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B-2017-0573CITY OF CUPERTINO BUILDING PERMIT BUIL.DINGADDRESS: CONTRACTOR: PERMIT NO: B-2017-0573 10991 NORTHSKY SQ CUPERTINO, CA 95014-0540 (316 40 005) ECONOMY ROOTER INC SANTA CLARA, CA 95055 OWNER'S NAME: BENJAMIN ROY B AND LACRAMIOARA TRUSTEE OWNER'S PHONE: 408-859-9802 LICENSED CONTRACTOR'S DECLARATION License Class C-36 Lic. #892045 Contractor ECONOMY ROOTER INC Date 05/31/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. 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 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 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, th pplicant understands and will comply with all non -point source regulati the Cupertino Municipal Code, Section 9.18. Signature ; Date 04-12-2017 DATE ISSUED: 04/12/2017 PHONE NO: (408) 249-4922 PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: ACE 40 GALLON WATER HEATER - GARAGE Sq. Ft Floor Area: Valuation: $900.00 APN Number: Occupancy Type: 316 40 005 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: 04/12/2 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: 04-12-2017 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 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. 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. APPUCANT CERTiFTCATION 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 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 04-12-2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 B Area Air Quality Management District I will maintain compliance with the C rtino Municipal Code, Chapter 9.12 and the Health & Safety Code, s 25505, 25533, and 25534. Owner or authorized agent: Date: 04-12-2017 CONSTRUCTION LENDING AGENCY 1 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.) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professional GENERAL PERMIT APPLICATION mmm E K P COMMUNITY DEVELOPMENT. DEPARTMENT • BUILDING DIVISION 10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255in m CUPERTINO (408) 777-3228 • FAX (408) 777-3333 - building cu erHno.or Isc WPLUMBING I—I MECHAl\aCAT, nFT R( -TR T(`AT I -KTTCrMT AT.TT'r1T TO PROJECT ADDRESS e C � ( ✓ APN# 31 C) J OWNER NAME PHONE 1 M O AIA 6.5 1 i � 08 � S� � 90Z E-MAIL STREET ADDRESS CITY, SATE, FAX ��ifv0 e� Sony CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FA3 ❑ OwNTER ❑ OR'ATER-BUII.DER ❑ OWNER AGENT 12 COAfTRACTOR ❑ CONTRACTOR AGENT ❑. ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE / BUS. LIQ ' COMPANY NAME / C.J MQ rw -�jC E-MAIL FAX STREET ADDRESS/ t � w I �1 1v2 ke �t CITY, STATE, ZIP oak CA- ?S13b PHO E 08ZVgyg21 ARCHITECT/ENGINEER NAME LICENSE NUMBER BIIS. LIC # COMPA*?Y NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF . _MIFD o DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WtLAND ❑ YES PROJECT IN ❑ YES URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK a TOTAL VALUATION C RECEIVED BY By my signature below, I certify to each of thefo lowing: 1 am the property owner or authorized agent to act on the pr pert; owner's behalS. I have read this application and the information I have provide 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 c tion. I authorize representatives of Cupertino to enter the above-!ide fled /operty for inspection purposes.Signature of Applicant/Agent: Date: Z - SUPPLEMENTAL INFORMATION REQUIRED OFFICE usEzii`iz OVER THE CO LN R e. EXPRESS -` ❑, STANDARD -- � ❑ LARGE A1EPMisc,4pp_2011.doc revised 06/21/11 SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(ai cupertino.orq PURPOSt; 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 INFORMATION _ Existin =sin le-familyand-multi-tam-ay-dw-elungs-shah.-he=pr-rvidecf-with S moke-Al-a-rms, and Ga�baz� - ----- - 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 ALAR_ M 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 -vvhich mud. tost be connecte_ the build' -_ 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. Address: 109q I V Qt�`�(( �'�,�d` (;��'i' 7�e� �i f Permit No.1� Z Specify Number of Alarms: ' #1 Smoke Alarms: 1 _271 Ff Carbon Monoxide Detectors: i have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: Signature.............. `. ...-.................................................................... Date:.7 �. Contracf'or Name: it Signature...................................................................... Lic.#........................................ Date:................... Smoke and CO form.doc revised 01/10%=017 CUPERTIN€) Owner Naive WATER -CONSERVING PLUMBING OWNER CERTIFICATE OF COIVIPLIANCERES [3-h tT 0973 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 FILE (408) 777-3228 • FAX (408) 777-3333 • building(a1cupertino.org�j7 Permit No. 57: Address 10C131 %Q(ZIh.` k,4 &140 G�� fi ��'�1Uo , e,4— I ! 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. X No Go to Question 2. 2. Does yourrealproperty 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. 0 The licensed plumber's certification has, been provided to_the_Building Division,_ _ v_ z 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? 0 Yes Civil Code Sections 1101.1 through 110.1.8 do not apply. Skip the rest of thee form and sign bottom of form. 0 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 fonn. ! 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. 0 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). My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after.Januar 1 2014,ecified 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-coinpliant 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 commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or irnprovements 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-donserving 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 installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the followine Daae. Owner or Owner Agent's Signature: � r,� �'1 Date: LP4 �i o +T Upon completing and signing this Certifrcaf please eturn it to the Building Division in order to final your building Yennit. SB4072015.doc revised 01/05/17