14050026Uk
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22946 LONG DOWN RD
CONTRACTOR: CONSOLIDATED
PERMIT NO: 14050026
PLUMBING INC
OWNER'S NAME: PERRY CHARLOTTE J
3732 CHARTER PARK DR STE D
DATE ISSUED: 05/02/2014
OWNER'S PHONE: 4087685825
SAN JOSE, CA 95136
PHONE NO: (408)978 -3093
me LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
REPAIR & REPLACE AS NEEDED (E) SEWER LINE.
License Class Lic. # �C>S- le, 2
INSTALL
Contractor %�L �/d✓!"ODate ��i�
(N) PROPERTY LINE CLEANOUT (HOA LETTER REC'VD)
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.
Sq. Ft Floor Area:
Valuation: $20000
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34240025 00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAY atlT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DA ALLED INSPECT N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulati ns per the Cupertino Municipal Code, Section
RE- ROOFS:
9 18.
Z
Signature Date /
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.
❑ OWNER- BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self - insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Mumci al Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 5533 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: s� -2
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
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9 18.
Signature Date
c y
05NERAL PERMIT APPLICATION 'O VMEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
EUpr:A mo (408) 777- 3228• FAX (408) 777 - 3333• building0cuoertino:ora ` �O MISC
KIPT.TM= r% riz-. \"
PROJECT ADDRESS
APN # -Z O �j �i
(/ ('/
OWNERNAME
PHONE
E -MAIi
STREET ADDRESS s?
d
CITY. ZIP
, ST I FAX
CONTACT NAME
P
j
STREETADDRESS1
CITY STATE ZIP
❑ O—A'M ❑ OVt M- BUB:DER Q iOWNERAGENT
O com? —Acr0R O CON RACrOR:AGEA7 ❑ ARCHITECT ❑ ENwgM ❑ DEVELOPER ❑ TENAhT
CONTRACTOR NAME
LICENSE NITN.$ER LICENSE TYP
BUS. LIC #
COMPANY NAME r
& r
l
I FAX
STREET ADDRESS ^y _�
//
CITY, STATE;
PHONE
ARCHTTECT04GINEER NAME
LICENSE NUMBER,
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ sn) or DUPLEX ❑ 24NL'II•FA ILi
BUIIDWC, COW fERCIAL
PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES
URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO
is THE BLDG A*I ❑ YES
EIMER HOME? ❑ NO
DESCRIPTION OF WORK
,
r�
OOF
n
e
'�
TOTAL VALUATION: ZD o
d
�- B �.
;
By my signature below, I certify to each of M +ing:
application and the information I hav ot"ded is correct.
ordinances and state laws rel
Si ena ure of Applicant/Age
lam oar er or authorized agent to act o o ave read this
e°1ee ' tion of Arork and-erify it ' ee to comply wdth all applicable local
th tii2tt1 of Cupertino to enter the above-i4ritified roperty for inspection purposes.
Date:
AL rFORMATION D
:t�gCEISPOY^
-r,
air -
_ - •S ,
A?EPARSCApp_2011.doc revised 06121111
CITY OF CUPERTINO
rr, r, rcrr7rAr A'Tl117 MTTT ."'FNC nIVICION
iU
FEE ID
. »••» •
QTY/FEE
ADDRESS: 22946 LONG DOWN RD
UNITS
DATE: 05/02/2014
REVIEWED BY: MELISSA
lia APN: 342 40 025
BP #:
*VALUATION: $20,000
*PERMIT TYPE: Plumbing Permit
#
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
IPPERMIT
PENTAMATION 1 RPSS
PERMIT TYPE:
USE:
Other Plumb Insp. 0.0 hrs
$47.00
WORK
REPAIR & REPLACE AS NEEDED E SEWER LINE. INSTALL N PROPERTY LINE CLEANOUT
SCOPE
(HOA LETTER RECVD)
PME Permit Fee:
APPLIANCE / EQUIP TYPE
FEE ID
. »••» •
QTY/FEE
QTY
UNITS
BP FEES
Sewer, Sanitary
1PRSEWER
Plumb. Plan Check 0.0 hrs
1
#
$24
Plumb. Permit Fee:
IPPERMIT
a' -k(' Pt:rit r;- 7 z <e
C)rtre, ;l i,. 1x� >.
