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B-2017-0076, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19250 TILSON AVE CUPERTINO, CA 95014-3529 (375 40 056) OWNER'S NAME: WINDERMAN STANLEYM AND SPERTELL EVAA TRUS OWNER'S PHONE: 408-910-8966 LICENSED CONTRACTOR'S DECLARATION License Class = Lic. #1012763 Contractor AIRPRO MASTER INC Date 04/30/2018 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. I hereby affirm under penalty of perjury one of the following two declarations: t. 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 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. APPLICANT 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 and state laws relating to building construction, and hereby authorize 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature &i6�1A&6_1'�a 9 Date 01117/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following_ two reasons: 1. I, as owner of the property, or my employees with wages as their sole 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 contractors to construct the project (Sec.7044, Business & Professions Code). CONTRACTOR: PERMIT NO: B-2017-0076 AIRPRO MASTER INC LAS VEGAS, NV 89102 DATE ISSUED: 01/17/2017 PHONE NO: (702) 598-4174 BUILDING PERNHT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: PROPERTY LINE CLEAN-OUT AND REPAIR Sq. Ft Floor Area: Valuation: $3800.00 APN Number: Occupancy Type: 375 40 056 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 01/17/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 01/17/2017 I hereby affirm under penalty of perjury one of the following three declarations:T'T' ROOF COVERINGS TO BE CLASS "A" 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. 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. s. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. ' APPLICANT 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 and state laws relating to building construction, and hereby authorize 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. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 01/17/2017 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 255533��andd 25534. Owner or authorized agent: _ �� A&0,n-o'- "'• Date: 01/17/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lenderrs Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shalf be used as public records. Licensed Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinaCa)-cupertino.or CUPERTINO -201-7?`�- misc, Vi PLUMBING 7MECHANTC'.AT, 7FT F("PRTrAT nrarcrr'T T A KTnnrTd PROJECT ADDRESS / Z 50 f L' ( ! APN # OWNERNAME 5 b�-W 2 c f� �I PHONE �C} ql{� V a b 1 l U E-MAIL STREET ADDRESS Mu -vu � ti L n �'+-vim. I CITY, STATE, ZIP,__,,, P G,,1 FAX ����� CONTACT NAME j� � ^ i� f� f I PHO"6e 1 �% 1 � /y p 33 3 E-MAIL STREET ADDRESS 1 © R , CITY, STATE, ZIP I,, -FAX r^ �%❑ I ElOwNER 11D OwNER-BUILDER ERR El OwNERAGENT - - CONTRACTOR ❑ CONTRACTOR AGENT 1:1 ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME p � p� � � J LICENSE NUMBER/,, Z �� ,(®�, LICENSSEETYPE 2�Lc-:16 G� 6 BUS. L # COMPANYNAMEEMAIL ��� �(� _ FAX STREET ADDRESS C� �` ps�C C CITY, STAT( PHONE JVD [# ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI FAMILY BUILDING: COMMERCL4L PROJECT IN WB-DLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZOI.'E ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK TOTAL VALUATIO . t=PCO By my signature below, I certify to each of the following: I an 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 re the Description ofWork and verify itis accurate. I agree to comply with all applicable local tat' of of Cupertino to enter the Rb;'dutifidropertyforinspectionpurposes. ordinances and state laws relating to ilding constructi=�Ss Signature ofApplicant/Agent: +� — Date:/ SUPPLEMENTAL INFORMATION REQUIRED oFFicE USE ISI 1 COUNTER EXPRESS U 'U ❑ STANDARD - LARGE ❑ MAJOR MEPMiscgpp_2011.doc revised 06/21/11 1/18/2017 Scan 2.jpeg SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COM UNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION I G300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CuoelmNo (4m 777-3228 - FAx (4oa) 777-333 . 