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14030161CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20173 APPLE TREE LN CONTRACTOR: CALIFORNIA DELTA' PERMIT NO: 14030161 MECHANICAL INC OWNER'S NAME: SHEPHERD CHRISTOPHER J AND JAN 6056 E BASELINE RD STE 155 DATE ISSUED: 03/26/2014 OWNER'S PHONE: 4083201231 MESA, AZ 85206 PHONE NO: (866) 692 -5273 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO BLDG ELECT PLUMB License Class Lic. # F F MECH RESIDENTIAL COMMERCIAL Contractor 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. Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 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: 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, 1 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 JOB DESCRIPTION REPLACING 50 GAL WATER HEATER LIKE FOR LIKE Sq. Ft Floor Area: 0 I Valuation: $1372 APN Number: 31633095 00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: 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, I 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. 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 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed -SMOKE 1 CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION aCt. PtMMO.— i 10300'; ORRE AVENUE • CUPER'nNO, CA 950143255 (408) 777- -3228 • FAX (408) 777 -3333 • bnildinrj& Woerttno.ora P Address L ©P 77 AIV41 1-"e A 14030 0 'This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2M3 CBC Sections 420.6 and 907.2.112 where no interior access for inspections are required. GENERAL WFt: RMA TION E:dsiing single-family and multi- family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterancos, or repairs to existing dwelling units exceeds $1000.00, CRC Section 8314 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 _ SMOKRALARM CO ALARM Outside of each separate sleeping area in the in=w diate vicinity of the bedroom(s)i X X On every level of a dwel ' urdt including basemients X X Within each gl a room j f --d Carbon. Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon moraw de alarms combined with smoke alarms shall comply wide CBC Section 420.5 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 permiitted to be solely battery operated where repairs or alteratiorts do not result in the removal of wall and ceiling finishes or there is Ao access by means of attic, basement or crawl space. Refer to CRC Section 8314 and CBC Sections 9072.11.4 -and 420.62- An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above- refi=ced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance withthe umufaeftrer's.instructims and m compliance with the California Building and California Residential, Codes. The alarms have been tested and are operationa% as of the date signed below. Smoke and CO form.doc revised 0311M4