B-2016-2185 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2185
7899 ROBINDELL WAY CUPERTINO,CA 95014-5076(362 19 025) THE PLUMBING GUYS
SAN JOSE,CA 95127
OWNER'S NAME: PREETHAM ARCOT J AND KRISHNAN MEENA \ DATE ISSUED:06/22/2016
OWNER'S PHONE:408-389-9544 PHONE NO:(408)637-1682
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class_Q Lic.#982128
Contractor THE PLUMBING GUYS Date 03/31/2017 X BLDG,_ELECT X PLUMB
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
license is in full force and effect. JOB DESCRIPTION:
(I)WATER SERVICE FROM METER TO HOUSE
I hereby affirm under penalty of perjury one of the following two declarations:
2. 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.
n z. I have and will maintain Worker's Compensation Insurance,as provided for by
S. tion 3700 of the Labor Code,for the performance of the work for which this
p emit is issued. Sq.Ft Floor Area: Valuation:$2700.00
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 62 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 362 19 025
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 PERMI SUANCE OR
Additionally,the appli nt nderstan�arrci ulrill comply with all non-point
source regulatio n perCup 6i Municipal Code,Section 9.18. 180 DAYS FROM LAS C SPECTION.
Signaturd/ Date 6/22/2016 Issued by:Alex Vallelungaa
.' Date:06/22/2016
O R-BUILDER DECLARATION
I herebyaffirm that I am exempt from theontractor'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)
2. 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:6/22/2016
I hereby affirm under penalty of perjury one of the following three'declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 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
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
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 Cup no Mumci a ode,-ehipter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Co , ec'ons 05—,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized en
APPLICANT CERTIFICATION Date:6/22/2016
I 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 thp rformance
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 6/22/2016 Professional.
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GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228 a FAX(408)777-3333•building(ci_)cupertino.org
Isc
CUPERTINO 6-20[(y" �z (ism
�O L MBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN# r„ZJ9 O`�
OWNER �Lvl PH E-MAIL
STREET ADDvI„i
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� CITYATE, / N u ` � FAX
CONTACT NAA 1 - � NE/n 7 )�/y � E-MAIL
STREET ADDRE �'f CTTY,STA ((/ZIP / �k i ZF 7 FAX
WNIIt ❑ OwNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR CONTRACTORAGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT7� w LICEN LICENSE T �E BUSo
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COMPANY NAIL
STREET AD7r7S el
/��,� CIT TI�ZIP
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD Or Duplex Y,i!Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: REC>IVSD BY
2
By my signature below,I certify to each of the following: I am th city o er or authorized agent to act on the property owner's behalf I have read this
application and the infonnation I have provide ' rrect. I e read the Description of Work and verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil ' g co ction. esentative%of Cupertino to enter the above-identified prop e for inspection purposes.
Signature of Applicant/Agent: Date: fp L Z 7/ `
SUPPLEMENTAL INFORMATION QUIRED of F cqs
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OVER HE-COUNTER
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x STANDARD`
'MAJ„OR ri
MEPMiscApp_2011.doc revised 03/16/11
IQSMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT.•BUILDING DIVISION f
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildingicDcupertino.org
l9fllffl P/a �N�
Permit No.
0
Address �� #of Alarms Smoke: G Carbon Monoxide:
"flPRTANOT � Ln A1�CrQMPI�]GTEI�tTztax CERTIk�CATE
S ANS 2ETIIRNE i r uzx � IS O,"
,T y
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide klarms,for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior ccess for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-familydwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs"to existing dwelling unil s exceeds
.x$'1000.00,CRC Section 8314 and CBC Sections 907.2.11.5 and 420.6 requirethat Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA. - SMOKE ALARM CC 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 co ply 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 batter operated.
In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alter itions 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 hasy 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 s fined
below.
I have read and agree to comply with the terms and conditions of this statement
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Owner(or Owner Agent's)Name: %22-/16
9C0� Pit signature ..,..._.. .. i ..... ate: /. .......
__—
Contractor Name:
Sinature...................................................................Lic.#......................................I late: ...................
Smoke and COform.doc revised 0.3/18/14
WATER-CONSERVING PLUMBING FIXTURES '
OWNER CERTIFICATE OF COMPLIANCE IF
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION'
10300 TORRE AVENUE CUPERTINO,CA 95014-3255 j
(408)777-3228•FAX(408)777-3333 building(a)cupertino.org
Owner Name AkCDT R �M Permit No.
Address 794TI Ra B 11vD L t_ k1 A Y-, C V fERT l YV'0 , Co 9SCD 14-
1, Is your real property a registered historical site?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
QrNO Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property oi 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 form.
`v 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.
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;
4Z 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 plumbin 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 plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conseiving plumbing fixtures throughout the building,(regardless of whether properly undergoes alterations o
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or irnprovements 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- cons rvmg
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 Indic ited,lin the
table on the following page.
Owner or Owner Agent's Signature: Date: � 2� leo
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08126/15