B-2017-1524 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1524
10080 N WOLFE RD STE SW3-190 CUPERTINO,CA 95014-2544(316 20 086) BLUELINE
ASSOCIATES INC
PLEASANTON,CA
94588
OWNER'S NAME: I&G DIRECT REAL ESTATE 27 LP DATE ISSUED:09/29/2017
OWNER'S PHONE:415-702-1312 PHONE NO:(925)4622200
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#739348
Contractor BLUELINE ASSOCIATES INC Date 09/30/2017 X BLDG _ELECT _PLUMB
MECH_RESIDENTIAL X 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
license is in full force and effect. JOB DESCRIPTION:
T.I;BLUE-LINE ASSOCIATES-(7392 SF)
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 •
I/ zperformance of the work for which this permit is issued.
`•' I have and will maintain Worker's Compensation Insurance,as provided for by
.'I Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$100000.00,
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 APN Number: Occupancy Type:
and state laws relating.to building construction,and hereby authorize 316 20 086 B(Tenant Improvements)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the ,
Cityjof Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED..
may,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 comply with all non-point •
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
ature 0 1op
Date 9/29/2017 Issued by:Abby Ayende
Date:09/29/2017
OWNER-BUILDER DECLARATION .
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: , , All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. 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.
' i sale(Sec.7044,Business&Professions Code)
2. .;,I,1as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to'construct the project(Sec.7044,Business&Professions Code). Date:9/29/2017
jI
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. '',i have and will Maintain a Certificate of Consent to self-insure for Worker's
I Compensation,as provided for by Section 3700 of the Labor Codc,for the
' performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
'2. .1 have andwill maintain Worker's Compensation Insurance,as provided for by 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. I will
permit is issued: maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
e Health&Safety Code,Section 25532(a)should I store or handle hazardous
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 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 the Health&Safety Code Sections 2505,25533,and 25534.
Labor Code,1 must forthwith comply with such provisions or this permit shall , 1 i
be deemed revoked. „da er or authorized agent: i�ll
' APPLICANT CERTIFICATION Date:9/29/2017 �
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws 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 per the Cupertino Municipal ARCHITECT'S DECLARATION
• Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature' ' , Date 9/29/2017 Professional
CONSTRUCTION PERMIT APPLICATION
� �� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONB -
{ 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
I5{:79f ( 15" ti
s
(408)777-3228 • building@cupertino.org PEMIT#B- rrr// i
CUPERTINO . REV 4 DEP it
•❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION T.I.L�}' ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS 1ooso w, YV V, 1 .1 I I io APNP 3 l�_ _ng to
OWNER NAME r��P o I 'dtut (�fl`l' P1115:1017 I {^ E-MA
wog, UVu�, iL CYrlfMerC, shin itArel�1i1 .
STREETADDRESS ' � , P
I ¶) r t 1 1fl\ n C s clic l ic1W)I• cs� 1 hot
. *.CONTRACTOR NAME DOWNER-BOLDER QQj� Y�!�ME Ao [ s LICEN UMBER LIC STYPE
. 13134?)
`Q
STREET ADDRES(l.I�� v_441.1 � �UU C11�Si�TE�_^ t�Q
E-MAIL VI] PHONE �� fir/1t BUS.LIICC10
41.5ci
LISPRCHITECT ❑,OWNER ❑OWNER AGGENT ❑CONTRACTOR AGENT❑ENGINEER❑DEVELOPER[ TENANT .
