B-2017-0045 CITY OF CUPERTINO BUILDING PE ' IT
BUILDING ADDRESS: CONTRACTOR: PI RMIT NO:B-2017-0045
23500 CRISTO REY DR UNIT 333D CUPERTINO,CA 95014-6530(342 53 107) BAY AREA
ENTERPRISE
SAN JOSE,CA 95148
OWNER'S NAME: LONGINOTTI JOHN F TRUSTEE&ET AL i TE ISSUED:01/09/2017
OWNER'S PHONE:650-537-1523 P:ONE NO:(408)238-5043
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT I' 0:
License Class a Lic.#817817
Contractor BAY AREA ENTERPRISE Date 03/31/2017 X BLDG X ELECT X 'LUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENT! _COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
• UNIT 333D-INSTALL LIGHT FIXTURES(7);UPGRADE
I hereby affirm under penalty of perjury one of the following two declarations: BATHROOM FANS(2); 'GRADE SHOWER PANNALVES(1);
1. I have and will maintain a certificate of consent to self-insure for Worker's UPGRADE OUTLETS/S ITCHES(42)
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:$6500.00
4." :k _.t NM 4 1k
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: 0 cupancy Type:
and state laws relating to building construction,and hereby authorize 342 53 107
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 EXPI' S IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. 'WITHIN 180 D YS OF PERMIT ISSUANCE OR
Additionally,the applicant unders ands and will comply with all non-point
source regulations pet Gu errtmo Municipal Code,Section 9.18. 180 DAYS F i`y' ' — =. a I` PECTION.
Signature' ./ t,' - .,--1i,— -'""-Date 01/09/2017 Issued by:MELISSA N',TE` �r
✓/ ,"-`�,. —,—.. — Date:01/09/2017
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:01/09/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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
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,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area 4iMnality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupegtino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Corjgtions 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
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be deemed revoked. Owner or authorized agent; '` �
APPLICANT CERTIFICATION Date:01/09/2017 /'r%' -
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 01/09/2017
Professional
en); :STRUCTV'N PERMIT APPLICATION-- -----:-.7,-,
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO CA 95014-3255
c.-..-'..2::.,••' .
(408)777-3228-FAX(408)777-3333-builcling(Fgcupertinc.org
CUPERTINO 9-- 00
0 NEW CONSTRUCTION El ADDITION 11r.: LTERATION/T1 0 REVISION/DEFE" I ORIGINAL PERMIT#
-----
PROJECT ADDRESS A
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OWNER NAME PHONE •-NIA]L "riA•IL Fcb r la'Poi
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STREET ADDRESS CID',STATE,ZIP, FAX
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• CONTACT NAME PHONE P MAIL
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STREET ADDRESS
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0 OWNER 0 OWNER-BUILDER 0 OWNER AGENT ii2f/CONTRACTOR 0 CONTRACTOR AGENT 0 ARcButcil 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE-11'111E BUS.LIC ii
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ARCHITECT/ENGINEER NAME , LICENSE NUMBER BUS.LIC ii.
COMPANY NAME E-MAIL FAX
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EXIS ; SE PROPOSED USE CONSTR • 0 ST ?ES
USE TYPE OCC_ SOFT. VALUATION(5) /
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FXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA '
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,
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PORCH AREA . DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA- 0 DETACH 11111
0 ATFACH
I DWELLING UNITS: ISA SECOND UNIT DYES SECOND STORY OYES
BEING ADDED? 0 NO ADDITION?
PRE-APPLICATION DYES IF YES,PROVIDE COPY OF ONO .....Ww.-011101111144111111
_.ddlleIr',..aillnt711(loIII15!1111111_a_e:;H"*t"Ci
IS THE BLDG AN 0 ' ,,,;,j..• ---"-- TOTAL VALUATION:
PLANNING APPL 0 0 NO PLANNING APPROVAL LE i TER EICHLER HOME? e....,*• WI,..,". - .--..lr''- ', - ,...4
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By my signature below,I certify to each of the follow' g: I am the property owner or authonz-•agent to act'.the pro.- 'owner's behalf. I have read this ------
application and the information I have provided is c ct. I haya,.d the Description of Work and vet'. is . •te. I agree to comply with all applicable local
ordinances and state laws relating to building cons ction. Ta,tvtrize representatives of Cupertino to• -r e above-i • UP:, properly for inspection purposes,
Signature of Applicant/Agent. AMMO\ . .Date: - -us,i_w -7
SUPPLEMENT'L INFORMATION REQUIRED _ PLAN CHECK TY•E ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
0 OVER-THE-COUNTER I 0 BUILDING PLAN REVIEW
- existing building(s). Demolition permit is required prior to issuance of building
permit for new building. 0 EXPRESS 0 TLANNINC PLAN REVIEW .
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD 0 PUBLIC WORKS
_
•
form if any Hazardous Materials are being used as part of this project.
0 LARGE 0 FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to 0 MAJOR 0 SANITARY SEWER DISTRICT
submittal of Building Permit application.
0 ENVIRONMENTAL HEALTH
BidgApp 201 I.doc revised 06121/11
SMOKE f CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300TORRE AVENUE CUPERTINO, GA 95014-3255'
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
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, alter":ations, 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:
e 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 eachs.leeping 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.
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 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 manufacturers 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: �g (f T® �1G � �� Permit No. — ( C`
Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors:
An— -1 -4 nnrnc to rmmnly miith tha tarmc and cnnditions of this statement
owner (or Owner Agents) Name:
r
Signature. ..................................................... I .................................... . ............. Date:
.. .. ................................................. ..
Contractor Name:
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Signatur ..... .............................. Lic.# .......... Date:
.................................................................................
Smoke and CO forrmdoc revised 09/27116
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
iQ3QQ TQRREiAVGNL11=- . CUPEi2T{N0, CA OGW 4-3206
(408) 777-3228 FAX (408) 777-3333 a buiiding(cDcupertino.orq
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your real property a registered historical site?
,kEl Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the forge and sign bottom of form.
No Go to Question 2.
2.' roes 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?
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 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 tbrough 1101.8 apply. Check one of the three following statements and sign
bottom of form..
I �y�
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
Ito be replaced witl-i water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-
cogripliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardlessof 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 cormnercial real property. See Civil Code Section 1101 a5.
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.
Qn or before January 1, 2019, all non-compliant Numbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or umrovegnents).
t I, as the owner or owner's ager_t of this property, certify under penalty of pegury that non-compliant plur��bing nxhu es 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
instedlatIdn requiminuiits, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the following a e.
Owner or Owner Agent's Slgnature�,: C3ate:
Upon completing and signing this CertiiFcate, please return it to the Building Divisioni i order to final your building permit,
SB407 2015.doc revised 08126115
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