B-2016-3265CITY OF CUPERTINO BUILDING PF
RMIT
BUILDINGADDRESS:
CONTRACTOR::
PERMIT NO: B-2016-3265
10165 MCLAREN PL CUPERTINO, CA 95014-2335 (316 21 050)
SPEED DRAIN OF J
LEE PLUMBING
MOUNTAINHOUSE
CA 95391
OWNER'S NAME: ZIMMERMAN MARTIN JR AND CAROLYN
DATE ISSUED: 12/13/2016
OWNER'S PHONE: 408-396-9945
PHONE NO: (408) 378-5309
LICENSED CONTRACTOR'S DECLARATION
BUILDING PE
T INFO:
License Class fW Lic. #911337
Contractor SPEED DRAIN OF JAE LEE PLUMBING Date 02/28/2018
X BLDG _ ELEC
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:
)3E-PIPE; FULL SF,
(2,300 S.F.)
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. �_1 have and will maintain Worker's Compensation Insurance, as provided for by
C t✓ Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area;
Valuation: $3500.00
permit is issued.
r APPLICANT CERTIFICATION
J 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 .
316 21 050
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 E3
PIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 18
DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulations per thTCupertino Municipal Code, Section 9.18.
180 DAYS FROM
LAST CALLED INSPECTION.
'`
Signature e`12/13/2016
Issued by: MELIS
ANAME
OWNER-BUILDER DECLARATION '
Date: 12/13/2016
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 ins
ected 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 Applican
:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 12/13/2016
I hereby affirm under penalty of perjury one of the following three declarations:ALL
ROO
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.
H)
ZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the ha
mrdous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Healtl
& Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain complianc
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,
air contaminants as
should I use equipment or devices which emit hazardous
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, S&Oons 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authoriz
d agent: t
APPLICANT CERTIFICATION
Date: 12/13/2016
I certify that t 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
ONLENDINGAGEN
Dec onstruction lending agency for the performance
here
relating to building construction, and hereby authorize representatives of this city
of work's for which t
iis 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
1 understand my pla
ARCHITECT'S FCT'4 DECLARATION
ris shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 12/13/2016
Professional
GENERAL PERMIT APPLICATION
EP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING D1 VISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 < buildingft—cupertino.org w /MIS C
4
-Z,0(6
-3
LUMBING [:]MECHANICAL []ELECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS
OWNER NAME"7 _ Q
Y'- GOC e�Y�\,/l%1. PHONEE4®e 4E--,°_,.�.,- .
STREET ADDRESS (1 CrrY, STATE, ZIP J FAX
CONTACT NAME
STREET ADDRESS ,� is
47-1
�l� `Q� Q
,�-"�
CITY, STATEE, �Z`PT Ot((
��
FAX
❑ OWNER El OWNER -BUILDER
❑(,OOWNEVR AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT
11 ENGINEER ❑ DEVELOPER
❑ TENANT
CONTRACTORN
LICENSE NUMBS�
LIC NSE TYPt7_3.�
BUS. LIC Z j n
�
7
COMPANY NAME
f(t�
E-MAIL l v4 �fl1l
FAX
STREET ADDRESS
1 0}
V
^
G�
CITY, STATE '7�
c (
/�y��
'fig g
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OFSFD or DUPLEX ❑. MULTI -FAMILY
BUILDING: ❑.0 CIAL
PROJECT IN W-II.DLAND - El YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN.
FLOOD ZO
❑ YES
❑. NO
IS THE BLDG AN
EICHLER.HOME?
El YES
❑ NO
DESCRIPTION OF WORK
co
rd-
TOTAL VALUATION:0 V
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 providecris correct. I have read the Description of Work and verify it is ccurate. I agree to comply with all applicable local
ordinances and state laws relating to building nstru tion. I authoare Ives of Cupertino to enter the above -identified property for inspection purposes
Signature of Applicant/Agent: Date:
8 LEMENTAL INFORMATION REQUIRED o CISE ONLY '
MEPMiscApp_2011.doc revised 06121/11
M
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
CUPERT1140 10300TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (40$ 777-3333- kbuil
Lding0cupertino.org pp
OwnerNarne, M014�11� + C.AXoL.-e4 -f. A ermit No.
Address _L-AftefA C -U 44 f- AT I r4 0, qwo I Z/
1. Is your real property a registered historical site?
0 Yes Civil Code Sections 1101-1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
A 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?
0 Yes Civil Code Sections 1101-1 through 1101.8 donor apply.
0 The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
*Q 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.
No Go to Question 4.
4, Is your real propettybuilt 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 test of the f%rm and sign bottom of form.
�Z
s My real property is built and available for use or occupancy on or be January 1, 1994. ye Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following stat cin =-is. 4nd sign
bottom of form..
Please check ONE of the following:
My property is asingle-jainily residential Teal 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).
0 My property is a multifanzily 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-conservingplumbing, 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-whetherproperty undergoes alterations or
improvements).
0 Myproperty is a commercial Teal property. See Civil Code Section 1101.5.
Omand 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).
1, as the owner or owner's agent of this property, certify under penalty of perjury that non-complia;t 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
g
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the fbHowina naae. A L—ANO-A
I Owner or Owner Agenfs Signature: -_Date: 12IZ012_014 I
Upon completing and signing this Certifi te, return it to the Building Division in oTder to final your
Z�
SB407 2011doc revised OW6115
SMOKE / 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 - building0cupertino.opq
PERMIT CANNOTBE FINALED UNTIL THIS CERTIFICATE IIAS BE&
COMPLETED., SIGNEM AND REJUH= TO THE BUILDING DIVISION
PURPOSE
a
------------
-L-17 �T_7&
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 9072.11.5 and 420-6, require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM__7
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
X
X
On every level of a divelling unit including basements
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 supplyi alarm(s) may be solely battery operated.
In 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 8314 and CBC Sections 9072.11,4 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. Lk
Address: W(Al M` P 1r 4 C't' t*j^'r4'40 C A q6'01'i Permit No. % lot6- 3 245
Specify Number of Alarms. # Smoke Alarms: 7 4 Carbon Monoxide Detectors:
I have lead and agree to comply with the terms and conditions of this statement
Owner (or Owner Agents) Name-
Smoke
SIqnature_ %411
........ .............
.. . .......
Contractor Name;
Signature... ......... ...... ...... -, ......... Uc.# ...,..........,..,..,.................Date -
....... ......... .......Date -
Smoke and COfonn. doc revised 09,12 7116