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B-2017-0854CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0854 1220 WEYMOTH DR CUPERTINO, CA 95014-4958 (362 10 037) STREET PLUMBING AND ROOTER SAN JOSE, CA 95128 OWNER'S NAME: SIVASANKAR MOHAN N AND MOHAN GEETHA TRUSTEE OWNER'S PHONE: 408-569-7875 LICENSED CONTRACTOR'S DECLARATION License Class C-3fi Lic. #582217 Contractor STREET PLUMBING AND ROOTER Date 12/31/2017 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: 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. t 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, the applicant understands and will comply with all non -point source regulaticPs per thg-Cupertino Municipal Code, Section 9.18. Signature '411 Date 5/31/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. 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: 05/31/2017 PHONE NO: (408) 496-1155 BUILDING PERMIT INFO: BLDG —ELECT X PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE 40 GAL WATER HEATER - SAME LOCATION Sq. Ft Floor Area: I Valuation: $1600.00 APN Number: Occupancy Type: 362 10 037 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende Date: 05/31/2017 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: 5/31/2017 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 Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Cole, Sections 25505, 2,5533, and 25534. Owner or authorized agent: x,r Date: 5/31/2017 CONSTRUCTION LENDING AGENCY I 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 I understand my plans shall be used as public records. Licensed Date 5/31/2012 Professional CUPERTINO r- az5q GENERAL PERMIT APPLICATIONMEP COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(cDcuoertino.orc3 PLUMBING n MECHANICAL M=LECTRICAL MISCELLAI MISC PROJECT ADDRM 1220 W e Yl 10 7-H PK www oWNERNAME 7-' l lI l OA l �l I PHOm L%p g .S7o9 - 7L SpREETADDRESS 1220 OG-ymo T" CITY, STATE,ZIP ,r�% , FAX CONTACT NAME STREET ADDRESS 27 rr3 W 4tpu <q7 h VLc AW CTIY. STATE, ZIP r� N •}y��C_ I �ZS FAX ❑ OWER ❑ OWNER -BUILDER ❑ OWNERA(al 000NM TOR ❑ CMIRACTOAJ`A`Gk2.TJ Q ARc-Hn T . ❑ R4aDdEF t ❑ DEVFux9m ❑ TENANT CONTRACTOR ATAME 1�A �I b r, � . T I]CEA'SE NUMBER J 6 Z 21 7 LICENSE TYPE BUS. LJC j1 QTG COMPANY NAM& P��N% =` 12r%0l E� IUrv�j( V W�CiI'� G}`cvt FAX '`GSSE STREET ADDRESS 2),73 (A)AcNu% 6 dam A�,, CITY. STATE. ZIP Or� CA gE-l 2�3 J J ARC TECTIENGJNESR NAME LICIIZSE NUMBER BITS. C s COMPANY NAME E-MAIL FAX STREET ADDRESS CITY. STATE, 21P PHONE r: 'USE OF SFD OT Duplex ❑ Multi -Family sTRUmma ❑ Commercial PROTECT IN wE DLAWD URBAN INTERFACE ARE:+ ❑ Yes ❑ No PROJECT IN FLOOD ZONE ❑ Yes ❑ No DEscRrPIION.aFwoRK ,(� � ��1 !nl - G�✓ r'G � b'c�v`-�- tl b � art- (rt C r TOTAL VALUATION: lj 0i) -was By my signature below, I certify to each of the following: I am the property owner or authorized argent to act on the pro}icrty owneds behalf I Lave read this application and ibe information I bave provided kap&4 I bave read 'an of Work and verify it is accurate. I agree to comply witL all applicable local ordinances and state laws relating 10 a upertino to enter the above -identified property for inspection pinposes. Signature of ApplicaWAgent: Ali' - Date: S / Z - 7 SUP ON REQ " .� - �y�� WI Nu 1111 = AePAfzscdpp 201 Ldoc revised 03116/11 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingaDcupertinc.org ' PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section 8314, R315,2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. —GENERAL INFORMA-TION - --- -- _ -- -- 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 ALARMCOALARM Outside of each separate sleeping area in the immediate vicinity of the Xbedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door)On every level of a dwellin unit includin basements and habitable attics X X Within each sleeping room 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.. �, } �� t r _ Permit ��-.rr 6� �� Address: ' zzo Wino I s �+' ' �� I�To. Specify Number of Alarms X r e # Smoke Alarms: X #Carbon Monoxide Detectors: I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Narne: p� �1 Si nature..................................,�,�a,i...........................................................Date:......... Coonntra t r Nam r t )�Pf,+ �(Mri'c/lel�(0( � � em Signature.... ..................... Lica .........Y.................!........... Date: .� ... �S 221 Srrroke and COform.doc revised 01/10/2017 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPER.TINO (408,A777-3228 •FAX (408) 777-3333 • buildina(E�cupertino.org Owner Name CgF=#m NIS Permit No Address (2Z0 k)L�Vq0 fi_1-� 1]x-1 VC 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. L*� No Go to Question 2. �l 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. L� No Go to Question 3. j� 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. j 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.. 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-conseiving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ Mypropertyis a niultifani.ily 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 coniniercial 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 -,eater-- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I. as the owner or o«nler's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above hath «Tater-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 -c nseiving plumbin fixtures comply with the requirements as indicated in the table nn the following Daae. Owner or Owner Agent's. Signature: Date: nleace return it to the Building Division in order to ficial your SB40 7 2015. doc revised 01/05/17