B-2017-0738CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0738
11057 LINDA VISTA DR CUPERTINO, CA 95014-4751 (356 06 013) DRAIN DOCTOR INC
SANTA CLARA, CA
95054
OWNER'S NAME: SPRAGUE KAYOKO TRUSTEE
OWNER'S PHONE: 408-996-1696
LICENSED CONTRACTOR'S DECLARATION -
License
A ATIONLicense Class C-3fi Lic. # 4A245B
Contractor DRAIN DOCTOR INC Date 01/31/2018
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license 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.
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
v� permit is issued.
APPLICANT NT 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, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date 05/9/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
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
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.
3. 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.
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, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature
DATE ISSUED: 05/09/2017
PHONE NO: (408) 970-3934
BUILDING PERMIT INFO:
X BLDG —ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE BUILDING SEWER/REPLACE SEWER MAIN
Sq. Ft Floor Area: I Valuation: $19500.00
APN Number: Occupancy Type:
356 06 013
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: 05/09/2017
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 05/9/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BE
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 Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date: 05/9/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency f the performance
of work's for which this permit is issued (Sec. 3097, Civ C
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Date 05/9/2017 Professional
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildina(a cupertino.orcl Rn
CUPERTINO MIA I S C
PLUMBING F1 MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS / L �J-t,_ p Y
APN # _® (aO ( 3
OWNER NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP / FAX
CONTACT NAME A . /� -{� j C (U
`^o��
PHONE v % (1
IL
STREET ADDRESS ^ll•)d oo k-
CITY, STATE, ZIP ^�a�a� / AX
❑ OATtER ❑ OWN'ER-BUILDER ❑ OWN -ER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME e --H (T- � v� Q LICENSE NUMBER /� �7
/ (/�- T (J
LICENSE TYPE
VVV
(,
COMPANY NAME %1' -n o � YI
E-MAIL
FAX
STREET ADDRESS D✓� b %JY1� Q
w
CITY, STATE, ZIP 5dVy&7'l G � % y/�
PHONE /,► i�
(r
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD or DUPLEX ❑ M`ULTI-FAMILY PROJECT LN wII.DLAND ❑ 1'ES
BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ 1'ES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
r n
v Yn o
b -Y
'Y\J
TOTAL VALUATION: /
RE 1
By my signature below, I certiff to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 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 con tion. I authorize tatives of Cupertino to enter the above-idntified roperty for inspection purposes.
/ +�!
Signature of Applicant/Agent:Date:
SUPPLEMENTAL INFORMATION QUIRED
FFICE USE ONLY
OVER-THE-COUNTER
f"
❑ EXPRESS
U
STANDARD
❑ LARGE
El AiAJOR
AYEPAPsc,App_2011.doc revised 06/21,111
lf/
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 - Fax (408) 253-5173
� 50.tlt9pp;,
CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over -the -Counter)
�ingle Family Project ❑ Multi -Family Project ❑ Commercial Project
Project Address:
Permit Number: \
Scope of Work:
Owner/Applicant Name:
Address:
Date:
C'� 4 do-
Prepared By:
U�'skrA-
DY
City Authorized Representative
� r
1, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for proposed project.
Date:
Signature:
Owner / Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Required Final Inspection Required
Date Scheduled:
Date: Conditional Approval By:
Authorized 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 Cup erti o.
Inspection Fee Paid Date Paid: - 1-'
Inspection Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
$150/unit - Single Family Residential already connected with existing cleanout in working order
D $350 Minimum — Commercial and Retail Actual Amount:
$200/each — Disconnect and/or abandon lateral service
Connection Permit Fees:
$350/unit - Single Family Residential connecting to existing lateral
$650/unit — Single Family Residential connecting with new lateral
D $100/unit — Multi, Hotel, Living Units, etc. Actual Amount:
$500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
Area and Frontage Fees Amount:
D Residential Excess Fees over 3.5 unit/acre Amount:
D Commercial and Retail Connection Fees Amount:
Commercial and Retail Change in Use Fees Amount:
Date: - -2t - 1 "l Final Approval By:
Authorized 1�ep sentative
Cupertino Sanitary District
CUPERTINO
PER T
COMPLK
PURPOSE
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 • buildingQcupertino.org
ANNOT BE FINALED-UNTIL THIS° CERTIFICATE HAS BEEN ;.
ED7 SIGNED AND RETURNED TO THE` BUILDING DIVISION
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
bedroom(s) - (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level ofdwelling unit including basements and habitable attics
X
X
.a
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.. q C f 9
Address: �� 'T ��� S1 L,. 501��0 Permit No.��.� �
Specify Number of Alarms: # Smoke Alarms: �7 # Carbon Monoxide Detectors:
r t, ., .4 n14 onraa fn nmmnly With the tPrm.c ar6rnnbv—jons of this statement
19
Smoke and CO form.doc revised 01/10/2017
Owner (or Owner Agent's) Name:
Sl�
fSi
naturT.. .... . ...... ........ ........... Date:..................
Contractor Name:
Signature...................................................................... Lie.# ........................................ Date:...................
19
Smoke and CO form.doc revised 01/10/2017
CUPERTINO
Owner Name
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 • build ino(a.cupertino.orq
:PW Ol O.0 f-11- Permit No,?'� " Z 01-4- - Di >S
Address
v o
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.
4 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?
IkYes Civil Code Sections 1101.1 through 1101.8 do not apply.
N 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.
C 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.,
ease 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-conseiving 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-conseiving 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).
0 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 peijury that non-coinpliant plumbing fixtures vill 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 pate. ----I — A _
Owner or Owner Agent's Signature:) a7Date: NO I l'— 1-rw1 T I
Upon completing and signing this Certificate, please return it to the uilding Division in order to final your building permit.
SB407 2015. doc revised 01105117