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B-2016-2503 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2503 1072 WALLIN CT CUPERTINO,CA 95014-5089(362 18 058) ALLSTAR PLUMBING CORPORATION SAN JOSE;CA 95112 OWNER'S NAME: KING LIONELAAND ROXANNE F TRUSTEE DATE ISSUED:08/12/2016 OWNER'S PHONE:408-472-2497 PHONE NO:(408)282-7020 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class CC-36 Lic.#732611 Contractor ALLSTAR PLUMBING CORPORATION Date 02/28/2017 X BLDG ELECT X 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: (N)DESIGNATED GAS LINE FOR FUTURE BBQ IN REAR YARD I hereby affirm under penalty of perjury one of the following two declarations: 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. 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:$1500.00 APPLICANT CERTIFICATION 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 362 18 058 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 all this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations pert G' ertino ,un' ipal Code,Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION. Signature% wi Date 08/12/2016 Issued by:MELISS Date:08/12/2016 ER- DER DE L N I hereby affirm that I am in t from the Contxa 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:08/12/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. 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. 1 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 Cupertino [I Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec' s 5,2553 and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent. z e APPLICANT CERTIFICATION Date:08/12/2016 - -- I certify that l have read this application and state that the above information is TR NDIN AEN Y correct.I agree to comply with all city and county ordinances and state laws I hereby affirm t herb-ls a construction lending agency for the pert ante relating to building construction,and hereby authorize representatives of this city of work's for 046h-this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Na"e 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 08/12/2016 Professional GENERAL PERMIT APPLICATION E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333 building(d)cupertino.org all cuP>�R-�INc� PON I S C PLUMBING ❑MECHANICAL ❑ELECTRICAL QMISCELLANEOUS PROJECT ADDRESS APN /" A OWNER NAME G!la%� I`�`/lL✓ PHOI\Tr�,Cy) Y7e, r Y?7 E-MAIL, STREET ADDRESS CITY, STATE,ZIP _ 1 F.AJ s eFie'fl tca e I CONTACT NAME �s PHOIS � EMAIL STREET ADDRESS CITY T((TE,ZIP FAX 111NER El OWNER-BUILDER ❑ OWI�TERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER �❑ TENANT CONTRACTOR NAME �S LICENSE NUMBER `, t LICENSE TYPE ?/& BUS.LICA 'J' ` y COMPANY NAME E-MAIL (� / FAX !— ` V / STREET ADDRESS 3 f CIT Y.S ZIP r Se C f 5ps// PHO �� )_ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC€ COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF Z SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE L7 Yes ❑ No DESCRIPTION OF WORK /v<n �.z'1✓�..�-,�,�,�.. r�� �—� Is 0 TOTAL VALUATION:. By my signature below,I certify to each o,,,frrthe'fol ing: 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 Provide 's 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 torildin construction. 