3 - bLgl6ino@_cupertino.org 7- PURPOSE This affidavit is a self -certification. for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section 8314, R315, 2016 CBC Sections 420.6 and 907,211.2 where no interior access for inspections are required. GVNtRALINFORMATION fan-tily mid nwid-family d�ven*igs, shall be provided-witl-LSmokeAlarms and .Carbon— Monoxide alarms. AM -ten the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000,00, CRC Section R314, 8315, and CBC Sections 907.2-11.5 and 4204require 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 — (Smoke alarms shall not be located within 3 feet of bathrockm door) X X -bedroorn(s) On_eve level of a dweRr�, unit includitgbasementg-and habitable attics X X Within each slee rt g room X Carlson '.monoxide alarms are not required in dwellings Which do not contain fuel -burning- appliances and that do not have art attached. garage. Carbon monoxide alarms combined with smoke alarms shall comply with C13C 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, h-, 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 dt is required for alarms which must be connected to the building wiring. As owner 6f the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been. installed in accordance with#je -qalifoKW-a, Buildin.,—, and California Residential Codes. The alarms specified below I -Lave been tested and are operational, as of the date signed below. Permit No. Address. I q -7 6a -7, Ve—(1711t (-xr-4/_-,,c Specify Num, ber of Alarms: if Smoke Alarms: Carbon Monoxide Detectors: -Sm,7ket and cofomj. doe mvised 01/101017 M 111 htips://maiI.google-com/mail/u/l/ffi*nbox/159bld7b382934e5?projector=1 1118/2017 Scan 3.jpeg 0: .0 M 00MMUNITYDtVELOPMERT DEPA TMENT. BUILDING DIVIMOR ELM 10300 TORRE AVENUE - CUPVRTIN'0, CA 95014-3256 117-322 8- F AX* {408"?77x333 buildina{ds cuDertino"Ona -7 Permit No. Address 1. Is yout..teal, property a iegisterod historical site.? 1 Cl Yes Civil Code Sections 1101.11biough 1101.8 donot apply -Skip the recti of the form and, sign bottom of form. No Go to Question 2, urn r Ce �m', th fi ti of e property 2. Does real pio ll"erly'bave a fir, einsedpi be rfif g. afdue', the :age g�,ara on di or its plumbin g,b�OoDation6fi"Wi���l)lunibing Is feasible? L❑ -3 Yes Civil Code Sections 1101.1 through 1.101.8 do not apply. Ski r flieitit of theFormand sign -b ottorn of form. No Go to Question 3, 3, Iswatervic7opcil'taAent'.1y.'ai�,c�.twec(�a for your f k4- h onn and sig 0 Yes J.j0j,,8dpnqtap0jy. .8 �stb;. f e I Code. ectioiw 1.1.0 abottom offarm. No Go to Quesilon 4.' an n 4. Is your real property built and available for use or occupancy or. before January 1,,1994? 0 No My real property is built and: ;V41abie -fpr.use* or o ccupan'cy'ialier: January 1;1994. Civil Code Sections 11013 thmugh,110134onot apply. Skip the rest of theformand sip bottom of form. Yes My real property is built and available for use or ocoupancyp_n ox be January 1, 1994. Civil Code Sections 1101A dough 11O1.8.9pply. Check one of the three following statement, andsign bottom of form. Please check 019E of the following, See Civil Code Section" A. OI on and aftef January 1, . 1014, b dfiigiltefatidls or in0rovcMdON! sUll`reqmro . 411 ion- c d : 6plihnt lilumbing fixtures to be replaced with bithrou out the building. On or before J '1 2417, all non- gh f - anuary 1. cc With wate I r�*cqns � M Utures regardless of wboth& compliant plumbing fixtures shall �6�:rp la d p UM! Ing property LmdergQes alterations -or improveirkents) " El My property is a multifandly,residenilatr6a see Civil Cotte Seotiohi1b1=5, On and after January 'or in $bal -requirJanuary1, 1 s- rN non- -compliant plumbing fixtures to be - a X s shall. be rep c jacedwith: water - On or before,january 1, t9, all , : 9 - ` ­ - !less ;of whether property undergoes alterations or consening plumbing fixtures. (jog, improvements) - On and after January 1, 2014, specified building alteration,; or improvements shall require non- compliant plumbing fixtures to be replaced NY & water-consm4bg plumbing fixtures. On or before January 1, 2,419, all non-.uoirpjjant. plumbing fixtures shall be replaced with water- ,rouse wing pluoih� k6ms..�irougfi6�tthabuildm�(iogaAesiof,Nvh6&i Ing property alttrations or hivrovem Is); L as tile owner or owner,s agent of this property, certify under penalty of pedury that non-compliant plumbing fixtures -will be replaced prior to date specified abo-W with water-couseiving plumbing fixtures in accordance with CivU Code Sootions 1101.1 through 1101.8, the euvent.California, Pluthbing Code and California Green Building Standards Codo, and manufacturer's installation requirements, and that the water -con,; . ing PI table on the fallo-A4ng 2age, ,, =s comply with the requirements as indicated in , the . ... Ay ­/Ukr Owner or Owner Agentz Signature:. Daw. L Upon completing and signing this erfi e, pie -ase Mum it to the Building Division in order to finWyourbuildin -permit. SB4071015 40C rellsed 08126115 IM hUps://mail.google.com/mail/u/l/ffi`nbox/159bid7b382934e5?projector=l 111