B-2016-3045 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT Nth B-2016-3045
22410 CUPERTINO RD CUPERTINO,CA 95014-1070(326 50 075) RANDO AAA HVAC
INC
SAN JOSE,CA 95125
OWNER'S NAME: GAVIGLIO GINA M TRUSTEE DATE ISSUED;11/04/2016
OWNER'S PHONE:408-872-0827 PHONE NO:(408)293-4717
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C43 C20 Lic.#768871
Contractor RANDO AA A HVAC INC Date 09/30/2017 X BLDG _ELECT _PLUMB
X MECH XRESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing — —
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE ALL(E)DUCT WORK
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.
� i. ;'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:$6428.00
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 326 50 075
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,the applicant understands and will comply with all non-point
source regulations.er the Cu.ertino Municipal Code Section 9.18, 180 DAYS FROM LAST CALLED INSPECTION.
fr
SignatureM Date 11/04/2016 Issue' my;ME ..i.*. – -�
Date: 11/04/2016
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 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:11/04/2016
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
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 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 Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cot e,S`ctions 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall ;
be deemed revoked.
Owner or authorized agen
APPLICANT CERTIFICATION Date:11/04/2016
I 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,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. I understand my plans shall be used as public records.
Licensed
Signature Date 11/04/2016 Professional
N,./..,,,, , . GENERAL PERMIT APPLICATIONm E p
. Ill...TA COMMUNITY DEVELOPMENT DEPARTMENTS BUILDING DIVISION
f,,, ,, 10300 TORRE AVENUE•CUPERTINO,CA.95014-3255
(408)777-3228•FAX(408)777-3333•buildinq@cupertino.orq
CUPERTINO PiO
M I C
0616-30Y.s---
• PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS --PROJEGI'ADDRESS .}d 1,01 .Q APN 2 4 - f 0 ' ` 9
,44-10
O\VNERNAhtE( 1 toot L7C'1 V 9 oil i
� PHON ��((12 ``��� E-M.ATL
STREET ADDRESS "l!u �f I o . ,�ACISTT 4' r I FAX
CONTACT NAME �y //�J/� /�' �7y
f y VCt1 W t. ._.. _.,. PHONF� � � cell
E-MAIL
STREET ADDRESS�9�l /� L A I i n 0 . C -A/per-ring CA 1 1 FAX
❑OWNER 0 OWNER-mama: 0�OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
f CONTRACTOR NAME iiin a LICENSE NUMBER-7 C0 Isi 1 I LICENSE TYP BUS,LIC# $? A
1
COMPANY NAME MA Furna0 E-3AI1,. -
-STREET ADDRESS 11 1/2,
J i e, `. ,CITY,S TE,ZIP ist q5.1
PHON
ARCHITECT.IENGINEERNAME LICENSE NUMBER BUS.LIC d
COMPANY NAME E-MAIL FAX
STREET ADDRESS
m��GQ CITY,STATE,ZIP PHONE
1, USE OF - 1 SFLD'or Duplex 0 Multi Family PROJECT. IN WILOLAND PROJECT IN
STRUCTURE: l❑a Commercial URBAN INTERFACE AREA 0 Yes 0 No FLOOD ZONE 0 Yes 0 No
DESCRIPTTON OF WORK pact \ fO
TOTAL VALUATION: to Ili'2/ 1 RECE[ ED B
Fes.
By my signature below,I certify to each of the following: I am the property owner or authorized agentto act on the property owner's behalf, I have read this-
application End 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 b d.1,11.nstraction. I•u. e representatives of Cupertino to enter the above-i ntifi d property for inspection purposes.
