the valuation of additions, alterations,or repairs to exisl' g dwelling units exceeds $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 CoALARM 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 Within each sleeping room Carbon Monoxide alarms are not required in dwellings which do not contain fuel burning appliar ces and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall con iply 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)ma be solely batter operated. In existing dwelling units, alarms are permitted to be solely'battery operated where repairs or alte rations 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 ele ztrical 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)refe enced above ha /have been installed in accordance with the manufacturer's instructions and in compliance with the CaliforniaBuilding and California Residential Codes.The alarms have been tested and are operation al,as of the datesigned below. i have read and agree to corm with the terms and conditions of t is statement Owner(or Owner Agent's)Name: 5 r-tb i A <2-a\PTA Si nature 4..... ..... ... . ... ... .a...............................Date. . ............... Contractor Name: // A- R-S F e S cu,e 09 nature. . . . ......Lic.#.. //°'�.....C�..5.�,6 6..Date. . .. 4 moke and COfonn.dok revised 03/18/14 i WATER-CONSERVING PLUMBING FIXTURES FIL OWNER CERTIFICATE OF COMPLIANCE - COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 11V 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPE TING (408)777-3228•FAX(408)77 -3333 building(ftupertino.org Owner Name Permit No. `-` o j 2 Address E- Aj ID 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 o form. `` 00 2. Go to Question 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? 0 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. f XGoo 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 o Fform. 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 form. es 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. Plea e check ONS of the following: y 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 plumb' g fixtures to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,201 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 property undergoes alterations r 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- cor serving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improve ents). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing J fixtures will be replaced prior to date specified above with water-conserving,plumbing fixtures in accordance with Civil Code ections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and man facturer's nserving plumbing fixtures comply with the requirements as ind cated in the installation requirements,and that the water-co table on the following page. Owner or Owner Agent's Signature: Date: P Upon completing and signing this Certificate,please return it to the Building Division in order to final your build ng permit. SB4072015.d c revised 08126115 I