B-2017-1038CITY OF CUPERTINO BUILDING PE-RIVHT
!BUILDING ADDRESS:
18980 NEWSOM ANT CUPERTINO, CA 95014-3618 (375 35 015)
C0N`TRtCTOR-
VOLTZ ELECTRIC
PER-AlrfNO: B-2017-1038
tt
SAN JOSE, CA 95123
OWNLIVS N&ME- HEINTZ ELLNOR E TRUSTEE
DATE ISSUED: 06.12912017
ONNINERIS PHONE: 408-391-3102
PHONE NO: (409) 464-258a
1IEN9FJ) r-.QN,:TBACTO1Z'S MCLARATION
BUILDNG PERMIT INFO:
License Class C-1 0 Lic, ga=
Contractor =Z_ELEQ-TR--1Q Date 0713112 0 1 8
XBLDG ZKLECT —PLUNIB
—
AIECH ]i RESIDE NMAL— COMMERCIAL
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
111cense
JOB DESCRIPTION:
is in full force and effect.
REPLACE PANNEL(200 AMP)- SAME LOCATION'
I hereby affirm underpenalty of perjury one of the following two declarations:
1. 1 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. 1 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: !Vifluation: 53500.00
permit is issued.
APPLYCANIT -CElZTIFFCATfDN
i
I certify that I have read this application and state that the above
iinformation
ANN Num ber: OccupancyType-,
is correct. I agree to comply with all city and county ordinances
375 35 015
I and state laws relating to building construction, and hereby authorize
IrepresentaWes of this city to enter upon the above mentioned property for
linspection 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
imay 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 complywith all non -point
!source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
'Date
Signature '14 612 12017
Issued by: Jasmine Archbold
Date: a6a9�L� 017
6�W I U-UJLDE—RDY.-C�LAR�N
I hereliv affirm that I am exempt from the Contractor's License Law for one of the
RFROOFS;
All roofs shall be inspected prior to any roofing material lacing installed. If a roof is
following two reasons- ],as owner of the property, or my employees wages as their sole
-
at$ for
installed without first obtaining an inspection, I agree to remove all new materials
compensation, will do the work; and the structure is not intended or offered for
inspection.
sale (Sec,7044.13usiness & Profession., Code)
2. 1, as owner of the pi operty, am exclusively contracting with licensed
Signature of Applicant-_
contractors to construct the project (Sec.77044, Business & Professions Code).
Date: W2912017
11 hereby affirm underperialty of perjury one of the following three declarations.,,
ALL ROOF COVERINGS TO BE CLASS "All OR BETTER
1. 1 have and will maintain a Certificate of Consent to self -insure for'Mcirker s
.. I
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. 1 have and will maintainWorker's Compensation Inswance, as provided for by
j 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. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. 1 certify that in the performance of flie,.voik- for which this permit is issued, I
Health & Safety Code, Section 25532(a),should I store or handle hn7ardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subjectto the
air contaminants as defined by the Bay Area Air Quality l4aringement District I
i
Wokc,'s Compensation laws; of'California. If, after making this certificate of
will maintain compliance wjtl� 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 -9;05,255,533,and 25534.
Labor Code, I must forffiwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent -
APPLICANT CERTIFICAIIQN
V
Pate. 6129/207 -,CbNSTRUC MD MLG ACENKY
I certify that I have read this application and state that the above information is
11 hereby affirm that there is a construction lending agency far the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
Ito enter upon the above mentioned property for inspection purposes. (We) agree
I
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
costs, and expenses which may accrue against said City in
1judgments,
consequence of the granting of this permit. Additionally, the applicant understands
land wilt comply with all non -point source regulations per the Cupertino Municipal
AR CHITECTI S-DILLARATI10—N
Code, Section 9,18,
I understand my plans shall be used as public records'.
Licensed
Signature Date 6129/2017
Professional
CUPERTINO
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Isc (408) 777-3228 • FAX (408) 777-3333 • build ing(d,cupertino. org
❑ PLUMBING ❑ MECHANICAL ><LECTRICAL ❑ MISCELLANEOUS
PROJECT ADDRESS n
APN # 3 -7 -c)S
OWNER NAME
PHO -S -
E-MAIL
STREET ADDRESS /
CITY, STATE, z _
FAX
CONTACT NAME /
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PHONE_
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C T C
STREET ADDRESS
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CITY, STATE„ ZIP _
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FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAM
il�C'
LICENSE NUMBER
LICENSE TYPE
BUS.
COMPANY NAME /
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FAX
STREET ADDRESSA 7/0 J
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CITY, STATE, ZIP f J_/,
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PH_ /IVE - y6 y, -k?
ARCIRTECTIENGWEER NAME
LICENSE ER
BUS. LTC #
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 ❑ "F.S
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: 0
RECEIVED BY:
Y
�CAX 0
-
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 behalf. I have read this
application and the information I have pro •ided 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 buil mg construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 6 z 7
WPI'LEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
W
❑ OVER-THE-COUNTER
A.
❑ EXPRESS
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❑ STANDARD
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❑ LARGE
❑ MAJOR
AIIEPMiscApp_2011.doc revised 06/21/11
s �..
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(abcupertino.org
PERMIT CANNOT.BE"EINALED UNTIL THIS CERTIFICATE HAS BEEN
COMPLETED, SIGNED AND RETURNED TO THE BUILDING DIVISION
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide E
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior a
inspections are required.
s for
for
GENERAL INFORMATION
---- --- Existing single-family and_multi-family_dwellings_shall be pr-o-vided_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 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or C arbor
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
'Z _11wi i d1✓ d
Outside of each separate sleeping area in the immediate vicinity of
the bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
j
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances ar}d 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 orraw]
space. Refer to CRC Section R314 and CSC Sections 907.2.11.4 and 420.6.2. An electrical permit is requir'd 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: ,IV D j�,� `isL�S[i�l 4j/L� C10,e '. y 91 �>T Permit No.
Specify Nurimber of Alarms: ,
I havc rani and orvraa to rmmnhi Wifh tha harms and rr)nr1itinnc of this .ctatamant
Owner (or Owner Agent's) Name:-%
----- —
Signature.... (......... Dater'
'Z _11wi i d1✓ d
...
::- .................................................................
Contractor Name:
j
Signature............................ *.................................... Lic.#...................................... Date:
.................................................................................
Smoke and CO form.doc revise , 09/27/16
CUPERTINO
Owner Farre ,L /ii
Address % J'�j �7,p
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE„OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPER'TINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 o buildingQcupertino.org
VIM
IFE
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
tQJ'No Go to Question 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.
re o 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
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
Lf5Yes 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:
CS�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 fixt
to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all r
compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures. (regardless of whe
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 orbefore 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- conservin;
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
;Own er_-o.r_ Owner Agent's Signature: CDate:' �—
Upon completing and signing this Certificate, please return it to the Bui r g Division in order to final your building permit.
SB407 2015.doc revised 01/05/17