2oTiZe representatives f Cupertino to enter the above-identified property for inspection proposes. Signature of Applicant/Agent: ------ Date: �r PPL MENTAL&FORMATION D OFFICE IISE aNLY W THE-COTi"NTER U XRGE " ar D;r1LAJOR � MEPMiscApp_2011.doc revised 031.16111 OMER�CEIZ MA (OF COMPLIANCE 1 2CUMM"UU-CITY'D�EtVEL'Of�MEt�T'DEPARTMENT B!BUILDING:DIVISIO'N Vv-VERTU NO10300 TO:RREAVEttJE�CU�EIT(N"O,GA 95014 3255 (408k)777-32: 8 ID':FAX f(4��8)777-3333 D��il�Iu�<,(�c�i�p��ino ora Ulis aff ldavit is a self-certification for the installation of aII requrred Sntol�e and Carbon Monoxide Alarms for cornplzance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for zztspectFant 9 are required. GENUAL INFORMATION PEN-1,s-t,Ong sli�gl'e farm y amd Multi-family dwellings shall be provided with,Smoke Alarms and Carbro IMloymo-�Xfde ala-rns When the valuation of additions,alferatW7ts,or re airs to existirc dwell' t; P g trig units exceeds X10'0'0'00;CKC Section 14314 and C is Sect* is 907 2111.5 algid 420.6 require that Smuke Alarms avd{ot Cal loin Wsez Alarm&be itrts4talted the followr-g local@,- AREA ; S., ,Gklt AtA I CO)AI Ou+t`std;e a1�each separate sleeping area in the irn�aedi aEhe�iccn�fy o£the-- �c ®`n egeII t1q�L-i©lx a�dwellim d t i , _.. _ unt�� ncludin baserment`� f V-'I each sfee=iaz-room ! r Cazbm U @,XM'e ailaffl&are not regUiired j, dwel.NM whfch da rzat comitai infuer-burning a illlanM and th d=g not k-ame amu a"taclnled garage Cal rinonaxicle alfa ms;co=i bYmed�wzith sh al e alarmrs sT�i++ l(1 eo p w CB1C SectioYl?42.0`6 and ANalll be aTpwaved by the Office of the Butte Hire Mars, Powe�Sn{= 1 dwell} i� Umits with w� catthnierIII pp y g - pbw'ey,suipp�ly„alar=�(s)1 ina�y b�s©Iel`+�b� er�opera�e'ct., I t exist gig dhoeilll ca rts;ala renis are}perz lifted to b)e s��ldy.battery operated,�,,-hele,z;epai ot, afilte�ag,@ dna? no t resua tl e remao a=l ofi'wa=lt aZ d cetl e f�xtn Sol,there1 its L1o>access,b g y tree.ma,of.,attic,lae,.{eriaf or ca#anr,ll space Refer tv,CRC Sectzoiha ROM aulct CBC Secfiotns 901.2..271.4 artd 420:6..2..An eliectrrcal per=}�tt is re cylx�e�l fog alari is vfi cls mmst.1?.e mi ed to,the bul wirnr . As owner of the above-rei?exemced property,,I Thereby cer.0y.,tkat the al'ann(s)referenced above Jasha e been{ msfiaIled k, uk aecut au L,,2,el witth-the ,,!aiiimIa,cturer`s,irestcDion6s at=n°di ill co pkamnce wwij Y the CalSHorn}iaa B:u�illzb =.>dz Ca1h,4 Res der<tza3l Costes.The almmsheave Ueeinatested aid ar=eY operaEiaylalx as of tyl e date sigge.d� b:elawr., r m If have readf ands a a vee o;cora carnth;h. r terms na c©ndif on,s,aFtfii';st.Gernet P F ., - ,.._� ��tt l i� lv 1 m�nat�re� ... D to WATER-CONSERVING PLUMBING FIXTURE ,a> OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT s BUILDING DIVISION CUPERI'1 90300 TORRE AVENUE-CUPERTINO,CA 95014-3255 (408) 77-3228-FAX(408)777-3333-buildin4ta�cuaer ino.or4 tt Owner Name `0 -L i is � Permit N o2 d 1 b � S(� Address A kL A U tit M 0 eft � S a 1 1. Is your real property a registered historical site? El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. P"'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? D 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. No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑des Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign.bottom of form. t LN No Go to Question 4. 4. Isy ur 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, 1904. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Ll, ❑ 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.. r-- 5. PI/ase check ONE of the fallowing: My property isa,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 pluinbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures. shall be replaced: with"water- conserving plumbing fixtures,throughout the building(regardless ofwhether property undergoes alterations or improvements).. 1,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 a d California Green Building Standards Code;and manufacturer' installation requirements,.and that the water-co erviii plumb' aures comply,with the requirements as indicated in the table onthe following page.e. Owner.or Owner Age ' Si nature 1 Dat J, i1 22- .. i 9 g ­ Upon completing and signing.this Certificate,plea e return it to tRe,Building Division,in order to final your building permit.. SB407 2015.doc revised 08126115