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B-2017-0370
CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0370 1233 WEYMOTH DR CUPERTINO, CA 95014-4915 (362 10 033) MIKE COUNSIL PLUMBING INC SAN JOSE, CA 95131 OWNER'S NAME: URABE SANDRA S DATE ISSUED: 03/06/2017 OWNER'S PHONE: 408-253-3275 PHONE NO: (408) 272-4900 BUILDING PERMIT INFO: LICENCED CONTRACTOR'S DEcL A D ATION License Class PLUMBING Lic. # 7 1 Contractor MIKE COUNS11 P=MBING INC Date 04/30/2017 X BLDG ELECT 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: I hereby affirm under penalty of perjury one of the following two declarations: REPLACE SEWER AND BUILDING MAIN; PROPERTY LINE CLEAN i. I have and will maintain a certificate of consent to self -insure for Worker's OUT 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. Sq. Ft Floor Area: Valuation: $15000.00 APPLICANT sTrnN* RTiFiC 1 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 362.10 033 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 PERMIT EXPIRES IF WORK IS NOT STARTED 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 OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. . C/ Signature 1 / Date 3/6/2017 � Issued by: AbbyA ende "` OWNER -B iI7 D R D ARATION Date: 03/06/2017 RE -ROOFS - I hereby affirm that I am exempt from the Contractor's License Law for one of the 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) z. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 3/6/2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. 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 DISCLOSI gE z. 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 Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 25533, and 25534. J be deemed revoked. "Owner or authorized agent: APPLICANT CERTIEICATION Date: 3/6/2017 I certify that I have read this application and state that the above information isCONSTRUCTION LEND_ING 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 Licensed Date 3/6/2017 Professional GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT,- BUILDING DIVISION 2 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO .(408) 777-3228 • FAX (408) 777-3333 • building@cupertino.orgmisc PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS i Z3` APN # OWNER NAME ( � �PHONE (! CION) C" E-MAIL STREET ADDRESS ' Z� 3 + A w �y CITY, STATE, ZIP I/ -w X KL' A fj /i /I®I FAX CONTACT NAME v� W PHONE ( 1 t C E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR X CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 146 n LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANYNAME'/ .n{',`� E-MAIL �r q��L (/Y�.`/ `1Ce. wYlji 1 ` W ��l i�7 �'6�l�QsV1"w+ Ic��b� ri �+f' FAX STREET ADDRESS / STA CITY, TE ZIP ^y G td PHONE, ®O z ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF J'SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND❑ YES TFLOOD ROJECTINIS THE BLDG AN BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO ZONE El NOS EICHLER HOME? El YES ❑ NO DESCRIPTION OF WORK�� [D�,1® W.� ��0 �� Ql.✓l ®4. � �i� $—! Ci(P 1�j/L, �1 � • _ MFi• t, v� S��J �f u.Qt0Q TOTALVALUATION: s 6®� RECEIVED BY:I �O'AhiJ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property o ner's beha . I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I a orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicantJAgent: Date: 7j SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W © OVER-THE-COUNTER ❑ EXPRESS V - © STANDARD U E] LARGE F, 14IA3OR MEPMiscApp_2011.doc revised 06121111 CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 • Fax (408) 253-5173 m�Q�`�ass�ir�Rro f my fs'aeLtSNE41�'�� CUPERTINO SANITARY DISTRICT pFM4IT LETTER Cupertino Sanitary District has adopted Resolution No. 1263. Building Permit Request (Over -the -Counter) Single Family Project ❑ Multi -Family Project ❑ Commercial Project Project Address: Permit Number: Scope of Work: Owner/Applicant Name: Date: Al� Prepared By: A2-Q_n33 e Phone: IYAV�Z_6F0 Citi Authorized Representative 1, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements will be met afl required fees will be paid prior to the approval of final inspection for proposed project. Date: Signature: v vwnPr i W CUPERTINO SANITARY DISTRICT OFFICE USE ONLY ❑ Pre -inspection Required ( Final Inspection Required Date Scheduled: 17`x Date:_ — — Conditional Approval By: Authorize6 Representative Cupertino Sanitary District District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc City of Cupertino. [V- Inspection Fee Paid Date Paid: Connection Permit Fees: ❑ $350/unit - Single Family Residential connecting to existing lateral (CCN & inspection included) ❑ $650/unit - Single Family Residential connecting with new lateral (CCN & inspection included) ❑ $100/unit up to 4 units & $65 above 5- Mousing (Multiple, hotel, condo, living units, etc.) ❑$500/connection - Commercial & Retail (Permit only. CCTV and inspection not included) $200/each — Disconnect Permit Inspection Fees: ❑ $250/unit - Single Family Residential already connected, but new cleanout required (CCTV & inspection included) , ❑ $150/unit - Single Residential already connected w cleanout (CCN & inspection included) Date:_ - Final Approval By: c Authorized( epresentative Cupertino nitary District SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION iCUPFfI`#ht C? 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinaa.cupertino.ora 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, 8315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMA'T'ION 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 bedroom(s) – (Smoke alarms shall not be located within 3 feet of bathroom door) X ' X On every level of a dwelling unit including basements and habitable attics X 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 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 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.. p Address: 2- S �}.� R Permit No.19 -'2.S} i-7 073-7 0 Specify Number of Alarms: # Smoke Alarms: 73— # Carbon Monoxide Detectors: I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent'ame: l) I10� ... ............. Si nature.....'.. . -..... ... . .... .... .. . .. ----------------------- Contractor Name: HASignature.............. / >''i`'�., ...... Lic.# ........ ..................... Date: �� Smoke and COforntdoc revised 0111012017 Owner Naive WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building (a)-cupertino.org c l 'r .- Permit No ~ ZD/7-037c) Address W w N 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 ign bottom of form. 9 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_ ? f Pff 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. El 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 ign bottom of form. No Go to Question 4. i 4. Is your real property built and available foruseor occupancy on or before January 1, 1994? . 11 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, 19914. Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. t 5. Please check ONE of the following. I 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-con4 liant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. ;On or before J inuary 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures regardless of 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). j • 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 �ornpliant: 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 alterationq or improvements). I I, as the owner or owner's agent of this property, certify under penalty of perjury that non-cornplia 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 C�de, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. f Owner or Owner Agent's Signature: / Date: 3 h► Upon completing and signing thKCertificate, please return it to the Building Division in order to ficial your building permit. ,SB4072015.doc77evised 08/26115