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B-2017-0613CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0613 7529 RAINBOW DR CUPERTINO, CA 95014-5235 (362 30 017) E G ELECTRICAL SERVICES CAMPBELL, CA 95011 OWNER'S NAME: JEFFERS ANNA M TRUSTEE DATE ISSUED: 04/19/2017 OWNER'S PHONE: 408-252-4587 PHONE NO: (408) 370-2222 LICENSED NSED ONT A TOR' DECLARATION BUILDING PERMIT INFO: License Class C-10 Lic. #978103 Contractor F G ELECTRICAL SERVICES Date 10/31/2018 X BLDG X ELECT _ 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: UPGRADE PANEL (200 AMPS) - SAME LOCATION; (1) SUBPANEL - I hereby affirm under penalty of perjury one of the following two declarations: HALLWAY; HARDWIRE SMOKE DETECTORS t. 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 Sq. Ft Floor Area: Valuation: $2500.00 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 362 30 017 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 againIt said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, theplicant understands and will comply with all non -point source regulation per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. -Signature Date 4/19/2017 Issued by: Abby A g OWNER-BUi� DER DECLARATION Date: 04/19/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the R 'F ROOFC 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: 4/19/2017 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. I in for is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532-a) should I store or handle hazardous s. certify that the performance of the work which this permit material. Additionally, should I use a ipment 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 B Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the C ertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Co Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: -1 APPLICANT CERTIFICATION Date: 4/19/2017 I certify that I have read this application and state that the above information is CON, TION LENDING Y correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this pee mit 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. Licensed Signature Date 4/19/2017 Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255, CUP RTINO (408) 777-3228 • FAX (408) 777-3333 • buildinuCokuoertino.orcl I IPLUMBTNC MTlfP(-r-rArrrCAr IXd— f-1. PROJECT ADDRESS ��(`� e € U1V11Jl;hLLANt'.UUS APN# +fF- OWNER NAME PHONE E-MAIL eA r R CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CPNIRAC NAM F LICENSE - LICENS E vt l E MAIL ra F kIL _ SS ( ^ A CI S A . , II 4/� y F ® L^ ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E—MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OFSFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN 11YES IS THE BLDG AN - ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE P& EICHLER HOME? ;2"NO DESCRIPTION OF WORK yt F V 8 t] Zlb C A TOTAL VALUATION:-_ tJ - By my signature below, I certify to each he 110 " I am the property owner or authorized agent to act on the.property owners behal . I have read thisrv" application and the information I have pr ed i o ct. 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 S tion. I authorize representatives of Cupertino to enter thea ve-i tlfied erty for inspection purposes. Signature of Applicant/Agent: F Date: SUP PLM TAL INFORMATION REQUIRED z,4 ..:. EXPMSS �� L7-:ILARCI MEPMiscApp_2011.doc I•evised 06/21/11 SMOKE / 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 • building(55)cupertino.org � F I pll�LC5 stash r� 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 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 roont 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 8314 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 o`,,rner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instnictions 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: Permit No.z a I S Specify Number of Alarms: # Smoke Alarms: F-77 Carbon Monoxide Detectors: 1 have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: Signature............................... ........ ...................................................... I....................... Date:................... Contrac , r Nam c v � c c Signature........... 94-51.6. Zj ...... ............................................ Lic.# ........... Date: ........ . Smol e mrd CO form.doc revised 01/10%7017 CUPERT# Owner N Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 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 fonn. fd`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. //Z/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 fonn. 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 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.. Pl se check ONE of the following: CMy property is a single fm�zily 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). ❑ 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, cei ' under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water/onstrving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbin/1mg and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -c i plumbing fixtures comply with the requirements as indicated' the table on the following Daae. I Owner or Owner Agent's Signature: �ZDate: LJ I Upon completing and signing this Certiftq6, please to the Building Division in order to final your building p rmit. SB4072015.doc revised 01/05117