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B-2016-3137CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-�Il1-3131 7489 STANFORD PL CUPERTINO, CA 95014-5814 (359 32 045) ALLSTAR PLUMBING CORPORATION SAN JOSE, CA 95112 OWNER'SNAME: MORSE SUSAN A TRUSTEE DATE ISSUED: )(1/17/2016 OWNER'S PHONE: 408-489-3619 PHONE NO: (408) 2182-7020' LICENSED ONTR A TOR' DECLARATION BUILDING PERMIT INFO: License Class C-36 Lic. #732611 Contractor ALLSTAR PLUMBING CORPORATION Date 02/28/2017 XBLDG _ELECT X PLUMB MECH X RESIDENTLAI, I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION` hereby affirm under penalty of perjury one of the following two declarations: REPLACE SEbETVAI NIT ARY' 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. nz. 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 -3F permit is issued. Sq. Ft Floor Area: Valuation: $6500.Q0' APPIACANT 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 Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 359 32 045 359 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 may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK WITHIN 180 DAYS OF PERMIT IS NOT STARTED 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. 2 4 S gnature91 Date 11717/2016 Issued by: Kim Dunbar Date: 11/17/2016 0-MMR-LIR DECLARATION may'"""` I herebyaffirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. 1, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for 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: 11/17/2016 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 f performance of the work for which this permit is issued. i. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS I have read the hazardous materials requirements California Health & Safety Code, Sections DISCLOSURE under Chapter 6.95 of the 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of work for which this maintain compliance with the Cupertino Municipal Code,. Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I 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 this of air contaminants as defined by the Bay Aijea Air Quality Management District I Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making certificate will maintain compliance with the Cupertino exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code ' ns 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall �- be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 11 /17/2016 L�NDJENG AGENCY 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 and state laws COAVU ON I hereby affirm that there i nstruction of work's for which this permit is issued (Sec. lending agency for the performance 3097, Civ C,) relating to building construction, and hereby authorize representatives ofi#his city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARCHITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 11/17/2016 Professional i -GENERAL PERMIT APPLICATION E COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 buildingCftupertino.org 1 -[N � 1�misc - 3) 3 PLUMBING DmEmANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS � � � I APN # OWNERNAM& P,QI1E -'?" at t EMAIL STREET ADDRESS`t -- ^�� CITY, STATE, ZIP e { C FAX —C •hCdl 3L CONTACT NAME O PHONE E-MAIL STREET ADDRESS / �/ �e, �Gs! lt�vC-- CITY, STATE, ZIP ose_ C'l J l FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑. TENANT CONTRACTOR NAME 1�4(' / �U� C LICENSE NUMBER I LICENSE T E BUS. LIC # , Q COMPANY NAMEE-MAIL V_r, 6 FAX STREET ADDRESS •� CLTY, STATE, ZIP PHONE (b 6 7 CT ^% ARCHITECT/ENGINEER NAME LICENSE NT 54BER BUS. LTC # COMPANY NAME E-MAJL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX FIMULTI-FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WII.DLAND El YES URBAN INTERFACE AREA -. NO PROJECT IN ❑YES FLOOD ZONE 10 IS THE BLDG AN ❑YES EICHLER HOME?NO DESCRIPTION OF WORK 2{'a Gc C i G ICtCem e,,, TOTAL VALUATION; g .... , By my signature below, I certi to each of the following: I ain the property owner or authorized agent to act on the property owner's behalf. I have read this application and the infonnation I have provided is correct. I have read the Description of Rork and verify it is accurate. I agree to ccf mply with all applicable local ordinances and state laws relating to b ' mg onnLmction. I authorize representatives of Cupertino to enter the above -identified prof erty for inspection purposes. Signature-ofApplicanUA gent: Date: �j/ '— / �� SUS EMENTAL INFORMATION REQUIRED „ , l oicE USE pNix , I.doc revised 06121/11 PURPOSE SMOKE 6 CARBON MONOXIDE ;ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014.-3255 (408) 777-3228 • FAX (408) 777-3333 a buildinoCalcupertino.org 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 CSC 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 bedroom(s) X X, 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, alarm(s) may be solely battery: operated. Iii 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. .Address: 7 I Edi. arcs- . L Specify Number of Alarms:. _ # Smoke Alarms: I I # I have read and agree to comply with the terms aDd Permit No. 13 aOl& /3) Monoxide Detectors: s of this statement Owner (or Owner Agents) Name: 77 Signature.... �r 14 a.... ..... ... ......... ..... .....................................................Date:/2 ... ....... ..... ......................... Contractor Names Signature ......... ..&.a ...:f/MJ31i.UfQ. Lic.# ... a611 ............ Date:f,7-6-16 ac S777oke and COJb7-777.doc revised 09/27/16 "F*91 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDII 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO DIVISION (408) 777-3228 • FAX (408) 777-3333,• building(a)_cupertino.org f �� l Owner Name, .5c J 5^PJ 1i,Ve_Permit No. L-3 137 Address _ 7,q S,_4j �—� 1. Is your real property a registered historical site? 11 Yes 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 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. 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. No Go to Question 4. 4 4. Is your 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, 1994. Civil 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. 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 umprovetnents). 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 Ibe 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 110 1.8, 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 pane. Owner or Owner Agent's Signature:,T ez, Date: 42— Upon completing and signing this Cpftificate, please return it to the Building Division in order to final your building permit. SB4072015.doc revised 08126115