B-2017-1989 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: - PERMIT NO:B-2017-1989
21529 TERRACE DR CUPERTINO,CA 95014-4741(356 20 012)• WHEN QUALITY
•COUNTS INC
•
MENLO PARK,CA
94026 •
OWNER'S NAME: SHASTRI SUBRAMANIAM S TRUSTEE&ET AL DATE ISSUED: 11/16/2017
OWNER'S PHONE:650-714-5240 PHONE NO:(650)323-6464
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#979380
Contractor WHEN QUALITY COUNTS INC Date 08/31/2019 X BLDG _ELECT X PLUMB
MECH X RESIDENTIAL_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:
REPLACE SEWER MAIN;PROPERTY LINE CLEAN OUT
I hereby affirm under penalty 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
rformance of the work for which this permit is issued.
' have and will maintain Worker's Compensation Insurance,as provided for by
1_ Section 3700 of the Labor Code,for the performance of the work for which this
•
permit is issued. - Sq.Ft Floor Area: Valuation:$7000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.)agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 356 20 012
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 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.
oronatureDate Issued by:Abby Ayende
Date: 11/16/2017
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.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business'&Professions Code). Date:
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
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. I have and will 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
• s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should 1 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 the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall _
be deemed revoked: signer or authorized agent:
APPLICANT CERTIFICATION Date:
I certify that I have read this application and state that the above information is CONST IO ENDING 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 Professional
CONSTRUCTION PERMIT APPLICATION
\ I
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION B .
.r.:1 lk 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 I p�
01.19,,t.l9fs (408) 777-3228 • building@cupertino.org PEMIT#B- �� lv/�l� .
CUPERTINO REV# DEF#
0 NEW CONSTRUCTION 0 ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF p SWIMMING POOL/SPA .
PROJECT ADDRESS L .2101 T c Dr
(APN f LW^ 40
---012_
OWNER NSPHONE E-MAIL
S has-1-n (DI O 7114 5240 s55Vla+i' a1+.1/e-{-
STREET AD RESS CITY, STATE,ZIP
21 2DI Terra r& Pr. CU,Pn aloo 1 CA 61 .o N-
B CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE
a1/1.0tI1 veld( DayQns Pluxnl7er3 01783$0 C- 1
STREET ADDRESS QTY,STATE,ZIP
92'1W6 WIsbvl ' - edwoo A , OA '4t'&.3
E-MAIL PHONE �� 32 � ���� IBUS.�h
COv� atitS e loa�ysl/1ore pitop ers1GornV 7
❑ARCHITECT'❑OWNER ❑OWNER AGENT (CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT
CONTACT NA'''' E-MAIL /1
�_ ta J mkt@ La y sifiD 217 i Lim l ers. Corr)
STREET ADDRESS CITY,STATE,ZIP PHONE '
aw' e ' c toilirete,h7r .
DESCRIPTON
•
reface st &i- hit
it —gni -Rome -h2 mere-' 1hitr- &ah o k-I-
cw p X. Co; ' i i4 U rt i l n wt Fire -
I' '
['SINGLE-FAMILY/DUPLEX ['MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
.I
REMODEL REMODEL KITCHEN REMODELOTHR GARAGE 0 ATTACHED •
BATHROOM SF i , SF SF SF 0 DETACHED
DOSIFIRED INKLE 0RS NEi2O >ICHLER ❑❑YESO SECOND STORY ADDITION ❑❑YES
DWELLING1
USECOND DWELLING ❑YES El ATTACHED❑DETACHED OTHER
NITS I 1UNIT ADDITON: 0 NO SF
Ii
POOLS' 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE ❑PREFABRICATED
POOL-SF "1 "SPA-SF I SPA ATTACHED❑YES ❑NO I TOTAL-SF
4RECF�VEDBY:AM VALUATION:
Commercial or Multi,Familp Buildings with Public Swimming Pools requires Department of Environmental Heath approval (/J.I�J,�p 1 p kl. -co 0
RE-ROOF EXISTING ROOF TYPE: ❑BUILT-UP ROOF 0 ASPHALT SHINGLES❑WOOD SHAKES 0 WOOD SHINGLES 0 E OTHER(SPECIFY)
REMOVE/REPLACE❑NOIF NO ' PLYWOOD ❑ ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
❑YES( '�"#OF LAYERS THICKNESS❑5/8" OTHER El El OTHER .12E
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed'copy of the Cupertino's Tear-Off Policy sF #of SQUARES
By my signatureibelow 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 for inspection purposes. I acknowledge and authorize all information contained on this application form.
to be made available for public record.
