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14050040rA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7451 FALLENLEAF LN CONTRACTOR: QUICK PLUMBING INC PERMIT NO: 14050040 OWNER'S NAME: LEE ELAINE F AND GENE S 1044 MARTIN AVE DATE ISSUED: 05/06/2014 OWNER'S PHONE: 4082574077 SANTA CLARA, CA 95050 PHONE NO: (408)732-1220 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] REPLACE (E) SEWER LINE & PROPERTY LINE _ License Class C- a C Lie. # IS -0 5 > S- CLE UT Contracto CSL kt�P4Dates 2G INS L( O I N L RY I hereby affirm that I am licensed un< the provisions of hapter 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: $3500 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 35928029 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 WITIIIN 180 DA - ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DA M LA ED INSPECTION. 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 Date: granting of this permit. Additionally, the applicant understands and will comply a with all no - int source reg lations per the Cupertino Municipal Code, Sect' RE -ROOFS: being installed. If is 9 18. S ZG� (� Signature Date / All roofs shall be in ctcd prior to any roofing material a roof 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. 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 w' a Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, ction 5505 33 nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: �' 6 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 GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(a)cupertino.org 17 n, TTAmT-.Tr-- I Ii,=rw,&MrAT I—IFT.TZr'TRT(-AL nMISCELLANEOUS PROJECT ADDRESS APN 3rq 9' T/ OWNERIQ.AME C' PHONE E -MS L ��Z! -7�` .e STREET ADDRES / CITY, STATE, ZIP. FAX /p / V j�•^`�j��/• PHO(/ / - l E -NCAA, 1111ACT NI)C C� 1P vi STREET ADDRESS �V /UILDEEL CITY, STATE ZIPFAX rC ❑J/OIAMMAGENT CONTRACTOR ❑ CONIRACTORAGENT ❑ ARC ECT ❑ IN�� ❑ DEVELOPER El TENANT ❑ OVq' R ❑ O"A'NER-B CONTRACTOR T t I A /' LICENSENUtMER5 V/�LICENSETYPE/ eZ J BUS. LIC 4 COMPAAYNAMT1l �ICi11ti9�/'�Y/iVL V E�rG(I(ivjl INC l�/IWiJ�i'I FAX _ STREETADDRESS6/lq,n'`�,�j A - CITY, STATE Z� _- ,) ^ I ��f i� l PHONE ARCHTTECT/�GINEER%NAME . LICENSE NUNIBER. I BUS. LIC 4 COMPANY NAME B -MAIL FAX STREET ADDRESS CTIY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MUI•TI-FAMILY I PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES BUILDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO I IS THE BLDG AN ❑ YES EICHLER HOI�? El NO _ b (n 4- j DESCRIPTION OF WORK ' � 1—d TOTAL VALUATION:RECE -� _ - _ �� TY -4—m- � 0 . I By my signature below, I certify to hof the following: I am the property owner or authorized agentct on the property own s behalf. I have read this application and the information I ave rovided ' correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin to bu ding co ion. I uthorize representatives of Cupertino to enter the above id mti5ed property for inspection purposes. Signature of Applicant/Agent: Date: 5 SUPPLEAETFORIAATION REQUIRED r l`l]T-A-TFR R. IRE R. MEFMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 7451 FALLEN LEAF WAY QTY/FEE DATE: 05/06/2014 REVIEWED BY: MELISSA BP FEES APN: 359 28 029 BP#: 1 PRSEWER *VALUATION: 1$3,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex Plumb. Permit Fee: IPPERMIT PENTAMATION 1 RPS USE: Other Plumb Insp. FO-01hrs $47.00 Orj.cr Inv), El PERMIT TYPE: WORK REPLACE E SEWER LINE & PROPERTY LINE CLEANOUT & INSTALL N FOUNDATION SCOPE CLEANOUT APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER Plumb. Plan Check 0.0 hrs 1 # $24 Plumb. Permit Fee: IPPERMIT t xz r . N'o - jr),'v) Other Plumb Insp. FO-01hrs $47.00 Orj.cr Inv), El Six'Ca tr'.•�j. 1"'v, f iw0. b%Sp. Fee: $24.00 1"'k'-(. lnsj $47.00 -F-F Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes C) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $24.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ The.ce fees are based on the nreliminarv, information available and are only an estimate Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan C°h(z(- : Fc'e: Elow w :Suppl. PC. F(e tk'<: 1,160" Plumb. Plan Check 0.0 hrs $0.00 1 'er." 1' f Permit Fee,. Plumb. Permit Fee: IPPERMIT t xz r . N'o - jr),'v) Other Plumb Insp. FO-01hrs $47.00 Orj.cr Inv), El Six'Ca tr'.•�j. 1"'v, f iw0. b%Sp. Fee: $24.00 1"'k'-(. lnsj NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc )_ The.ce fees are based on the nreliminarv, information available and are only an estimate Contact the Dept for addh 7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS Plan C°h(z(- : Fc'e: :Suppl. PC. F(e PME Plan Check: $0.00 L xc''.'rinil lee. Agarpp/. holy Fee PME Unit Fee: $24.00 PME Permit Fee: $47.00 -F-F Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes C) No $0.00 -i (,�L'(d77C'f'L/ h/cl%7lY7Ylir F{�(,.5: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp_ Stds Commission Fee: IBCBSC $1.00 `Y ��4: $163.501 $0.00 TOTAL FEE: $163.50 Revised: 04/01/2014 CUPERTINO Address IN 1 PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aecupertino.org I , ,, Permit No. 14� Ito � � ` # of Alarms Smoke: I Carbon Monoxide: PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION 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 42k62l*n electrical permit is required for alarms which must be connected to the building wiring. FILE As owner of the above -referenced property, I hereby certify that the) referenced above has/have been installed in accordance with the manufacturer's instructions and in cnce 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 agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: % !? e Le ei ................. Signature.. ............................................................................ Date: Contractor Name: �i'CII �n�S C-3icl SO S Sa. h✓a1'ZL� Si nature ................. .......... ............................ .......... Date: ..9...1...... Smoke and CO form.doc revised 03/18/14