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B-2016-1967
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1967 940 ROSE BLOSSOM DR CUPERTINO,CA 95014-4216(359 06 027) AFFORDABLE WATER HEATERS AND PLUMBING INC 28358 CONSTELLATION RD VALENCIA,CA 91355 OWNER'S NAME: RAO PATNALA D AND VINUTHA D TRUSTEE DATE ISSUED:05/18/2016 OWNER'S PHONE: PHONE NO:(855)345-9087 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: \ License Class PLUMBING Lie.#627368 Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date X BLDG —ELECT —PLUMB 09/30/2016 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. REPLACE 50 GALLON WATER HEATER SAME LOCATION I hereby affirm under penalty of perjury one of the following two declarations: (GARAGE) 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. 2. 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 Sq.Ft Floor Area: Valuation:$1700.00 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 06 027 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 regulations per the Cupertino Municipal Code,Section 9.18. �- Issued by:Patricia Garcia Signature Date .Date:05/18/2016 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 1. I,as owner of the property;or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date: contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 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 2. 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 Code,Sections 25505,25533,and 25534. 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: be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 and will comply with all non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18. Licensed Signature Date Professional �J 05/1712016 13:42 (FAX) P.0011001 Wank GENERAL PERMIT APPLICATION MEF COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPEFiTII G1 (408)777-3228•FAX(408)777-3333•buildincIO)cupertino.om M I E"li C &,P-LUMBING [_]MECHANICAL QELECTRICAL []MISCELLANEOUS PROJECTADDRESS O 1 Q ' 0 Y . ANN N :55(q_ 0 1 _ OWNER NAME Q a PITONS A O 8 &MAIL t`J 8 4 O - �tS STREETADDRESS CITY, STAT IP y FAX G o 5 2 ��S�ow� tu^ e�-qI pv�-, of '50 CONTACT NAME �S ID- PVC �'f f 10 E-MAIL C r,�i 1 - W ( STREET ADDRESS l CITY.SPATE,ZIP FAX e3s8' Gan �- I 10 10., (.�} q 13SS q_q CS ID ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 96NTRACTORAGENT ❑ ARCHITECt' ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACrORNAMLICENSENUMBEI LICENSE TYPE BUS.LIC d� C kfln COMPANY NAMEL'-MAIL FAX a 01 o " e STREETADDRESS CITY;STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC if COMPANY NAML E-MAIL FAX STREET ADDRL•SS CITY,STATE,ZII' PHONE USE OF FDcr DUPLEX ❑ MUL'rl-FAAJILY PROJECTINWILDLAND ❑ YES PROJECT IN ❑YES I&Tr1EBLDGAN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑ NO DESCRIPTION OF WORK o w a � r �-e at.e r am !� C 61 " A TOTAf_VALUATION, r✓:RL•F' 61?>~u;l3 -y'_igi ii2!=c�"::_. _ - - _ - _ _ By my signature below,I ertify to each of the following: T am the property owner or authorized agent to act on the property o\per'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 representatives of Cupertino to enter the above-identified properly for inspection purposes. Signature of Applicant/Agent: i Date: cS SUPPLEMENTAL INFORM TION REQUIRED iaR MEPA-fiscApp_2011,doc revised 06/21/11 SMOKE]GA 80N iKON E OWNED:CEFF.IFICATEOF COMPLIANCE IFILE i; odd t f �<S —LL # COMMUNITY DEVELOPMENTDEPARTMENT>BUILDING DIVISION 10300 TORRE,AVENUE-"CUPERTINO,CA195014-3255 (40'8)777-3228 FAX('408)777-3333 buildSmg it cwpertino.org �-� ��5�.'. i� lis'S2�'� �- -•--. 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. G NERAL NPOI-MATION, 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 8014 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locatiotns: AJEA SMOKE ALARMCO Al AAIZ Outside of each separate sleeping area in the immediate vicinity of the X X laedroorn(sf-- On ever level.of a dwelling unit including basements X X Within eaclt sleeping room y 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 sIt-all coinply with CBC Section 420`.6 and shall be, approved by the Office of the State Fire Marshal. Power Sup pl'=.y:In,dwelling units with no commercial power supply,alarm(s)inay be solely battery operated. In existing.dwelling uiuts, alarms are perm,itted to be solely battery operated,where repairs or alterations do not result rn tie removal of wall and ceiling finishes or, there is no,access by means of attic,basement or crawl space°.Refer to CRC Section 8314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical per, is-required for Alarms.which must be co erected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarin(s)referenced above has/h ive been installed in accordaitce with,,the manufacturer's instructions and in compliance with.the Catlilfornia Building and Cal forrvia=Residential Codes.The alarms have been tested and are operational:,as of the date signed below. 1'have read and,a lee to com l: with;the terms and c©ndttions©f this sCatement 7 ......................... 3 baCe, tQ� ......... ......... ...Lr- +. Dafe — -m, WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION CUPERTiNO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building a().cupertino.org Ovine Nmne�` A.-1 N A '1-- A � , P, PSD I Permit No. Z-D Ito 1 .167 f 4 P (C L te-) G a 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. 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. � / 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. (� 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. i- ._ 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). 0My 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 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 pluinbing 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 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. Owner or Owner Agent's Signatu , Date:_ Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08/26115