Signature ofApplicantlAgent: '•ffi CAL •1 @
Date: 1 i 7® i
SUP L MENTAL INFORMATION REQUIRED
(® :i CD COU TLR
in EXPRESS
yz O STANDARD
`CARO)
Cl AWWWOR
MEPMiscApp_201l.doc revised 03/16/11
1
A
W flCal '1 .O+X LA N. l0 V U7 W F+ el `. D Pnf7 p
DJ
o
(111 cn
CD C
w O tD 0 3 0 tD O112 N 3 O m
,< s -n O� Q' O D Z 71 to -,+ y -11
N X 0 CD a+ m 3 n 0
5. F a r-
0
3 5' O
= . 3 S y y oD n, p O
013 A ,-^ Q O
N p O c til
o Cr 3 CL D
n`'i m G 3 H C V C CD ..7 Z
vco A =O Q O N y 3 ° = m
a D -c c D .vi
9. rt cDo
. oo N m p cnh cn
C
3
mo v" �p _ C;= p 'a Z vCn W , a 'n C . D
ul
EL o mo G) '4 .P -, O°+ ° m °o cm v - 3(D Oro
. cll...
fD
fD
ru
... O r-O 'S 7- Gn Q A9 � T
0 In
In ^F s o D = 7
m CDD rD tD m -'1?,,,,..
p D
rt W Q y
d
in
7 m D
in
fD -.ro3
p A • ...s v A
.a �,5 .+
I!9 z O CO UC O O CD
CD m 0 N ..+ aiID l rt DJ ,,F- Q
3-6 00. to V ,y
c �. • 0 _ � S
N =
N '_^ 3. a' a .yr N 0 O O O
3 N m 0rt Z O 0 C ^ Z T O -O W 0 3
1 o o0 m 3 V o m S. m ao
N _
1 `r' 3 3 O O-
ui a ti x tin c�D D 3' 5 3 Q D
•
o co
r 00 ° -..•co Po n
m 3s'� ), �=,u~ '; •TS w 7e: r: m a ago
?
0 01
0 Oo m w g
0On
O N asao 0*
o m o �v ':ai
w P� :
' F 3' 0 0. = F°
.
- am ao 3
301
Do c v
En
w D cD o.
~'3, m
3 < C b (D
co m-,L,,,,
i r < 3'
o n .+ '3 Ocm
Z co v '` ,a 0 2.
tn
D 3 CDDoo c
N
m ti
Q 2 N.
m CT
S`<< -0 rp 3 D °
cn .r CD )
N o S o m n p r' A
Q : N .+ (D M Lf C .fl T
fp 2 N O (D N O
[i .+ Q O •f N N 0
W m m C D Q N W O
iiiW C
r-r rnt 0 .Wr m
Lk)I
n!
D A T_ fpD Z. 2.x T , n -n T T 6 T m _ ..
rD OU O O K n N D O N N N C 'N fl7 Q > A
w c. rn . ro m a 70m 3 77 77, 75. a. D m
E rt rt viao � 3 �. KKo EFEm N 3 -
O .� N Qo N N 'N N "" N m O p rN•' Z �•; .... T e
3 Z -'^ �v, T o m Ra Ro 0 z z m p 3 co rOr• 'C Q- H �1
c z w 3 co
b: 3 M L ° 3 77a rnTT3a_ R'D v, 3 i-' _ Z ,a C m
v � o' LT, T =.m d H O
p n _ 0 •r1
rn m O m n, m r° n K K n ? 3 n• p (D 0, A
j FN-, n 5m X Mfl 'AziIn nm p 3 h CD 0
1 FpF. O E, it 2 N O N N cg 2 _., Q 0 0 A
.n D 3 Q ti• A. , W w N e• N Q ti: n •
y 3 O
cn A a °T 35. '^ CD y; = a.-e- Q D
n, V fD p m n m m p va O s m O O '_*• z
Q tD - ti 3 d 3 3 C a v v U U N r•+ 3 O m
CD o. ncm 0
• v, 03 ryq
v, o 'p c 3 Li, .., , ,,, on,CO , 3 V. O 0 <VI
p — N C m A< `G -. m V! O - .0 H
N p a m G
z 0 3 fD.x in n z A 3 3
p m -n N D p = O O CA
m n' a
�^ O ? m 3 m,« w o r0—r. O 3 713 O m Vf
M telwo Nm• 00 0 N 0 = IcD A/ A -sm 0 (/) -, rD mm 3v y ° ` 0 • 3 a 0 C o : u, s
p A m m n n 3 s OQ V1 N h
0i MS
0. m -pn 03
n a va P. 0 N O, _ fD N
3 k' :: n, r+ N --I
-I
3 '^CD 8 19 a m m n s' 0 a. N 3 O A M
DJ y 7 m CO (j2} v O K
• N n. D'q 7' a- 3 D
7. y <v, p a O v' a. A
V1 n N n -S
m v, ° 3 7 d " v n m 3 m V
C) fp a o p m ▪ x rf �• C _-. h
�. d. an m O' N p' • r0+ yoj O
Q p a n p a ,' 'Er' cr, 7 G
y Q C O m a§ Q A. r..h a.
