14020162CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11520 WELL SPRING CT CONTRACTOR: LOS GATOS ROOFING PERMIT NO: 14020162
OWNER'S NAME: WHITESIDE FREDERICKA M AND ROB I P O BOX 1726 1 DATE ISSUED: 02/27/2014 1
OWNER'S PHONE: 4088912000
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic.#
Contractor
Date
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 hereby affirm under penalty of perjury one of the following two declarations:
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.
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 Municipal Code, Section
9 18.
Signature
LOS GATOS, CA 95031
PHONE NO- (408)298 -9399
BUILDING PERMIT INFO- BLDG ( ELECT I PLUMB'
I.'
MECH RESIDENTIAL t COMMERCIAL
JOB DESCRIPTION REMOVE EXISTING SHAKE ROOFING INSTALL 19 SQS
GRAND CANYON LIFETIME COMPOSITION OVER EXISTING
PLYWOOD
Sq. Ft Floor Area: 0 1 Valuation: $7297
APN Number: 36651037 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Date I Issued by:
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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)
1, 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:
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.
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.
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 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 Municipal Code, Section
9 18.
Date
Date:
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant: Date
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. 1 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 authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec 3097 Civ C )
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professiona
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • 13VILDING DIVISION
CUPERTINO 10300TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) T77 -221i • FAX (408) 77-3333, jIV1I0=ffiIcuae 1np gLq
Address AS"Z0
Permit No. '/( Wj it Z.
PERMIT CANNOT BE F.WALED AND COMPLETED UNTIL THIS CERTITICATE
HAS BEEN SAD AND RETURNED TO THE BUILDING DMSION
PURPOSE
77us affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314, 2013 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 M14 and CBC Sections 907.2.115 and 420.6 xequire that Smoke Alarms and/or Carbon
Monoxide Alums be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside o.f eacch separate sleeping area in the immediate vicinity of the
bedroom s
X
X
On every level of at dwelling unit includinK 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 4.20.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply; In dwelling units with no commercial, power supply, alarms) may be solely. battery. operated.
in existing dweffm' g 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 CDC Sections 907,2.11.4 and 420.6.2. An electrical permit is ,regtured 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 have been tested and are operational, as of the date signed
below.
1 have read and sores to camoiy with the terms and condlUons of This statamant
Owner (or Owner Ager4'syMeme;
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Contra r Name
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