B-2017-0347CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
11662 VINEYARD SPRING CT CUPERTINO, CA 95014-5135 (366 54 011)
CONTRACTOR:
HERITAGE
PERMIT NO: B-2017-0347
CONSTRUCTION
GROUP INC
SAN JOSE, CA 95136
OWNER'S NAME: NG JEFFREY KAND LORI A TRUSTEE
DATE ISSUED: 03/01/2017
OWNER'S PHONE: 408-218-0793
PHONE NO: (408) 266-8303
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CZ Lic. #931230
Contractor HERITAGE CONSTRUCTION GROUP INCDate 04/30/2017
X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
NIECH 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:
I hereby affirm under penalty of perjury one of the following two declarations:
REPLACE 17 WINDOWS & 1 SLIDING GLASS DOOR, LIKE FOR
LIKE (WILL MEET EGRESS & BE TEMPERED PER CODE)
L 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
J
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area:
Valuation: $14000.00
APPLICANT CERTIFICATION
certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
366 54 011
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.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS O SSUANCE OR
source regulations per he Cupertino Municipal Code, Section 9.18.
180 DAYS FROM L CTION.
`.l
Signature 11 -�/ '�'� Date 03/01/2017
e
v
Issued by: MELISSA NAMES
OWNER --BUILDER DECLARATION
Date: 03/01/2017
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
m. 1, 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: 03/01/2017
I hereby affirm under penalty of perjury one of the following three declarations:
m. I have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
3. 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 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, Sec 'ons 25505( 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
s' 1
Owner or authorised agent:1' t1
APPLICANT CERTIFICATION
Date: 03/01/2017 ~ -T J i
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.
1 understand my plans shall be used as public records.
Signature Date 03/01/2017
Licensed
Professional
Pd
CUPERi-[i' O
C-ONSTRUCTICN PERMIT APPLICATION
COMMUNITY DEVELOP10ENT DEPARTMENT - BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinocupertino.org ^ j 03 ,/
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ED ON'A'ER ❑ OR'?�ER-BU'LTD,ER ❑ U9,NZERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCEITECT ❑ FI:
CU PERTINO
SMOKE 1 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 • buij1 ingna.cupertino.orq
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with. 2016 CRC Section R314, R315, 2016 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, R315, 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:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
X
X
bedroom(s) - (Smoke alarms shall not be located within 3 feet of bathroom door)
Signature..... ..................... ...........................................Lic.# ......................................Date:..................
On every level of a dwelling unit including basements and habitable attics
i X
�X
Within each sleeping room. — 0
X
�—
Carbon Monoxide alarms are not required in dwellings whi.cll do not contain fuel -bun -Ling appliances and that
doi 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: lin dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
La 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 firdshes 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 iwhich 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.
C \
Address: l k. (02 V1Y\L�4 %lJI :5 q of 41\ Ct , Loych ry Permit No. 6 -Zo l7 —o347
Specify Number of Alarms: _ r Smoke Alarnns: t Carbon Monoxide Detectors:
1 have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
LC?�lSignature
......... ...... .p.. .. .......................................................................Date:J.L l.l.
Contractor Name:
Signature..... ..................... ...........................................Lic.# ......................................Date:..................
S7770he and CO form. doc 7-erised 0111012017
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CtiPERTttQ 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 building CDcupertino.orq
Owner Name .. Ct R G� Lvy i Permit N o. -7-D
j " I
Address to( 2 V k'YA e S. aA i A� i1(l.t
1. 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 properly 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?
1-1 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
L-1 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?
11 No Ivry 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 fora.
5. Please check ONE of the following:
My properly 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 improvements).
El 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).
El 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 Green Building Standards Code, and manufacturer's
installation requirements, and that the water-consetving'plumbing fixtures comply with the requirements as indicated in the
table on the following page. , n .. /-) - ,, i i
Owner or Owner Agent's Signature: Date: -51!11/ /
Upon completing and signing this Certificate, pleas6jkturn it to the Building Division in order to final your building permit.
SB4072015.doc revised 08/26/15
JEFF NG
11602 VINEYARD SPRING CT.
CUPERTINO, CA 95014
REPLACE 17WINDOWS AND 1 DOOR
WITH LIKE FOR LIKE WINDOWS/DOOR.
N® S12C c"ANGF-S
:11i:Y��'tii i� `I ilDM-N I \�T�
APPROVED
wr'pt at the
:-b site dlurinc C:-^Sii'iCfk0f1. It is uml i'„}Ju iG r1ake any
changes or On sainie, or to ue'viate
herefr',r..�; 4Viv �c;Jt apprcva! from, the Bu.idinid Jfficiai.
The.Stamping of iN pan and specif-31 ons SHALL N0T
be held to permit 0, tc, b pprcvai cf 11he Vitiation
of any previsi, di ian e or State Lave.
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