Signature of Applicant/Agent: --—i.. / Date: I I/IIQ/ I7
SUPPLEMENTAL INFORMATION RUIR' i
*New SFD/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.
WHOA-Provide.a Otter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
ya sr.niranr,.
CUPERTINO SANITARY DISTRICT �'
20863 Stevens Creek Blvd#100, Cupertino, CA 95014 iv
Tel(408)253-7071 • Fax(408)253-5173 'r,7,1011,,,Sv CUPERTINO
SANITARY DISTRICT PERMIT TETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over-the-Counter)
n Single Family Project n Multi-Family Project ❑ Commercial Project
Project Address: 21 s7c1 179,y-canct pr.
Permit Number: 1"7-0`-4-- 1Ctiq
Scope of Work:
•
Owner/Applicant Name: 3Q.S'kcot bare S Phone: ((QS(b 623 —(e 1('(-1
Address: 3\S T Po\ISo r {a RrAjc,
Date: IA' n- Prepared By:
C ty Authorized Representative
I, as property owner or authorized agent acknowledge that all Cupertino Sanitary District requirements
will be met and all'required fees will be paid,prior to the approval of final inspection for proposed project.
Date: IIf (9 11 Signature:
Owner/Authorized Agent
olc' CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
• Pre-inspection Required -0 Final Inspection '-•wired
late Scheduled:
Date: I`/\` p Conditional Approval By: , /r///
Authorize/Representative
Cupertin.Sanitary District
District will notify owner of the required fee within 5 days after Pre-Inspection has been completed and cc
City of Cupertino.
7 Inspection Fee Paid Date Paid:
Inspection Fees:
%179, $250/unit- Single Family Residential already connected, but new cleanout is required
$150/unit- Single Family Residential already connected with existing cleanout in working order
CI $350 Minimum—Commercial and Retail Actual Amount:
$200/each —Disconnect and/or abandon lateral service
Connection Permit Fees: "
$350/unit- Single Family Residential connecting to existing lateral
$650/unit—Single Family Residential connecting with new lateral
$100/unit— Multi, Hotel, Living Units, etc. Actual Amount:
$500/connection - Commercial and Retail Actual Amount:
Connection Use Fees(See Attached Calculation Sheet):
0 Area and Frontage Fees Amount:
Residential Excess Fees over 3.5 unit/acre Amount:
Commercial and Retail Connection Fees Amount:
0 Commercial and Retail Change in Use Fees Amount:
Date: Final Approval By:
Authorized Representative
Cupertino Sanitary District
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 • build ina(a-)cupet no.ora
I'ER1I�IIT CAIUN�T �E,F,I��AL��I. UNTI3s TSS CEi2TI�'I��TE �7A5-BEEN:
CoLT% I NETt TI IETTEI) TO THE B1TGI�II�iGIVISIO
. ...
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 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, 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 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 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 907.2.114 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 P 2��7
Address- 2 � Jr2� Temate- Dr Permit No0
Specify Number of Alarms # Smoke Alarms =#Carbon Monoxide Detectors
--
1 have read and agree to comply with the termsrd co�of this statement
-9wreF(a Owner Agent's) Name:
VA
'I I"a�—
Signature ................................ ...... ...... .... I .. .. ........... ....... ......... Date: .f..... ...
Contractor Name:
Samtei
l
Signature Lic,# 0171,39'0 Date:
17
Smoke and COforrn.doe remised 0111012017