B-2016-2704 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2704
10221 STONYDALE DR CUPERTINO,CA 95014-1029(326 37 018) ROMANO ELECTRIC
SANTA CLARA,CA
95054
OWNER'S NAME: WEINBERG RICHARD AND TARA DATE ISSUED:09/12/2016
OWNER'S PHONE:408-313-6355 PHONE NO:(408)564-0583
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#911126
Contractor ROMANO ELECTRIC Date 02/28/2018 X BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH 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.
PANEL UPGRADE(200 AMP);INSTALL CIRCUIT FOR EV CHARGER
I hereby affirm under penalty of perjury one of the following two declarations: IN GARAGE(MAINTAIN 20 FT BY 20 FT CLEARANCE IN GARAGE).
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
ir performance of the work for which this permit is issued.
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. Sq.Ft Floor Area: Valuation:$4550.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy e.
information is correct.I agree to comply with all city and county ordinances p cy Typ .
and state laws relating to building construction,and hereby authorize 326 37 018
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 PERNIIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the grantingof 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.
Signet t_ E Date 9/12/16 Issued by:SEAN HATCH
Date:0/12/2016
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 shalt be inspected prior to any roofing material being installed.If a roof is
i. 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:9/12/16
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
a. 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,aftermaking 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. Owner or authorized agent:
APPLICANT CERTIFICATION Date:9/12/16
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 ARCHITECT'S DECLARATION
and will comply with all non-point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code,Section 9.18.
Licensed
Signature Date 9/12/16 Professional
kk GENERA.L PERM[.'T APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORPE AVENUE• CUPERTINO,CA 95014-3255
CUPEl TIN4 (40.e)777-3228• FAX(408)777-3333•buIldinaa(�ouoertino.orq 1 A . i . M I S C
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USE OF 0 SPD or DUPLEX 0 MULTI-FAh�Y PROJECT IN WILDLAND ❑ YES PROJECT N ❑YES IS THE BLDG AN 0 YES
BUILDING: ❑COAD ISRCIAL URBANA'TERP_ACE.AREA 9 NO FLOOD ZONE 0 NO EIC_HLERISO1`E? 0?rro
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By my signature below,l�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. 1 agree to comply with all applicable local
ordinances and state laws relating to bu•.ine construction.. halite representatives of Cupertino to enter the above-id ratified property for inspection purposes.
S.i r nature of ApplicantlA ,- Date:
LEMENTAL INFORMATION REQUIRED _:,•-`-� o-..L..c�Lss.ol< �� ;;. ,
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MEPMisckpp_2011.dac revised 06121111
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SMOKE / CARBON MONOXIDE ALARMS •
.. OWNER CERTIFICATE OF COMPLIANCE
t-,,� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•r buildino(a�cuoertino.oro ?
l14.4,!'T-E:: IIT OT`BE EINALED UNTIL THIS C RTIFICAT.EHAS BEEF 4 m --
'.f 0 .tei* ETE13, I NE'D 1 RET D o TH ING DI .ISIO�N �:
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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 SmokeAlarms-andCarbon
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 X X
_bedroom(s)—(Smoke alarms shall not be located within 3 feet of bathroom door)
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
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 907.2.11.4 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. f 4
Address; i -9 74y ME Wakfrit9 Permit No. - /(-
R 17
Specify Number of Alarms': ' '#Smoke Alarms: I - I' #Carbon Monoxide Detectors,: LI
I have read and agree to comply with the terms and conditions of this statement
`Owner(or Owner Agent's)Name - ''
17 V +F✓' WOK-G-7' Signature elotekik, ,. `.; 1..., 1-Date-:-It 17/.7
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ContractorName:
4-fF0 O I a Li l e V\/a FAY Signature2�(/ - Lic.# 0 Z 7'S LD 'Cr---- Date: 1.2:-/..t111.7
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Smoke and COform.doc revised 01/10/2017
gif WATER;CONSERVING/ING PLUMBING•FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINtt 10300 TORRE AVENUE••CUPERTINO,CA 95014-3255
(408)777-3228•FAX 08)777-330•buildinqa(�,cupertino.orq
Owner Name g,e iD 9- }4)41- Permit No. a 0f 6--210`'f
Address 002 A/ E -P ... p `v 51044
... -to,
1. Is your real property a registered historical site?
D• Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No. Go to Question 2.
2. Doesyour 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?
D Yes Civil Code Sections 1101.1 through 1101,8 do not apply.
D The licensed plumber's certification has been provided to the Building Division.
Skipthe rest of the form and sign bottom of form.
f ' ,No Go to Question 3.
3. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101;1 through 1101.8 do not apply. $kip the rest of the form and sign bottom of form.
! `'No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1,1994? -
El 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.
V.Yes Myreal 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
X 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 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).-
El 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
improvements). •
El 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 plumbing fixtures comply with the requirements as indicated in the
table on the following page. . x
1-0 ifo
Owner or Owner Agent's Signature: Date: .)tI 2-
it to the B ' Division in order to final your building permit.
Upon completing and signing this Certificate,please return g
•
SB4072015,doc revised 08/26/15