Other Plumb Insp. 0.0 hrs
$47.00
Oth,,, r t ie� . I s"),
E �
PME Unit Fee:
$24.00
PME Permit Fee:
h /I i.E J }. Fco'
I'lsiwL hisp. F: !e:
i.vC137, trucm)lq 717:0:
1', fGL -. Insp, l`i'e:
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$24.00
Stronfz Motion Fee: IBSEISMICR
NOTE: This estimate does not inctude,jees due to otner uepanmems (t.e. x— rtrttrtg, . ttt,tt. .. •• . »•• - - -•. _. _ ___. ___, _ __
District, etc ). lllese fees are nasea on me reurrurtur
FEE ITEMS (Fee Resolution 11 -053 Eff. 711113)
trt yr ntuwvt acres••..•
FEE
. »••» •
QTY/FEE
- -- ------ - - - - -- -
MISC ITEMS
� _
Li rcti Plan C&"(1(
Plumb. Plan Check 0.0 hrs
$0.00
PME Plan Check:
:�i.
Plumb. Permit Fee:
IPPERMIT
a' -k(' Pt:rit r;- 7 z <e
C)rtre, ;l i,. 1x� >.
Other Plumb Insp. 0.0 hrs
$47.00
Oth,,, r t ie� . I s"),
E �
PME Unit Fee:
$24.00
PME Permit Fee:
h /I i.E J }. Fco'
I'lsiwL hisp. F: !e:
i.vC137, trucm)lq 717:0:
1', fGL -. Insp, l`i'e:
Administrative Fee: 1ADMIN
NOTE: This estimate does not inctude,jees due to otner uepanmems (t.e. x— rtrttrtg, . ttt,tt. .. •• . »•• - - -•. _. _ ___. ___, _ __
District, etc ). lllese fees are nasea on me reurrurtur
FEE ITEMS (Fee Resolution 11 -053 Eff. 711113)
trt yr ntuwvt acres••..•
FEE
. »••» •
QTY/FEE
- -- ------ - - - - -- -
MISC ITEMS
a'lcan Chec if Fee:
PME Plan Check:
$0.00
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
i.vC137, trucm)lq 717:0:
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
�G /L'Ld;7e'f.'L��IilYlIZt�e; /'TC'PS: -
Travel Documentation Fee: ITRAVDOC
$47.00
Stronfz Motion Fee: IBSEISMICR
$2.00
Select an Administrative Item
Bldg, Stds Commission .Fee: IBCBSC
$1.00
$165.00
$0.00 TOTAL FEE:
$165.00
rceviseu. V4 /l/ uw I4
U�
a. SAN, ►T9rPs 2 N GREEK BOULEVARD, SUITE 100
TOTAL
t
$1,200.00
Page 1 of 1
f„
CO1VIIUNITY MANAGEMENT SERVICES
To Whom It May Concern
March 18, 2014
Re: De Anza Oaks Homeowners Association
Dear Sirs:
Consolidated - ;Plumbing, `Inc. has the association's permission to seek permits for the repairs of any domestic
waterlines orsewer lines located within the De Anza Oaks community.
i Services, Inc.
Bill I "t)bard �iAssociation Manager
De Air a Oaks Homeowners Association
BH /st
cc: Board of Directors
1936 Dry Creek Road, Suite 203 ■ Campbell, CA - 95008 -3631 - voice (408) 559 -1977 ■ fax (408) 559 -1970
B e n
C
Address
opd QUG,ui'S�s
SMOKE / CARBON MONOXIDE ALARMS
OVN`fVE'R CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 /
PURPOSE
This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314;'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 R314 and,CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be instal14 in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate �eeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping roo
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 - .O Q. ' � ffice of the State Fire Mars
'c
r
Power Supply: In dwelling units with no commercial power supply, rm(s) may be solely battery operated.
In existirb dwellirg _uri+& aL3=, �rP nPrmittPd to lsQly 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 have been tested and are operational, as of the date signed
below.
l have read and a. ree to comply with the terms and coed' ' this statement
Owner (or Owner /q���j/nt s):NAam'e::
;Cf--6 '(��r Signature...., ....... ........ ............ .. ...... I ...... ............. Date: . /. ✓..........
antr r Name: J/
Si nature ..... .... ..... ........................ Lic.# .�(.(?....... Date: ..? I...
Smoke and CO form.doc revised 03 118114