B-2016-2323 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2323
22355 RANCHO VENTURA ST CUPERTINO,CA 95014-2772(357 01 073) FULMER ELECTRIC
SAN JOSE,CA 95124
OWNER'S NAME: VANDER KOOI JUDITH TRUSTEE DATE ISSUED:07/15/2016
OWNER'S PHONE:408-446-1936 PHONE NO:(408)410-5279
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#945805
Contractor FULMER ELECTRIC Date 04/30/2018 XBLDG 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 AMP);SAME LOCATION
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.
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:$2500.00
APPLICANT CERTIFICATION
1 certify that 1 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 357 01 073
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agre o save indemnify and keep harmless the
City of Cupertino against liabil' es,judgments,costs, nd expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said Ci a consequence l th granting all
this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant nderstands and will ply with all non-point
source regulations per - Cupertino Munici ode,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 07/15/2016 Issued by:PAUL O'SULLIVAN
Date:07/15/2016
R- ER D TI N
Ihere affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
folio g 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 ofAppiicant:
contractors to construct the project(Sec.7044,Business&Professions Code), Date:07/15/2016
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. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. 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 e/Air
ces which emit hazer us
air contaminants as defined by the Baty Managemen rstr'Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cul Code,C er 9. and
exempflon,I become subject to the.Worker's Compensation provisions of the the Health&Safety Code,S533,a 5534
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:07/15/2016
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 and state laws I hereby affirm that thereis a tSstruction tling agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this perm' 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 07/15/2016 professional
GENERAL PERMIT APPLICATION
COMiMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION M EP
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERT[NC3 (408)777-3228•FAX(408)777-3333• buildingg cueertino.org misc.
❑PLU-N BING ❑MFCFLANTICAL. [2-ELECTRICAL ❑MISCELLANTEOUS
PROJECT ADDRESS APN 1
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OWNERNA?ME PHONE
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E3 OVER ❑ OWNER,.BUIIAER ❑ OW'?\TERAGEnT ❑ CONTRACTOR ❑CONTRACTOR,AGE.NT ❑ ARCHITECT ❑iTG12NEER ❑ DEVELOPER ❑ TE AAT
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USE OF ]K SFD u DUPLEX ❑ MULTI-FAMILY PROTECT LN W ILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑l tS.
BLILDII.G: ❑COMMERCIAL LY.BALNInT'ERFACEAREA ❑ NO FLOOD ZONE ❑NO EICIILERHOME^ ❑ NO
DESCRIPTIO: OF R%ORT
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TOTAL VALUATION:
By may si_natere below,I certify to each of the fo�ll wing: lam property owner or authorized agent to act on the proper},owner's behalf, I have read this
application and the information I have provide dfis correct. I ha ' r��e✓ad�Ie Description of VJo k and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin_s to builonstruc6on. I uttuxnze representatives of Cupertino to enter the above-identi�fi^e-dpro e fy for inspection purposes.
Signature of Applicant!Agent: / Date: "Z7 4 J
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INFOR>\4ATION REQUIRED
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COMMUNITY DEI�ELiOPMENT!DEPARTMENT>BUIL=DING DIVISION
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affidavit is a self_cernfication for the installatiaii of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CIBC Section 8314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access.for
inspections are required.
l xistm 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 wellin
p $ •dg units exceeds
$7.000'.90;CIBC Section 83.74 and C,8C Sections 907.2,11.5 and 4-20.6 require that Smoke Alarms and,/Or Carb
1vIonoxide Alarms be installed in the following localio�% s: ari
At2A S1G10'J€(> �;ilLAtT C0 AtA RMM
(DUt'5,ildeof each separate sleeping area in the immediate vicinity of the x
On eves leek of a dweYlin unitincluclrr :lasernerits
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Carbon: Ylortoxide alarrris are nat re a sired rn dwelbn. which rc ontairi
q g h h do not c fuel+burning appliances,and:t<<a
donotItiave n attached arae e. CarbonMonoxide alarins combine with sm ke alarms s1a,l compI�y wilt,
CBC Section 42.9.6 and shall be approved by the Office of the State Fire 1v mshal.
P'owe�e S�ppIy In dwe`Iing,uini is with no,commercialpotwer,sufpply,alar- ( )�;nay solely tier:y operated..
e . b3
Iru existWig,dWvel7ing.i uots; alamms,are permitted tap b-,e sol0:battery operalted where repairs or alteratio-zs,clo}
not resurlt m,they removal of wall aittd ceili�gig,finishes,ox theue is ino,access by means of attic,b aseme��t o�cra,vl
space.,Refer to)CRC`Sectioani 13314 amd CBC Sections 90!7".2..1.1.4 and 420 6.2..An electrical per m t pit is.regru'=e d,tor
aTa,xms.which must b ei eoi-in,rected to the b u,ildimg wr_rRi fv
As owner of t;,e above refereineed[pi,aperty,.I lnereb-y certify that the `arin(s).referenced abovelna ? avebe i2.
i�stalled m accordance with;the rr awafacturer's instz.ctions aamdit eempl ance wi+th.the California;B'uil'di!Ltig
and CaBfo,mwi,a:Residen=tial:Codes.I ke alt arrins have b,e, tesited ai2d are oreratiozeal,as:of the d,at,e slgzzecl
b.el'o .,
t have3readtandta: ree f' corn,l>,with tFie t?er wzand.c4nditrc�ns of'fhrs st :#eme t'
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WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
CO'MMUN'ITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(4,08)777-3228•FAX(408)777-3333•building(cDcupertino.org r
_Z3 2-3
1'ernitt No Z®t'�
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.
I�J 01"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?
❑ 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.
12 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.
ID FT"No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
El 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.
0"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:
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 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 indicated in the
table on the following age.
Owner or Owner Agent's SignatuLrre: Dat
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SE4072015.doc revised 08/26115
NOLAN
1227 Fairview Ave
BUILDING San Jose, CA 95125
6 • �. y'ur 4+ ,. nr'' f F,,?:r rr;rlrr jr ,f Iy,'.... r.'M' r^y'/_.r' rv`rJr,".iffrl.,r rur+lt .r.r:u. ri a:.✓_M :v'is jv'w,
To: City of Cupertino
Location: 22355 Rancho Ventura Street
Cupertino, California
Date: August 9, 2016
This is acknowledgment that Nolan Building and Design installed lathe
paper and stucco in accordance with State and Local codes.
Craig Nolan,
Nolan Building and Design
License # 897342
nolanbanddmail.co