B-2016-2226C
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2226
21726 NOONAN CT CUPERTINO, CA 95014-5912 (357 19 069)
M F A
CONSTRUCTION
SAN JOSE, CA 95136
OWNER'S NAME: LIN ROBERT AND LUO WENDY
DATE ISSUED: 06/28/2016
OWNER'S PHONE: 408-218-1019
PHONE NO: (408) 509=3461
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class A B Lic. #564782'
Contractor M F A CONSTRUCTION Date 94130/2017
X BLDG _ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
_ MECH X RESIDENTIAL _ COMNIERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect,
JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations:
DEMO SWR4 IING POOL (FOR LANDSCAPE POSES
ONLY)
I have and will maintain a certificate of consent to self -insure for Worker's
�1.
'6�C6mpensation, as provided for by Section 3700 of the Labor Code, for the
J} performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Cf
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $6000.00
APPLICANT CERTIFICATION
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
and state laws relating to building construction, and hereby authorize
357 19 069
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 ISN
T STARTED
may accrue against said City in consequence the granting of this permit.
Additionally, the applicant understands and willl ' comply wnon-point
WITHIN 180 DAYS OF PERMIT ISSUANCE
OR
source regulations per the Cupertino Municipal Cod , ection 9,18.
180 DAYS FROM LAST E
SPECTION.
Signet_ n ��� Date 6/28/2016
Issued by: Alex VallelunEa
Date: 06/28/2016
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 be
ng installed. If a roof is
1• 1, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection,.I agree to rem
we 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. 1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 6/28/2046
I hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
I ROOF COVERINGS TO BE CLASS "A"
R BETTER
..
_
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 DISCLO
;URE
z. 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, 25513,
and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Cod
, 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
Dr handle hazardous
shall not employ any person in any manner so as to become subject to the
material. Additionally, should I use equipment or devicei
which emit hazardous
Worker's Compensation laws of California. If, after making this certificate of
air contaminants as defined by the Bay Area Air Quality
will maintain compliance with the Cupertino Municipal Code,
Management District I
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: i
APPLICANT CERTIFICATION
Date:/6 X8%201.6 ___ -1
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING E
CY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agen
y 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.
Signature Date 6/28/2016
Licensed
Professional
SwimPoolApp_201 Ldoc revised 03116111
SWIMMING POOL / SPA PERMIT APPLICATION
,,.
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
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PROJECT ADDRESS �72 r _ IV N, g iy C 1—
APN # /Z4�
OWNER NAME D �.% / L! [f mobfr L'I 'I,
PHONE&j, 10
E-MAIL
STREET ADDRESS 72_ ( {� p
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CITY, STATE, zip � B� FAX
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CONTACT NAME ./ �� a
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PHONE
E-MAIL
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❑ OWNER ❑ OWNER -BUILDER ❑. OWNER AGENT M CONTRACTOR El CONTRACTOR A+G�ENT ❑ ARCHITECT ❑ ENGINEER ❑ DEvEioPER
❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
EL710ENSZFTYPE
BUS. LIC #
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COMPANY NAME N /l FA / , /ri/t L2 (ya L 1 1
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
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STREET ADDRESS -
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK t
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USE OF FD or Duplex ❑ Multi -Family
TYPE
MATERIAL TYPE (CODE)
AREA (SQ. FT.)
VA
LUATION ($)
POOL
STRUCTURE: ❑ Commercial
POOL/SPA MATERIAL TYPE CODES: SPA
h
V - VINYL -LINED
F -FIBERGLASS DEMO
G - GUNITE f
VE, gq4
P - PREFABRICATED R�ECEIE� Yom" TOTAL V
ATION:
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read this
By my signature below, I certify to each of the following: I am the property authorized agent to act on the property owner's behalf. I have
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 a
plicable local
ordinances and state laws relating to building construction. I authorize. representatives of Cupertino to enter -the above -identified property for inspect
on purposes.
Signature of Applicant/Agent:� Date: r
SUPPLEMENTAL INFORMATION REQUIRED
x
_ Commercial or Multi -Family Buildings with Public Swimming Pools;
Health required.
Department of Environmental approval
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RE VIEVt E� s R t��3t�EEG�3iUii�LlA�9CE
SMOKE I CARBON MC' ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
CIIJ Pit RTIN (0 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 a FAX (408) 777-3333 - b-U-H1di-r!Q0cuDerfino.ora
rul'Mjbt
T1 -d5 affidavit is R; self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013CRC Section R314,2013 CBC Sections 420.6 and 907.2,11.2 where no interior access for
inspections are required,
GENERAL INVORMAT101i
Existing single-family and multi family dwellings-shallbe provided with Smoke Alarms and Carbon
Monoxide alarms, When the valuation of additians, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC. Section 8314 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:
I �MR�i4 CF A
A AM
Outside of each separate sleeping the X
ity of the ,
bedrep-m(s) X
2t-ty level of a dwellin& unit includingbasements
X
,j.Wi!hm each 8ILeLing 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) maybe solely battery operaled..
In exist dwelling units, alarms are permitted to be solely battery operated where repairs or aIter atiolqsdo
not resWin the removal of wall and ceiling finishes or there is no access by means of attic, basement ar crawl
space. Refer to CRC Section R3-14 and CK Secti6ns 907.2-11.4 and 420.6-2. An electrical permit is required for
alarms whir% must be com, aected 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 manufacturers instructions and, in corn- pliance with the Califainia -Blu-.1
dinS
and Calif orrda Residential, Codes. The beers tested and are operational, as of the date signed
below.
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WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT= BUILDING DIVISION
10300 TORRE AVENUE * CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build1ng&cuoertino.orq
1. Is your real property a registered historical site?
C�,,- 2-27- 6
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
N_ JV No Go to Question 2.
2. Does your real property havc a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation ofwaler-conserving plumbing fixtures is not technicallyfeasible9
O Yes CivilCode 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 fon- and sign bottom of form-
No
ormNo 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:
t 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).
❑ 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
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or unprove-ents).
I, as the owner or owner's agent of this property, certifyunder p natty ofpc�lury thatnoa compliant plumbing fiatures will lie
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-conservr plumbing fixtures comply with the requirements as indicated in the
table on the following : page:,,_
Owner or Owner Agent's Signature: 1Jaie= , f
Upon completing and signing this Certificate, please r it o the Building Division in order to final your building permit
SB407 2015.doc revised 08126115