s m m (ID n d _g � st m o o •< mr m CD
r0 a0 Da ln rt p 3 O N ' rt. .0
3 -. rr 7 p 6 .m. p o ti C O
171) IV
kk PI 0 a3op Oly .
01
in W S •-• CD▪ N o f .. `�.' OU 04
B a St
tri fQ
VI 00 ro n 7 % 3
1-. 0• N• N CD N ll*E G O. 0 O
nsa "O Z O fD rr00 O rt vm . _ ,v. ? p O z N
•
CD
°1 a 3 O O
o m fir, 4; n, 0 0 O 3
fDUQ K . y
O '''',A 3
- DICD
wN :>a -1?
NV-om to i . nmo0 D , x • vO rr -, n. OF+
F) Oo � � � -
r, S O O 7 vDf c,r. SQ rs CM
` N v, O `<3 -3'
Ku
=
CD
A * ▪ ':: V -I m _._ A N
G7 c 0- O = O_ O n C 0Oq W •..
CD 7 IT '^• O ••G = v
(D v, F+
v X m
CD
A) mQ S 7ti4 0-
0
o v
r+ m 3 a r, "
co7)
r+
N o N d Q A
O p' m _.
1--' r�o 3 cm
F
D Z N D
N A as m * O '
NJ LU
N ti IQ I-
;I
u, F+ -n O
ta NJ
71
w N CD 0 ,� m
1
i
n T b N n 1-' D CO. n 73A _ 73 N n N a 70 n 70 o N
D m ki• D A V a DO °) 2 m D< vQ Do v 0 0 > A M
co •
m z-.--. N CD v m.O to . w N N +: m z N i j N z Q:O — rD =
.-r .� O. M N '^ O ' '< 0 O d (n ,n O m al C. ^
E, Di v, v, --I O-< m o= 3• o N D � Q 5 3 B rt
'a m N O D " 7 m m In m O > 'TI CY `�-
m D n OO , v s n m- d s (l rn D n' o' = 3 >
T z a D m ii, a _ F, 0 c . 3 a, o D D o '+ rr )^ -1
m (xi C < �• 'O^,.. 3 v c ro s ra '-3" La"V cnn C _ F v Ca 0 m
m Cr m N Z n z F " 3 3 ; v 3 c fD N Z (-) o .* 7 '6 O
a Ln C d !^ m .A w •i o rD 0, = H U'1 C S D y n
N m Z 3 - s a O. '^ on c o m O m Z a n O
- 1-' n m o . d (0 0 -< Q m 3 n 3 Cno 7
rn y ° o ti v-a' a s {ri A A
s m m v
n. D y. m. s -� m 3 C Z O
to o CM• ° v fflU
m. �-.Da 01 n in
I cu Q y �' n ° �,a o s `, 'F M n su 3
NJ 0
0 0 y. y 3 v 3 W .-p 1. 1 to V
o a - o ,' m -
m oo c < =i n m n a t y 3 3 '* O
= o • O o v`o D 3: O_ o rF n (D
,_r• 0 o< , c d '. v 3 0 (D 3. 2
w r-.-... m T`�,z` 3' N o a , 0 (D m
o 21', y n o`0 0 'ro so m 0 n rt '�
3 a m ...,,,,-.3..-:,8,...,,o . a 3 3 `D C -n
c
'6 ,a `M a n '3'1, V.. H DN
I+N' 0 ( N N N O_ P „ f
3 om -.
