B-2016-2213 CITY OF UPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2213
21979 OAKDELL PL CUPERTINO,CA 95014-1104(326 39 004) FUTURE VISION
REMODELING INC
VAN NUYS,CA 91406
OWNER'S NAME: SHERWOOD CHRISTOPHER R AND RACHEL M DATE ISSUED:06/24/2016
OWNER'S PHONE:408-833-0900 PHONE NO:(800)485-4919
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic.4221840
Contractor FUTURE VISION REMODELING INC Date 04/30/2018 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:
REPAIR DAMAGE IN SHOWER PAN;REPLACE SHOWER DRAIN-
I hereby affirm under penalty of perjury one of the following two declarations: MASTER BATHROOM
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 Lab�r Code,for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurancd,as provided for by
f� Section 3700 of the Labor Code,for the performance of the work for which this
/ permit is issued. Sq.Ft Floor Area: Valuation:$3000.00
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 relatingto building construction and hereby authorize 326 39 004
9 Y
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 ijhis 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. 8. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6 2412 1 Issued by:Abby A,eY nde
Date:06/24/2016
OWNER-BUILDER16ECLARATION
I hereby affirm that I am exempt from the Contractor's License La1w for one of the RE-ROOFS.-
following two reasons: I 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 inte ded 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(Sce.7044,Business&Plrofessions Code). Date:6/24/2016
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 Laboi 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 ork 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 p�rmit 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 rovisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions o r this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:6/24/2016
I certify that I have read this application and state that the above information is CONSTRUCTW<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 the performance
relating to building construction,and hereby authorize representa ives 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 applant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I 1 understand my plans shall be used as public records.
Licensed
Signature Date 6/2412016
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
1
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildinaCcDcupertino.org
CUPERTlNO �l( MISC„
LUMBING ❑MECHANIC [:]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS Lj� J� �� APN# n�
OWNER NAME D ' PHONEQ1Uu a EMAIL y� ✓(hv�S L�
STREET ADDRESS // ` 0�// CITY, STATE,ZIP r� f19 Lf FAX
CONTACT NAME O� 7� t-(� PHONE JG,R/ �� O (v�iJ E-MAIL
STREET ADDRESS ��/S w � 'W71 CITY,STATE,ZIP � FAX
❑OWNER ❑ OWNER-BUILDER `Y WNERAGENT ❑ CONTRACTOR ?�4 TTRACTORA ENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME `!(��n IJICENSE NUMBER �t/L�� ,L LICENSE TYPE BUS.LIC#
COMPANY NAME L E-MAIL _D6/'!13L FAX /
STREET ADDRESS I CITY,STATE,ZIP /�� PHONE C10 1L v6- fe4/
ARCHITECT/ENGINEER NAME �ENSE BER ' BUS.LIC# '1
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
I
USE OF El SFDorDuplex ❑ Multi-Family P�OJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial ITBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ NO
DESCRIPTION OF WORK r �N �/
TOTAL VALUATION: 3�) RECEIVED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner'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 auth 1 representatives of Cupertino to enter the above--ide iifiedypro
rtty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL O �ON REQUIRED orrtcE;USD oxiY
w I OVER-TH&COUNTER
”'F EXPRESS
0,STANDARD
Us
Z_
❑ LARGE'r'r
`❑ MAJOR-`
MEPMiseApp_201 Ldoe revised 03116/11
'I.
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
Gi'iE1"1 1.0300 TORRE AVENUE•CUPERTINO,CA 05014-3255
(�08)7�—� 7732(�•FAX(4 08)777-3333•building(aDcupertino•org �`
Owner Name i 6 on 2/ 6� Permit No. f� J
Address ��k��E �` lR.'t�N �L� l�f
1. Is your real property a registered historical site?'
1 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?
1 Yes Civil Code Sections 1.101.1 through 1101.8 do not apply.
❑-.Thelicensed plumber's certification has-'oeen provided-tq the.Blailding Division'. _
Skip the rest of the form and sign bottom of form.
fX No Go to Question 3.
3. Is water service permanently disconnected for your building?
1 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? j
i
C 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 acid sign bottom of form.-`
Yes Code Sections 1101.1 through 1101.8 apply.cChe k one of the three�following 9tatele'nts an J
My property p Y D' '
° 'Civild sign ..
bottom pf form..
5. Please check ONE of the following: i
.My property is a single-family residential real property. See Civil Code Section 1101,4. j
On and after January 1, 2014,building alterations or improvements shall require all non-compliarif 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).
1 My property is a multifamily residential real property. See Civil Code Section 11011.5. }
On and after January 1,2014,specified building alterations or improvements shall require non-
-7
on-- lumbir' fixtures to be re'laced with water=conservif- lumbo fixtures.
p g p�� gp g
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 no
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 pripffo date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101:81 current California Plu _ g Code and California Green Building Standards Code,and n anufacture`r'
installation requirements,and that the w er_ ons.ry g plnbing fixtures comply with the.requirements as indicated in the
,a
table oil the'following page. t --
Owner or Owner Agent's Signature: Date:
Upon completing and signing this Cert ate,plea eturn it to the Building Division in order to final your bui ding permit.
SB4072015.doc revised 08126115
SMOKE /CARBON MONOXIDE ALARMS
OWNED CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION'
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
PEITIi
(408)777-3228 FAX(408),777-3333-buildinapcupertino.ora ,
Permit No.
p
e h #of Alarms Smoke: Carbon Monoxide:
Address. D/�C1s`6LFL(.� t1k
PERl�IIT ANNCiT I3Er LNr�LED AN',CrQMPLETEi)LTI TIL T II GERTWCAT
k ESN L A7D FibE$iILDI< G IaI �IiN°
PURPOSE
This affidavit is aself-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 j
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 CSC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
SMOKE ALARM CO ALAR11vt
-�
AREA
X X
rZ
ide of each separate"sleeping area in the immediate vicinity of the i
bedroom(s) _ —very level of a dwellin unit including basements
X -�_J
Within each sleeping room
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:Indwelling 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
7.
not result in the ren�aval of wall-and coiling.finiishes`or=there=s=no accQssby means-of attic,basementor 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 a ree to comp l e terms and conditions of this statement
Owner(or Owner Agent's)Name: /
...._...... Dat 1. {°
Si natur
_Contractor Name: � rp�j p��1 �
Si nature. .. :.... ...................
Lic.#.`9 ONA U...:...........Date: .... ...
j.
Smoke and Co form.doe revised 03118114