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B-2016-2256 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2256 7728 OAK MEADOW CT CUPERTINO,CA 95014-5201(366 26 012) RAYO REMODELING SUNNYVALE,CA 94089 OWNER'S NAME: DUBEY PRADEEP KUMAR AND MADHURI TRUSTEE DATE ISSUED:07/01/2016 OWNER'S PHONE:4082399666 PHONE NO:(408)773-8526 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CIO Lic.#953378 Contractor RAYO REMODELING Date 10/31/2016 X BLDG X ELECT —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: / I hereby affirm under penalty of perjury one of the following two declarations: UPGRADE PANEL(200 AMPS);SAME LOCATION UNDERGROUND. 1. 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. 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:$6200:00 APPLICANT CERTIFICATION 1 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 366 26 012 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 qOT 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 07/01/2016 Issued by:PAUL O'SULLIVAN Date:07/01/2016 Tpfakz 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 eing installed.If aloof 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 r move 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:07/01/2016 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 DISC OR 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements u der 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 25505,2 5533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal C de,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 de ces which emit hazardous air contaminants as defined by the Bay Area Air Quat ty Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Munici 1 Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Se ions 25505, 533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. -t � Y Owner or authorized agent: J APPLICANT CERTIFICATION Date:07/01/2016 1 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 the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Qv G.) 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'SD LARA N Code,Section 9.18. 1 understand my plans shall be used as public recor s. Licensed Signature Date 07/01/2016 Professional GENERAL PERMIT APPLICATION EP COMMUNITY DEVELOPMENTDEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 UPEFt` INO (408)777-3228•FAX(408)777-3333 buildingfakupertino:ong Isc ❑PLUMBING [:1 MECHANICAL ®ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS -7 s 9 6r6i� / APN# 0 ` OWNER NAME yam'A 0 b6l - - 0 9_3q „i, E-MAIL - STREET ADDRESS CIT ST ✓a ,r, Ar"`l ,g�,�; FAX CONTACT NAMEts P 0-ft � E-MAIL STREET ADDRESS � � 1 v CIT �T � p � FAX ❑OWNER ❑,OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑'TENANT RA tJV 1oft1 L F�NUM _ NSE YP jC)_ BUS.LIC# - r C A NA E E-MAIL FAX DOV-�C r 6 C� s CIT S'A E �P ARCHITFCT/ENGINEER NAME - LICENSE NUMBER BUS.LIC# COMPANY NAME - -E-MAIL - FAX STREET ADDRESS CITY,STATE,ZIP - PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES --_ BUILDING: E]COMMERCIAL URBAN INTERFACE AREA E] NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK - 30 h IS V TOTAL VALUATION: - ,. RECEIVEDBY: By Illy signature below,I certify to each of the following: am the property owner or authorized agent to act on the prdperty owner's behalf. I have read this application and the information I have provide is correct. '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 buildi g c instruction. authorize representatives of Cupertino to enter the above-identified prop rty for inspectio purposes. d Signatnie of Appticant/Agent: Date: C6 a SUPPLEMENTAL INFORMATION REQUIRED OAR I-c UNT it 7777-7777777 - nU � � � LA72GF1. s� MA761i r MEPMiscApp_2011.doe re ised 06/21/11 I '�SMOKE ALARMS TY'IIFIC;e�tt;T"E'OF ,"COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION rX [; 103Q0 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 FAX(408)777-3333►buildin4;(d�cupertino.or4 _ �p T f PURPOSE " Tills affidavit is a elf-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 22113 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access.for inspections are re uired. GtNPRAL IiN,FORMATION BXisting single-faraily and multi-farnily dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions;alterations, or repairs to existing dwelling units exceeds $10001.04, CRC See ion 8314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarm I be installed in the following locations: AREA SMOKE ALARM CO ALARl�hI Outside of each,separate sleeping area in the immediate vicinity of the x �eclroorm(s)' On ever leve ,of a dwelling,unit including basernertts X Within each skegjn, room X Carbon Monoxide alarms are not required in dwellings which do not contavn fuel-buming appliances and that do not.liave ani at ached garage. Carb°on monoxide alarills combined with smoke alarms shall comply with CB-C Sectioi1429. and shall be approved by the Office of the State Fire Marshal. Dower Supply-En dwelling units with no corninercial power supply,alarm(s)i may be solely batfery operated. Ii1 exrs&tiilg,dwell< ,g units;alarms are perrilifted to be- solely baftery operated where repairs or alterations do riot result in the r moval of wall:and cell ng finishes or there is no access by means of attic,basement ar crawl space..Refer to C C Sectloi'l 8314 and CBC Sections 907'.2.11E.4 and 4201.6.2,An electrical per i m F t s.reguired for alarms which rn t st be cotulecfed to the building.wirinlg. As owner of the bove-referernced pzoperty,i 1lereby certify that tl':Ze alarin(s)r referenced above lnas/have been installed in accor arzce with the,imazluf acture,s instructions.Gild in cornpl`.iance with.the CazIiforna Buildislg and Cal fonlia R sidenttal.Codes.The alarms have been tested and are operational,as of the date sighed below. Gh,ave read andf agee to com,1 y with tl:e terms;and'conditions©f this.sfafemenf' 1 ,A .. r� �t riatCrre:�. .<�3ate' 60 ' ZJ tc. atd, r_ i WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CURERT NO (408)77 28-FAX(408)77 33- •buil in cu ertino.or OwnerN ie -'►� Permit No. Ac1clr ss772 Q �tZ- '14)0 s 1. Is your`real pi operty 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. `L 'No G 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? ❑ Yes Ci it 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. =L�No Go to Question 3. 3. Is water service permanently disconnected for your building? 11 .Yes Ci it Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. No Gc to Question 4. 4. Is your,real pi operty 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. Ci it 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. Ci it Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bo om of form.. 5. P ase check NE of the following: Myproperty is a single-family residential real property. See Civil Code Section 1101.4. On and afler 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- compliantplumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether property uirdergoes alterations or improvements). ❑' Myprope is a multifamily residential real property. See Civil Code Section 1101.5. On and aft 3r January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or befc re January 1,2019,all non-compliant plumbing fixtures shall be replaced with water- conserv. plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improve m nts). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and aft er January 1,2014,specified building alterations or improvements shall require non-compliant pluirbing 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-cornpliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 11018,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation re quirements,and that the wa e c serving plumbing fixtures comply with the requirements as indicated in the table on the f)l1owing page. Owner or Own 3r Agent's Signature € Date: Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permr . f SB407 201 S.doc revised 08/26/15