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B-2016-2686CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2686 22268 BELLEVUE AVE CUPERTINO, CA 95014-2703 (357 01 094) MOOMAU PLUMBING SAN JOSE, CA 95118 OWNER'S NAME: YESSNE PETERAND GAIL B TRUSTEE DATE ISSUED: 09/09/2016 OWNER'S PHONE: 408-257-2010 PHONE NO: (408) 396-3837 LICENSED CONTRACTOR'S DECLARATION { BUILDING PERMIT INFO: License Class C-38 Lic. #792821 Contractor.MOOMAU PLUMBING Date 08/31/2018 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: REPLACE 50 GAL WATER HEATER, SAME LOCATION 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. 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: $1800.00 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 relating to building construction, and hereby authorize 357 01 094 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 this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, th applicant understands and will comply with all non-point source regulaf ns per a Cup ntcipal Code, section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date Issued by: MEL OWNER-BUILDER DECLARATION Date: 09/09/20 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 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: 09/09/2016 I hereby affirm udder 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 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 material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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 provisions of the the Health & Safety Code OS 533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorize APPLICANT CERTIFICATION Date: 09/09/2016 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY I hereby affirm. that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city 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 DECLARATION ARCHITECT'Seas Code, Section 9.18. I understand my plans shall be used s public records. Licensed. Signature Date 09/09/2016 Professional CUPERTtNG GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildim a7cuoertino.ora r-, MEP fr MISC PROJECT ADDRESS ��1 9I� �{ MAX APN T ��' OWNER NAME p F 1\ ` v(l� PHONE ( O%]7 51' 2 D 10LE-MAIL N 1 STREET ADDRESS ��j �j n e y p , CITY, STATE, ZIP � � j{�� /� �N o I (A ( 5 n is FAX j /A ' CONTACT NAME rpi if f ` Y1 ( U U VV�`YCIT PHONE 1 E L iA d W }fit! L W r STREET ADDRESS `� I (-}}Y, STATE, ZIP �j �/I 7 UI , t FAX 1 OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHTTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Q ( t /j A, / v ivi �U P � ` „s b IW UYI(l LICENSE NUMBER�� j /� LICENSE TYPE Lt7� BUS. LIC r COMPANY NAME 1� �� l � U Id EMAIL /��tv4� F� liU-v��'✓ � 1 STREET ADDRESS j� l �i^„ �IVA1 I� , ^ 01 CITY, STATE, ZI /I� j'` n C P V rPHONEARCHITECT/ENGINEER Nv { G NAME LICENSENUMBER BUS. LIC' COMPANY NAME E-MAIL FAX — STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK I In Ntl 5 MUM M infMlll WIPA VIV TOTAL VALUATION: s W, 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 buil construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ,-L ---� Date: CJS/ I q /! La SUPPLEMENTAL INFORMA MEPMiscflpp_M Ldoc revised 03/16111 SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVEL:OPMENI` DEPARTMENT •'BUILDING DIVISION 1.0300 TORRE AVENUE • C;UPERTINO, CA 95014-3255 'CUPERTL01 (4 8) 777=3228 FAX (408) 777-3333 • buildingCo)cupertino•org Address PURPOSE This affidavit is a self -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 r rspectiorts areoquired GENERAL INFORMATION 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 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: AREA SMOKE ALARM CO .ALARM Outside of each separate sleeping area in the immediate vicinity of the X.- . . X bedrooms) Si nature.. ....................Lic.# ...I..ICL.(.l j.......... .�.. _ On every level of a dw_elh unit iMludix basements X X— �— Within ea&csling room X JI 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 CSC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In '' �-units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarrri -_ ermitted to be solely battery operated where repairs or alterations do space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permif 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. thc tarmc and rnnrlitinn.4 of this stateimnt Own owner As) Name - = ate Si oat .... ....... D .:...:. Contractor Name: Date:.1. Ul Si nature.. ....................Lic.# ...I..ICL.(.l j.......... .�.. i Smoke and CO form.doc revised 03118114 CZUPERT 0 Owner Name r}- Address0(Q_ WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 =3228 - FAX (408) 777-3333 , buildingCa-cupertino.org .D 1., t '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 fon-n. E" '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. Slap the rest of"the`foim an sign ttom of form. CSS No Go to Question 3. 3.`Is water service permanently disconnected for your building? ❑ Y),.es 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? Q 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. R Yes, .My real.propertyis 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... S..,PIse 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 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- consei-ving plumbing fixtures throughout the building (regardless of whether property undergoes alterations -or improvements). El 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- onse'rving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101 8, the current Califoriva Plumbin de and California Green Building Standards Code, and manufacturer's installation requirements;" and'that the water -c ns v'' g plumbing fixtures comply with the requirementsas indicated in the table on the following page. Owner or Owner Agent's Signature I V �. Date: `—� , °T Un— rmmniptinv and gifl„iny this Certificate_ please returil it to the Buildine Division in order to final your building pe t. SB4072015.doc revised 08126115