B-2016-2057 CITY OF OUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2057
7988 SUNDERLAND DR CUPERTINO,CA 95014-4914(362 11 03 ) ALTAP ELECTRICAL
SAN JOSE,CA 95160
OWNER'S NAME: NAG DEBASHISH AND USHA DATE ISSUED:06/01/2016
OWNER'S PHONE:408-406-5515 PHONE NO:(408)309-8290
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class CC-1'0 Lic.#692291
Contractor ALTAP ELECTRICAL Date 07/31/2016 X BLDG X ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapte 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Co a and that my
license is in full force and effect. JOB DESCRIPTION:
UPGRADE PANEL(200 AMP)SAME LOCATION
I hereby affirm under penalty of perjury one of the following twodeclarations:
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 Lab r Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insuranc ,as provided for by
J!" Section 3700 of the Labor Code,for the performance of th work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$2200.00
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 362 11 034
Number: Occupancy Type:
and state laws relating to building construction,and hereby aut,orize 362
representatives of this city to enter upon the above mentioned r roperty for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expel ses 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 per the CupertinAo,�Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature ate 6 Issued by:Abby A ey nde
Date:06/01/2016
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 a i 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 ini ended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting wit licensed Signature of Applicant:
contractors to construct the project(Scc.7044,Business&Professions Code). Date:6/1/2016
I hereby affirm under penalty of perjury one of the following thr a declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-in ure 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 Insuranc ,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 th 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
Iair contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after mak'I g this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall 17—,—
be deemed revoked. Owner or authorized agent: YCif7� �x�
APPLICANT CERTIFICATION Date:6/1/2016
1 certify that I have read this application and state that the abov, information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances ar d state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize represe tatives 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 aga nst liabilities,
judgments,costs,and expenses.which may accrue against sal City in Lender's Address
consequence of the granting of this permit. Additionally,the ap licant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S a DECLARATION
u
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 6/1/2016 Licensed
Si
9 Professional
I
GENERAL PERMIT APPLICATION
COMMUNITY DEVELO [HENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228• FAX(4)8)777-3333 buildincCaDcuoertino.org M I
CUPERTINO CK)C6
❑PLUTBING ❑NIECIiANICAL e'PLECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 7
p q i`j S ' APN n 6' (q
OWNERNAME zC S \5 I PHONE L� E-M,Am
STREETADDRESSCITY,STATE,ZIP J FAX
CONTACT
S'u,,der fa,d fin CuP.r F,ti.d
CONTACT\.A-ME /�� I � P NE E-AZAIL
STREET ADDRESS i CITY5,STATE,ZIP �O F.AX
? / ��G✓"d a c� if'� a � S-e i cfl-9 x/20
❑ OWNER ❑ OR NcR-BUII D R ❑ Obi NER AGENT 131011TRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGI EER ❑ DEvELOPER ❑ TEN.A_NT
CONTRACTOR NAME j LICENSE NUA4IBER LICENSE TYPE BUS.LIC
'b/ec�F r►C� 62 2 2 91 0 2(�2�
CO\4PAI�Y N,Ab1E E-A AIL t l� I FAXL� � �leG�r� �C�u���eC f r � cct ce
STREET ADDRESS CITY,STATE,ZIP PHONE
3/ /c✓ao� Ue -ttaS e10�pg 3 a 9_�`2�9 0
ARCHITE'_T/E.NGLNEERNAME LICENSE NUMBER BUS.LIC r
C OMPANY N AME E-?JiAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF L SFD.,DUPLEX '❑ MULTI-FAMILY PROJEILT LN wIlALAN'D ❑ YES PROSECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: El COMMERCIAL I LRB.4���II.TERFACEAREA ❑ NO FLOOD LONE 0:70 EICHLERHOME? [] NO
DESCRIPTION OF WORK D� _ �J (J, fops--
r LL•L� -ems---
.
TOTAL VALUATION: 2 Q }tECEIVED Bl ;
By my signature below,I certify to each of the follo� ink: I am the property owner or authorized agent to act on the property owner's behalf. I have read ibis
application and the information 1 have provided is collect. I hay e read the Description of.IA,ork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I au horize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant�kgent: Date:
SUPPLEMENTAL INFOR-1 IATION REQUIRED OFFICE LSE.`01\L1
h
❑ 01 ER THE-COU'�TER� > ?
� ❑ EXPRESS* � ,y� s'.
❑ STAN'DARD���` r c r; •.
❑ A AJOR' n
A'fEFA?isc,4pp_0JJ.doc revised 06121/11
SMOKE / CARBON MONOXIDE ALARMS FILE
OWNER CERTIFICATE OF COMPLIANCE _--T
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 5A
10300 TORRE AVENUE�'CUPERTINO,CA 95014-3255
ctiprERTINO (408)777-3228•fAX(408)777-3333•buildingAcupertino.org
�t CA:pu w� Permit.No. 0/ z e s-?
Address #of Alarms Smoke: Carbon Monoxide:
PERMIY CA TOT BE Z I LES,AND+COMPLETED UNTO TIIIS CERTIF1C �E
E �
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 X X
bedroom(s)
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 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)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 crawl
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.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Date.Si nature: : ......... ..... .:�.
Contractor Name:
Signature...................................................................Lic.#......................................Date: ...................
Smoke and CO form.doc revised 03/18/14
WATER-CONSERVING PLUMBING FIXTURES F1 LE
OWNER CERTIFICATE OF COMPLIANCE 6_ ; .� 1 I
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPiERTI NO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingAcupertino.org
Owner Name rAc1Y�a a te\ cl r�'f Permit No. '2 C '
-7 t p
Address d '9 9 �D ��C eta/'.2
1. Is your real property a registered historical site?
❑ iYes 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.
El 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?
El 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.
9/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:
Er 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 property undergoes alterations or
improvements).
❑ Myproperty 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 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 Signature: tF Date:
Upon completing and signing this Certificate,please're rn it to the Building Division in order to final your buil ing rmit.
SB4072015:doc revised 08/26115