B-2017-0338 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0338
10243 BEARDON DR CUPERTINO,CA 95014-1922(326 32 025) REGAN SCOTT
KOSCH
SAN JOSE,CA 95158
OWNER'S NAME: CHIN GOODWIN RAND ALICE L S DATE ISSUED:02/28/2017
OWNER'S PHONE:408-2097202 PHONE NO:(408)248-3012
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C10 Lic.#794792
Contractor REGAN SCOTT KOSCH Date 05/31/2017 X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL 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:
UNITS 1-4;REPLACE 60 AMP SUB PANEL IN EACH UNIT(4 SUB
ereby affirm under penalty of perjury one of the following two declarations: PANELS)
is 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. Sq.Ft Floor Area: Valuation:$3980.00
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 32 025
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 'I comply with all non-point
source regulations per the Cupertino Mu ' 'pal Code,Section 9.18. 180 DAYS FROM LA 7,..%%WI. SPECTION.
--
Signature// _ Date 02/28/2017 Issued by.'`+I LISSA►_J.
Date:02/28/2017 �______
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 roofmg 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:02/28/2017
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
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 Air Quality Management Di rid I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter/12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code .-tions 25505,2 3 ,and255.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. f/,
Owner or authorized agent: ...._.......y....44( /1i
APPLICANT CERTIFICATION Date:02/28/2017
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
1 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 02/28/2017 Professional
(44 GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
a's4r't'a, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq(aCUPERTINO ,cupertino.oI S C
rq
, 20/ 9- - 033
❑PLUMBING ❑MECHANICALELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 107- 3`-- _ Rtou DR... 7 AP"
# 2_6- ' 32_ - 2_5-
OWNER NAME PHONE
600V IV/A-) / 1-) k.J 910g- 707 -7
202 E MAII
STREET ADDRESS CITY STATE ZIP FAX
CONTACT NAME - s Log- acr7 /�f cz_[ a E-MAIL
STRE D ESS ADC STATE,ZIP FAX
�'"�C3 Arch 7v7
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
I
1 CONTRACTOR NAME LICENSE NUMBERg p q LICENSE TYPE BUS.LIC#
iZ AV G l / i 2 C4 13041
COMPANY NAME ,�,, �[f( --p jay E-MAIL FAX
//
STREET ADD ESS CITY,STATE,ZIP PHONE
PI:9 l tJ CA-- 937S' Log 3®7 .5-ZIT
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
I COMPANY NAME E-MAIL FAX
1
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF 0 SFD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN 0 YES IS THE BLDG AN 0 YES
BUILDING: 0 COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE 0 NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK S p `_ 514S
PA- l
TOTAL VALUATION: gyp$ RECEIVE
By my signature below,I cert0 to each of the following: I am the property owner or authorized agent to act o F eLty owner's behalf. I have read this --
application and the information I have.rovided is correct I h ve read e Description of Work and verify i accurate. I agree to comply with all applicable local
ordinances and state,laws relating . .flding constructs . autho epresentatives of Cupertino to enter the above-identified property for inspection purposes.
i Signature of Applicant/Agent: Date: z-z-
SUPPLEMENTAL INFORMATION REQUIRED Q OFFICE USE ONLY
0 OVER-TRE-COUNTER
0 EXPRESS
tJ
U
0 STANDARD
U
0 LARGE
❑ MAJOR
1
I
MEPMiscApp_2011.doc revised 06/21/11
FORME
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CU�0 I 10300 TORRE AVENUE a CUPERTINO, CA 95014-3255
(408) 777-3228 ^ FAX (408) 777-3333 • building(�cupertino.ora Q;;
Owner NameCs 001Dwl A! Permit No W f7-0339" _
Address !S1" CA*J y --4V ®Il S 1 y <n4 s `�
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.
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. t?�
❑ The licensed plumber's certification has been provided to the Building Division. f `7
Skip the rest of the form and sign bottom of form.
No Go to Question 3. '~ G
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.
Flo 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 fonr_.
'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-coinpliant 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
properly undergoes alterations or improvements).
My property is a rnultifanidy 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-compliantplumbing 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 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 110 1. 1
through 1101.8, the current California Plumbing Code and California GreerpBuilding Standards Code, and manufacturer's
installation requirements, and that the water -conserving' pl�} nb' g fixtur comply with the requirements as indicated in the
table on the following page. L7 / m
Owner or Owner Agent's Signature: ' Date: { I
Upon completing and signing this Certificate, please return it to the Building Division in order to final vour building Den -nit.
SB4072015.docrevised 08126115