B-2017-0601CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0601
20558 CEDAR13ROOK TER CUPERTINO, CA 95014-0438 (323 45 052)
ATKINSON
CLIMATROLLERS INC
SAN JOSE, CA 95112
OWNER'S NAME: NAREVICH ROMANAS AND NAREVIC EGLE
DATE ISSUED: 04/17/2017
OWNER'S PHONE: 408-569-5994
PHONE NO: (408) 294-6290
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-20 Lic. #258540
Contractor ATKINSON CLIMATROLLERS INC Date 12/31/2018
X BLDG _ELECT _ PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
X 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:
REPLACE FURNACE - CLOSET; ADD A/C - ROOF
Y hereby affirm under penalty of perjury one of the following two declarations:
r. 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 ofthe work for which this permit is issued.
z 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
Sq. Ft Floor Area:
Valuation: $10361.20
permit is issued.
APPLICANT CERTIFICATION
1 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
323 45 052
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 will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
D
180 DAYS FROM LAST CALLED INSPECTION.
Signature Ut CB L, u/ Date 4/17/2017
Issued by: AbbyAygnde
OWNER -BUILDER DECLARATION
Date: 04/17/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons: -I
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: 4/17/2017
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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
,f
Owner or authorized agent:
APPLICANT CERTIFICATION C
-Date: 4/17/2017
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
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
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
AR DECLARATION
ARCHITECT'S
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
I understand my plans shal1l1 bbe e used a as public records.
Licensed
Signature Date 411712017
Professional
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINOg
F1 PLUMBING Y rWCHANICAT. I/IF.T.FC'TRTrAT MAnTcrFTT ANI>~nTre
(408) 777-3228 •FAX (408) 777-3333 • building[7a.cupertino.or
PROJECT ADDRESS �%
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ri
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I`CENSE NUMBER /y_
LICENSE TYPE C�
BUS. LIC #qaoos
COMPANY NAME
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FAX
STREET ADDRESS71
CITY, STA�ZIP ��J S E
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ARCHITECT/EN1tGINEER NAME
LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK VQY-ef l �g F -v rei UL $ �; �j lo 5 eA 11
1 � d
TOTAL VALUATION: �®
'TLEECEIVEDBY:
By my signature below, I certify to' each of the following: I am the property owner or authorized agent to act on the property owner's beh f. 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 authorize representatives of Cupertino to enterthe b ve-ide tifred property for inspection purposes.
Signature of Applicant/Agent: A—ay�CZ� is 44✓ Date:
SUPPLEMENTAL INFORMATION REQUIRED
CE OVER--rMI Ctfi NIMR
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MEPMiscApp_201 1. doc revised 06121111
m,Onl
. ' \ SMOKE / CARBON
\ .. MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
,,,f,N,. COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPEt2 1NC3 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinq at7,cupertino.orq
PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS.BEEN
COMPLETED, I Q..N k'` AND,1fTIt =.TO THE B BJN ISJO '
PURPOSE _. _ e-� --
This affidavit is a self-certification for the installation of all required Smoke and
Carbon Monoxide Alarms for
r
compliance with
p 2016 CRC Section R314,R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access
for inspections are required.
GENERAL INFOR
MAT'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 locations: _-
v. 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) //
F On every level of a dwelling unit including basements and habitable attics X X
; Within each sleeping roomX
' 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
II 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 p C C Section R314 and CBC Sections 907.2.114 and 420.6.2.6 .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
Address: 2_° J 3 O4 Wit-1rr-®0 -re.u- Cep.-g-- h C A iSb1 ermit No. 1"U� ,/ 4/
Specify Numlier of Alarms_, #Smoke Alarms #CarbonMonoxide-Detectors- I
—____ __----, /have read and agree to comply with the terms and conditions of this statement
OWner(or"Owner Agent's)Name: ,c�,
E�� '
Signature r Date: g./.14..11.2.
Contractor Name:
Signature Lic.# Date: .
Smoke and CO form.doc revised 01/10/2017
u
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
r.�s COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX.(408)777-3333•buildingt icupertino.orq
Owner Name 11.0 Nf3.,rq,,,,Oft
Permit No.
` - 1
Address`` 1-°y J C+A0® 0-1V-",% C gee 14
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 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.
The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
cl".;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.
-1*No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
LI 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, 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-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).
D 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).
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 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 following page.
O er or Owner Agent's_Signature: 9 1V ems_.__, Date: ?— t 4—7-o()
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
513407 2015.doc revised 01/05/17