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B-2017-1259CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1259 7562 NEWCASTLE DR CUPERTINO, CA 95014-5221 (366 17 015) CALIFORNIA POWER AND LIGHT SAN MARTIN, CA 95046 OWNER'S NAME: BISHARAMAGDY S TRUSTEE OWNER'S PHONE: 408-314-1702 LICENSED CONTRACTOR'S DECLARATION License Class ELECTRICAL Lie. #Z20$4 Contractor CALIFORNIA POWER AND LIGHT Date 04/30/2018 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 herebiy affirm under penalty of perjury one of the following two declarations: t I , e 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. iilloe 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 regulations per the Cupertino Mural Code, Section 9.18. Date 8/1/2017 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 CERTIIFICATION I certify that I have read this, application and state that the above information is correct. 1 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 8/1/2017 ISSUED: 08/01/2017 PHONE NO: (408) 406-5832 BUILDING PERMIT INFO: X BLDG X ELECT _ PLUMB MECH X RESIDENTIAL COMMERCIAL DESCRIPTION: R2ADE PANEL (200 AMP) - SAME LOCATION Sq. Ft Floor Area: I Valuation: $3000.00 APN Number: Occupancy Type: 366 17 015 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Jasmine Archbold Date: 08/0111017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 8/112017 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 Code, Sections 25505, 25533, and 25534. Owner or auth agent: Date: 8!_1017 � CONSTRUCTIOA E Y I hereby affirm that there is a co ruction len ing 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 Professional COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255 CUA PPER�INO (408) 777-3228 • FAX (408) 777-3333 • building cupertino.org e'-Z0t-j—MAA1SC ❑ PLUMBING ❑ MECHANICAL ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS 2 I n , ' rA& ]k APN rt OWNER NAME moi% PHONE E-MAIL _ STREET ADDRESS CITY, STATE, ZIP I FAX i CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, S TE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAN7 CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # �� COMPANYE E-MAIL FAX STREET ADDRECITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN El ,,Es 1S THE BLDG AN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK - 2ZU cam. ✓yi lil � �' %7/- r— r �'��� TOTAL VALUATION: p �- RECEIVED BY: By my signature below, I c rtify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I h ead this application and the information I have provided is correct. I have read the Description of Rork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building co tr een: I auth ' e r resentatives ofCupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: f SIA NT INFORMATION REQUIREDoFFic$ USE ONLY. ❑ OVER THE-COU1\TER `. r' .: ❑ EXPRESS "� 0 STAISDARD ..: ❑ LARGE F ❑ MAJOR I` � r MEPMiscApp_2011.doc revised 06/21/11 RL CUPERTINO 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(c)cupertino.orq PERIVIIT GAN1(?T. BJ.FINAD UNTIITILS` CERT3F1<CATES BEEN CO�7PI:E'TE�;,;5` z'=:-.AND_RE'i°T1RD,�'fl T Bi7ItiDi1tiDI�I{iISI. PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314,2016 CSC 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 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) X X On every level of a dwelling unit including basements X X 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) maybe 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 907.2.114 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 j Address- I SG Z N e W &-f fL V.r i V<_ C,� Permit No. 1 Specify Number of Alarms: # Smoke Alarms. FW -41 # Carbon Monoxide Detectors = I have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: p Signature �''�-- Date: 0 (T -(o Contractor Name: Signature Lic.# Date: Smoke and CO forna.doc revised 12/15116 00 CUPERTINO. Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 d( 08) 777-3228 • i13 FAX (408) 777-3333 • building(a.cupertino.org y is � &rc-- Permit No. �6L �u e- qa p 1)tI � j 6 trw,,�%YtC? Is your real property a registered historical site? ❑ Yes Civil Code Sections 1 101.1through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 1 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. No Go to Question 3. Is water service permanently disconnected for your building? 11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of forn. 19 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. Cg 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: E My property is a single fanidy 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 multifanzily 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, 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 plurnbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: Date: upon compiering ana signing uus t-eiuncate, please return it to ine rsuiiaing uivision in oraer to nnai your ouuaing permit. . SB407 2015. doc revised 01105117