c o O ; O , rt .•
co d O O,,,,,.....,.0-..,- N -, SD su r0
`C
-, m 3 3 3' p, n =
m o .a m o m A
^ da,. n
u m v o -,
t o4a• T ^* O - M
64
Vs m (D o` ro. row . .., L -, v
a Us 0 0 n- ^n,(. O
°) m_i o 6 m c m n
N n O .+ ,p v V = N v z n CD E m Q v Z n N �? p 30
v_. = a) O T oT n p °' ro c .o- =.o -,. .o:. O \ ^' pas o
v o c CO Oo D 4:,3
Q -7, 4•444� -' 3 D o n -12
O 3 v N m 0o m �. v'• n.' ac 3 `:.,.� N .O 2 �. 3 M
0 NJ o ‘..L° FV' sr' m y^ m w a SD 7
m M
In w 1 �. •A '� 0., m„ S p -. n � O •
,
w 7a 3 ,< 1- p o m a ds.* `x3- a N 4 O� •. 3
O N U — D:{{ OQ 4.-;-.„6-06667,666-466`;T+. cr V C1 A
Ti74
CO
• 3 ��
o j• O 6.a. m „65...644.6„;40 fl. m
S4
.,
'
:r o •
MN 5 . Q . -
— C tD n
-•
111� 3o a▪ Q ��z
O- a, s n m
I m m ;• m a
''* 0 0,, -O. -
1 o < 0 - �
▪_'+: DtD N 0Q
a su
a _
C m n
o a'a 3``' '^ 3
4 o ,, v m -
• 3 0 m o CD
9- m.. 'CO▪ d 3 On O
w o 3 6
O tri = m a
91 v ' 3 - m
d a
< p
N 9
✓ ,f, o v (D. D
N m v 3 w 1
N
W A 6 O W N
w: N N m, m
1
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
ips, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
UP RTIM 10300 TORRE AVENUE CUPERTINO,CA 95014-325500
(408)777-3228 a FAX _08)777-3333 m buildingtca�,cupertino.orq p�
Owner Nam �"3 I y `'�° % "� y Permit Nos 2,t; 1 30'
4,.:
Address 10 t...�. ( ) V
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.
• , to 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.
'la"No Go to Question 3.
3. Is water service permanently disconnected for your building?
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 F7 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.
41Yes 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:
iN 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 perjurythat 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 follZnalurei
ing page. s
(„1
Owner or Owner .j " ` f F Da
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08/26/15
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
<c.�K,ts COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buiIdinq(a,cupertino.orq
PERMIT CANNOT BWFINALED F .NTII,THIS CERTIFICATE MAS B ERT
tz MP_ D IGN) i At.ND F-TIIR-NTD TO`-�Z BV D YG D= SiON fi'=
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
inspections are required.
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 R314 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 X X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping 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, alarrn(s)may be solely battery operated.
h1 existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit 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 specified below have been tested and are operational, as of the
date signed below.Ja or
4Ts I�� � 1 Permit No. 2-0 3045
Specify Number of Alarms: { #Smoke Alarms:' #"Carbon Monoxide Detectors:
I have read and agree to comply with the terms and conditions of this statement
Omer(or Owner Agent's)Name:/ sL.41 `'
-� �� _
Signatu _ '�.:: .._:
r. ��
Date:
Contractor Name: / Q Q
�J Signature Lic.# . ..Aft. .O 1 Date:
dime-Dn
Smoke and CO form.doe revised 09/27/16