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B-2017-1027
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1027 1057 S STELLING RD CUPERTINO, CA 95014-5018 (362 22 002) SAFE STEP WALK-IN TUB COAVANY INC HIMINGTON BRACH, CA 92649 OWNER'S NAME: RAW MARY DATE ISSUED: 06128/2017 OWNER'S PHONE: 408-253-9900 PHONE NO: (714) 373-8545 LICENSIM CONTRACTOR'S DEO ARAnQO L BUILDING PERMIT INFO: License Class B Lic. 4983603 Contractor SAFE STEP WALK-IN TUB COMPANY INCDate 06/31/2019 X BLDG X ELECT _ PLUMB 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing w MUCH 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: (N) WALK-IN TUB (N) GFI (20 AMPS) I hereby affirm under penalty of perjury one of the following two declarations: a L I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of tho Labor Code, for the performance of the work for which this permit is issued, shave and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the porformance of the work for which this permit is issued. Sq. FtFlogrArea: Valuation: $19480.00 Aj'PLICAIQT L ERTIFICATION I certify that 1 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 36222002 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 WORD IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signet Date 06-28-2017 Issued by: AbbyAvende Date: 0 612 8120 1 7 OWNER -BUILDER DLI CLAR,ATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the R&ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is * 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(See.7044, Business & Professions Code) * 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 06-28-2017 I hereby affirm under penalty of perjury one of the fallowing three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER a. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided forby Section 3700 ofthc Labor Code, for the a• performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE i I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.9S 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 shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 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 Labor Code, I must forthwith comply with such provisions or this permit shall the health & Safety Code, Sections 25505, 25533, and 25534, �n be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Dake: 06-28-2017 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance 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 and will comply with all non -point source regulations perthe Cupertino Municipal A�tCHIT1rGT}S DECLARATION Code, Section 9. 18. I understand m fans shall be used public records. y P Signature Date 06-28-2017 Licensed (Professional GENERAL PERMIT APPLICATION -PME COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION =1 I 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255% U1P#wRTlid� (408) 777-3228 • FAX (408) 777-3333 • buildingAcupertin_ _o..orcl rH 0,1_4 M al tao -UPLUMBING ! IWrIIANTCAi. ZT1T.V1-TPrrAr narrcrrrr a,rnnrrc PROJECTADDRESS `� �� (� } � � � APN # OWNER NAME ' �(i4{f I C �%{•tAi PHO l U�` Z�J�',7 � ! / GiC� E-MAIL STREET. ADDRESS j �} �+y + �j G0 �L4Tn t]7G�{! IAC CITY, STATE, ZIP 1 /+ �. •'ep,41nj C 7�dfV FAX CONTACT NAME PHONE E-MAIL LA STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR El CONTRACTOP AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ✓ ' LTC "NSE NUMBER � LICENSE. TYPE {� L COMPANY NAME E-MAIL FAX STREET ADD) .tF1SS� 2.1,i-1 Yt� CITY�LSJ L 1 11 P� ARCIRTECTIENGINEER NAME LICENSE NUMBER BUS. LTC # COMPANY NAME F MAIL FAX STREET ADDRESS CITY, STATE, ZIP PRONE USE OF SPD uDUPLEX ❑ MULTI-FAMTLY BUILDING: [3 COMMERCIAL , PROTECT M WILDLAND ❑ YPS URBAN INTERFACE AREA ® NO PROIGCT 1N ❑ i'Es FLOOD ZONE ❑ NO I5 THE BLDG AN ❑ Ym EICHLER HOME? ❑ NO DESCRIPTION OF WORK � N wedtic 1 r, T UJclb TOTAL VALUATION: �J © WE IVX: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on he 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 relatin to ba ding construction. I at rte representatives ertmo to enter the above -identified p:•operty for inspection purposes. Signature ofAlaplicandAgettt: "J — Date: _ 6� SUPPLEMENTAL INFORMATION REQUIRED OFfiiCE USE'ONI Y - 61"ER-THE:COUNTER .. a ''FI>,RESS STANDARD. ©`LARGE MF–PMiscXpy?011.doe revised 0612 111] C*Pl 0 SMOKE l 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(d)cupertino.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 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, 8315, 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 of a dwelling unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alarm's 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 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: I )t)_1 Permit No. �'2GtZ_Z®afi Specify Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: I hwo ron'4 nnn' nivraa to emmnhi jq fh the terms and conditions of this Statement Owner (or Owner Agent's) Na Si nature... .. .... ..................................................................... Dater .E7^aa...1.. for Name: ,� /`�� /Contrac Llcyy s' W1i-S0 Li.-.# Date:................... Signature.............................................................. ........................................ Smoke and CO form.doc revised 01/10/2017 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r �- pt��;Pjw CUPERT NO I 10300 TORRE AVENUE • CUPER'TINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 -; building(alcupertino.ora Owner Name VV14 ry Ila w - Permit N o (3 2 0l 1 ` W AJ Address _ IO2)1 So%J0,% Sk.e th nom, Rb 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 forin 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. I'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. o/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. ,Zyes 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. Pase check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4. n 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 nnprovements). ❑ My property is a commercial real properly. 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 January1, 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 followinz vaize. 1-1 r ___ Owner or Owner Agent's Signature: !( i \ (iAR A M� a_ ) Date: ,1 l, L�? / 1 I Upon completing and signing this Certificate_, s `return it to the Building Division in order to final your b ilding permit. SB407 2015.doc revised x1/05/17