CONTACT NAME :Ott
a �� r-
STREET ADDRESS 4 111.....5NI
DECRIITDN \tlt 1-1 NA) Jl E-3MAIL4144e61'T l ", IOW lUn
cfidiraPon ow, a Itol PEON
i. ` (iLf p
•
•
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL IQ COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SE DEMO SF STORIES U I TOTAL NET SF USE TYPE OCC SQ.F F. VALUATION($)
REMODEL REMODEL KITCHEN /REMODEL OTHR GARAGE ❑ATTACHED Ott j't/ '�I) 1,ta01
BATI!ROOM SF SF SF SF 0 DETACHED 1,f 1 Il I `'JJ fI "II 1L-
EXISING ❑YES, EICHLER 0 YES SECOND STORY ADDITION El YES
FIRE SPRINKLERS um 0 NO 0N
DWELLING f SECOND DWELLING', 0 YES 0 ATTACHED DETACHED OTHER I
UNITS a UNIT ADDITON: 0 NO S F
POOLSI ❑FIBERGLASS ❑VINYL-LINED ❑GUNITE []PREFABRICATED
POOL-SP 'SPA-SF ;- SPA ATTACHED BYES ®NO I TOTAL-SF
RECEIVED BY: T L V
Commercial or Multi-Fmrdht Buildings wit:,Public Swimming Pools rewires Deunrtmenl of Environmental Heath improvet ALUU0TION:
f v/
RE-ROOF EXISTING ROOF TYPE:.❑BUILT-UP ROOF 0 ASPHALTSHINGLES❑WOOD SHAKES 0 WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACED NO IF NO' PLYWOOD ❑1" ❑3/6" PLYWOOD TYPE: PITCH: .„, ROOF CLASS
OYES 8 OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER 2 I A
PROPOSED ROOF TYPE:❑BUILT-UPROOF DASPHALTSI•]INGLES❑WOOD SHAKES❑WOODSHINGLES ❑OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF Sof SQUARES
By my signatures 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 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 construction. I authorize representatives.of Cupertino to
enter the above-identified property fo inspection Ipgses. I acknowledge and authorize all inforinatior cont •ted on this application form
to be made available for public record.II [ rn I
Signature o'Applicant/Agent V i / ` Date: 11 L
SUPPLEMENTAL INFORMATION REQi TIRED l
*New 5E13/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. .
*Commercial Buildings: Provide;a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter:of approval from the Home Owner's Association
I' '
Bldgflpp 2017.doc revised 08/01/17
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
4s•194.s COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUP ERTI N O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building@cupertino.org i�
rt
Owner Name: ?4V('jt" tV VK NI O Permit No: ,//oW-l v 1 [
Address: {DOM Wolfe road 1 S ( IC)
CODE REFERENCE(S):
Senate Bill 407(2009)/California Civil Code Sections 1101.1 through 1101.8
2016 California Green Building Standards Code(CALGreen)Section 301
BACKGROUND:
As of January 1, 2014, SB 407 requires non-compliant plumbing fixtures to be replaced with water conserving
plumbing fixtures when a property is undergoing additions, alterations or improvements. Applicants seeking to
obtain permits for any of these types of work will be required to replace noncompliant fixtures prior to final permit
approval or issuance of a certificate of occupancy by the local building department. This law applies only to
properties built on or before January 1,1994.
Per Civil Code Section 1101.4,for any single-family residential real property,on and after January 1,2014,building
addition, alteration or improvement will require all non-compliant plumbing fixtures to be replaced with water-
conserving plumbing fixtures. See list on the following page for scopes of work that are exempt from these
standards.
Per Civil Code Section 1101.5,for any multifamily residential real property and any commercial real property, on
and after January 1, 2014, specified building addition, alteration or improvement will 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 (regardless of whether
property undergoes alterations or improvements).
Type of Property(choose one): 0 Single-Family 0 Multi-Family E!Commercial
Property Information: YES NOf
1. Is your real property a registered historical site?If YES;skip the rest of the form and sign bottom of form. ❑
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? If YES,skip the rest of the form and sign bottom of form.
3. Is water service permanently disconnected for your building? If YES,skip the rest of the form and sign ❑
bottom of form.
4. Is your real property built and available for use or occupancy on or before January 1,1994? If ❑
NO,skip the rest of the form and sign bottom of form.
I/we, as the owner(s) 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' the table on the following page.
Owner or Owner Agent's Signature: Date: d '''‘'/ 371//
*Upon completing and signing this Certificate,please return it to the Building Inspector at final inspection in order to final your building permit.*
SB407 2015.doc revised 08116117