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14040193'214 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21786 HYANNISPORT DR CONTRACTOR: ALLSTAR PLUMBING PERMIT NO: 14040193 OWNER'S NAME: SORCI JOHN B AND EDMONA A 326 PHELAN AVE DATE ISSUED: 04/29/2014 OWNER'S PHONE: 4082576532 SAN JOSE, CA 95122 PHONE NO: (408) 230 -5569 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ 7r� RE -PIPE BENEATH KITCHEN AREA (35 S.F.) REMOVE & License Class Lic. # REPLACE (E) KITCHEN LINE & REPLACE IMPROPER i�% f� CONNECTIONS Contractor � C1U Date I hereby affirm that I am licensed un er 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 Sq. Ft Floor Area: Valuation: $650 p formance of the work for which this permit is issued. =and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 35613017 00 Occupancy Type: 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 IT 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 1 LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Zue Date: 1 granting of this permit. Additionally, the applicant understands and will coreffy with all non -point source regulations per the Cupertino Municipal Code, Section RE- ROOFS: 918. o n Signature %` / Date o2 7 ( All roofs shall inspected prior rata' eing installed. If a roof is installed wit irst o an inspection e to remove all new materials for inspection. ❑ OWNER- BUILDER DECLARATION Signature of Applj Date - I hereby affirm that I am exempt from the Contractor's License Law for one of .00O 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. I 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: %ti+ Date: 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 CONSTRUCTION LENDING AGENCY 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 CUVIERTINO GENERAL PERMIT APPLICATION AEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95 014 -3255 1 (408) 777 -3228 • FAX (408) 777 -3333 • buildina(cDcupertino.org ` 1`�\ misc iW DT T TV, An MTf'- F1M -Pr-u AI.TTr AT_ 77P.T.Tzr-rRMAL F— MISCELLANEOUS PROJECT ADDRESS 1 / / ' v (, ( ' v I APN # -3 :51' / � WhERNAME �6 � N2 57- b E MA/ IL . STREET ADDRESS / p ' c .� I �t •�N• CITY, ST .ZIP. ��tN I FAX CO'.N'TACr NAME oe PHO,7B F MA.I - STREET ADDRESS �r7 to CITY, STATE, ZIP C �� D pct FAX WNER ❑ OwNER- BUILDER ❑ OWNERAGEN ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ EN&TIEER ❑ DEVELOPER ❑ TENANT VC1N7?ACrOR CONTRACTOR NAME y� �f� ! , ! LICENSE NUhIBER LICENSE TYPE /F(1( fl/ BUS. LIC # COMPANY NAME /a // Oct E -MAIL a y FAX �> STREET ADDRESS��O �i Q � I.CrNSTATFZIP �/ � l3 ARCHTfECT/ENGINEERNAME LICENSENUMBER G(� BUS. LICC4 COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ muummmax BUILDING: ❑ COMMERCIAL PROJECT IN WIL.DLAND ❑ YES PROJECT IN URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ YES ❑ NO IS THE BLDG AN ❑YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK G tv-e � Oom o Z - u,'ko -ew � .. � J� x � I!p/�� j?0Mjp0 x, �CGt >°o✓ L.vy� b TOTAL VALUATION: r ,. E RI By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on ro e owm ' . 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 v,ith all applicable local ordinances and state laws relating to ilding construction. I authorize representatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INTFORM[ATION REQUIRED � ` OEF[CE37SF3b1�I WON, .. x _ 1 a- �.`qre. Im R i XPRESS Rem -cG am_ y OEM ��STv1I�'DA3ZD �-a - r ME } m=— 0� 1 MEPMisa4pp_2011.doc revised 06121111 WNW CITY OF CUPERTINO FF.F, ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE 21786 HYANISPORT DR DATE: 04/29/2014 REVIEWED BY: MELISSA IlaADDRESS: APN: 35613 017 BP #: `VALUATION: $650 rPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex # PENTAMATION PERMIT TYPE: 1 RPR WORK RE -PIPE BENEATH KITCHEN AREA 35 S.F. REMOVE & REPLACE E KITCHEN LINE & SCOPE REPLACE IMPROPER CONNECTIONS APPLIANCE / EQUIP TYPE FEE H) QTY/FEE QTY UNITS BP FEES Re -Pipe Interior 1PRREPIPE 1 # $14 Pool'-14 Ff . SyY) /, Ins!) 1 -'ee PME Unit Fee: $14.00 PME Permit Fee: $47.00 ( °Onsiruction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $14.00 Strong Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, fire, Sanitary Sewer District, School nf, 1 Th— £nnc Cnntact the vent fnr addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eff 711113) FEE QTY/FEE MISC ITEMS 1}l Li.'1 ( "hecll FCC, PC PME Plan Check: $0.00 Pool'-14 Ff . SyY) /, Ins!) 1 -'ee PME Unit Fee: $14.00 PME Permit Fee: $47.00 ( °Onsiruction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 -a Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBO� $153.50 $0.00 TOTAL FEE: $153.50 Revised: 04/01/2014 Address fl SMOKE / CARBON MONOXIDE ALARf OWNER CERTIFICATE OF COMPLIAN COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DI' 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building (a)cupertino.org I L 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 installed in the following locations: AREA SMOKE ALARM CO ALARM. Outside of each separate sleeping 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 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 907.2.11.4 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. I have read and aaree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: r0 s ( 3 0 °� 1 f -( IV 13. S 9C' Signature.,/.4 . ........................................................................ ............................... Date:................... Contractor Name: Si nature ............. ..............C- ............... ..... ......... Lic.# .. .......... Date: .....30 U 732 d `C Smoke and COform.doc revised 03118114 y