B-2016-2100 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2 100
21386 AMULET DR CUPERTINO,CA 95014-1301(326 43 017) ALLSTAR PLUMBING
CORPORATION
SAN JOSE,CA 95112
OWNER'S NAME: ZIMMERMAN ARLENE S TRUSTEE DATE ISSUED:06/09/2016
OWNER'S PHONE:408-739-7094 PHONE NO:(408)282-7020
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class PLUMBING Lic.#732611
Contractor ALLSTAR PLUMBING CORPORATION Date 02/28/2017 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:
REPLACE SEWER LINE-FOUNDATION CLEAN OUT
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.
�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
permit is issued. Sq.Ft Floor Area: Valuation:$7000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 326 43 017
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 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 Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6/9/2016 Issued by:AbbyAyende �p9,�p�
Date:06/09/2016 I�JINme,�
OWNE -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(Sec.7044;Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/9/2016
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. 1 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
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making 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
be deemed revoked. Owner or authorized agent-
APPLICANT CERTIFICATION Date:6/9/2016
1 certify that I have read this application and state that the above information is CONS16 U TION LEND 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 6/9/2016 Professional
pw GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUP>=RTtNt} (408)777-3228• FAX(408)777-3333• buildinOCCDCuoertino.org I I S C
PLUMBING ❑MECILANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS I `�, 11„—� r APN# 32(o
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STREET ADDPESS g` p SA V t� fiY• CITY, STATEE,,ZIP FAX
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CONTACT NA14E � • PHONE�jog) �3cpy E-MAIL
STREET.ADDRESS rI E 1 g1 C` Qel
CITY,STATE,ZIP ` t 1 FAX
¢y C'AIKER ❑ OIAINTM3 BUILDER ❑ OW^.�'h AGEN' ❑ CONTRACTOR ❑CONTRACTOR AGENT J❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TEN.AXT
CONTRACTOR NAME /1{� LICENSE NURSER �3 2/ Cr S tTYP BUS.LIC# 72 rj 01
COMP.ANYNAAME 1111J�1 r I E-MAIL �. V FAX 1 _{
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STREET ADDRESS 1530 13 t rr y 4 s5 A A - / CITY,STATE:ZIP s q� C)4- 75/„HONE (14DS)25/-60,90
kRCM TECT/ENG➢\ZEER N.01E LICENSE NUMBER BUS.LIC r
COMPANY NMISE.. E-MAIL F.AX
STREET ADDRESS CITY,STATE,ZIP PHONE
liSE OF ❑SFD.,DUPLEX ❑ MULTI-F,*4MY PROJECT IN,WILDL.AND ❑ YES PROJECT IN ❑YES IS THE BJ.DG AN ❑ 1T 5
BUILDLNG: ❑CO7vLV,ERC1_AL URBAN 11.'TERF'ACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? ❑ NO
DESCRIPTIONOF WORK
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CdAecce-J to A-t✓.C_ e2u%5�,�1�. faunoufi M .
TOTAL VALUATION: �t O V'D RECEIVED Bl
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property ov,ner's beh ]f. I have read this
application and the information 1 have provided is collect. I have read the Description of'Work and verify it is accurate. I agree to comply Nvith all applicable local y
ordinances and state laws relating to building construction..1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicantCkgent: x0a_
C Date: d G
UPPLENIENTAL IINIILORA4ATION REQUIRED OFFICE LSE.ONLl ";, ;
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AZEPA�iscApp_?011.doc remised 06/21/11
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERT NO 10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a)cupertino.org
Permit No.201
Address ti1J U I(t ts /' #of Alarms Smoke: CarbonMonoxide:
PE2MIT CANNtJT B FINALD ANp CMPL�TED'U1TZL PHIS CERTIFCA I R
1 yi��X./9✓/ { 5
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:
7 -r 01 t Si na re.....,,r: ' L 2!. ............................................Date:!•/7
Contractor Name: f
Signature...................................................................Lic.#......................................Date: ...................
Smoke and CO form.doc revised 03/18/14
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
j 777-3228•FAX(408)777-3333•building(a)cupertino.org
Owner Name .�! _i't 2 a [n1 a)4 Y�,;r W'A N Permit No. ll
Address / I"U �Zn � !rte I � V� E7 V'�I t'1��/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.
Ki-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?
Q 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.
QTNo 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.
®.-,fes 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:
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).
El 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 plum ing fia tures.
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 S ction 1101.5.
On and after January 1,2014,specified building alterations o 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 110 1.8,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 age. f
Owner or Owner Agent's Signat rre:,zzi 444 fi t (9 Date: �1-16-1
Upon completing and signing this Certificate, e return it to the Building Division in order to final your buildindpermit.
SB4072015.doc revised 08126115