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14050032CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21342 MILFORD DR CONTRACTOR: JONES MASONRY PERMIT NO: 14050032 OWNER'S NAME: WEBSTER IRVIN H JR AND MARY 14629 BRANHAM LN DATE ISSUED: 05/05/2014 OWN S PHONE: 4083531985 SAN JOSE, CA 95124 PHONE NO: 4083777512 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ tr LICENSED CONTRACTOR'S DECLARATION REPAIR/REBUILD (E) CHIMNEY FROM ATTIC STRAPS UP n ^.� # License Class Lic. 2ND STORY, REBAR IN PLACE) n 'I Contractor 1tS?�Q� 1�� `i Date I hereby affirm that I am licensed under the provisions f apter 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: $3900 have and will main am Worker's Compensation Insurance, as provided for by APN Number: 32641094 00 Occupancy Type: Section 3700 oft h L ode, 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 DAYS OF IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter 180 DAYS A D INSPECTION. upon the above mentioned property for inspection purposes. (We) agree to save ,F 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 oft ermit. Additionally, the applicant understands and will c y' with all n - oin source regulations per the Cupertino Municipa e, Secti 9 18. RE- ROOFS: Signatur 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. ❑ OWN - 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 (See.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 us quipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the a Area Air Quality Management District I performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by will maintain compliance with the u ert' Municipal Code, Chapter 9.1 and the Health & Safety Code, Sectio 50 , 2 33, an 534. r r Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: `f 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 LEN CONSTRUCTION DING 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 1CUPERTINO 1 — I I I NPW (Y)NSTRTTCTT(1N V CONSTRUCTION PERMIT APPLICATION uD COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building (aftupertino.org I I AT)I)TTIOW I I AT.TPRATTON /TT I I RPVTST(11q/T)RFFRRPT) r)RUITNAT.PFR MIT ii PROJECT ADDRESS APN # �f I , O OWNER NAME a JS� 2� E -MAIL ^ STREET ADDRESS CIT STATE, ZIP FAX Ih CONTACT NAME PHOT E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME T LICEN E NUMBS LIC SE TYPE BUS. LIC,# v COMPANY NAME T E-MAIL FAX 2 STREET ADDRESS ` I CI TATB, W^ ` PHO X72- 330 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ^ t ^,,` I INA �, EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC, SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN 011-IER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH [] ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEA'G ADDED? []NO - ADDITION? ❑NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES z TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO s 0 43260 By my signature below, I certify toe o the following: I am the property owner or ed to act on the operty owner's behalf. I have read this application and the information I ha pro idled is correct. I have read the Description of Work and verify it i urate. I agree to comply with all applicable local ordinances and state laws relating t i in struction. I authorize representatives of Cupertino toe the ab ve -i ent' led property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEAENTA O btATION- REQUIRE New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building r-• OYER:�'H�COUiNTER�� -� �D :BUILDII�OPI;AI�REyIE , permit for new building. �� _ p� y� — ONE _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �s��s� ,JiARD � M form if any Hazardous Materials are being used as part of this project.ATZG., Copy Planning Approval Letter Meeting Planning to a te" _ of or with prior ILIA submittal of Building Permit application. R- w. AN ARYSE, RDISTRICT °• i,111 BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO A VIM Ti V CT7M A rnU _ RTTTr .nnvG DIVIgION w&�(:" . Plcrrr f. �ac2 1bwil). 7'lon Check f'r -c:- r� � x L naacf Fee: Plum!", P rmit l'i'e: f "err? zt Fcc' ?thr r .1/trc:lf. oMer Plumb frup. f)tlrer 1psfr. Li tec ° 1"�( ln'y iasz). I e 7lrr?. T p. 'e; : f �:e NOTE: This estimate does not include fees due to other Departments (i.e. manning, rumic rrortw, I-tre, oui,icuiy -.i utstrtu, etc. . l r1V3V 3 u/G O... — N.c , cw.. w..w. FEE ITEMS (Fee Resolution 11 -053 Eff. 711113) 21342 MILFORD DR DATE: 05/05/2014 REVIEWED BY: MELISSA ILEADDRESS: APN: 32641 094 BP #: "VALUATION: 1$3,900 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex p PME Plan Check: PENMIT TY ON 1CHIMNEY PERMIT TYPE: USE: Permit Fee: $0.00 WORK REPAIR /REBUILD E CHIMNEY FROM ATTIC STRAPS UP 2ND STORY REBAR IN PLACE hrs $0.00 SCOPE PME Unit Fee: w&�(:" . Plcrrr f. �ac2 1bwil). 7'lon Check f'r -c:- r� � x L naacf Fee: Plum!", P rmit l'i'e: f "err? zt Fcc' ?thr r .1/trc:lf. oMer Plumb frup. f)tlrer 1psfr. Li tec ° 1"�( ln'y iasz). I e 7lrr?. T p. 'e; : f �:e NOTE: This estimate does not include fees due to other Departments (i.e. manning, rumic rrortw, I-tre, oui,icuiy -.i utstrtu, etc. . l r1V3V 3 u/G O... — N.c , cw.. w..w. FEE ITEMS (Fee Resolution 11 -053 Eff. 711113) r.. v.... ».. ........ FEE --- -- - - -- --- - QTY/FEE - -- -- MISC ITEMS Plan Check Fee: $0.00 I—! .J # Chimney / Chimney Repair $557.00 ICHIMNEYR Chimney Repair Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. ® OT p,p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('071,wr ction r�C filllPl.s "(1`L7tl`;c' Fee: Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential E) Building or Structure 0 � 1) °tr >t l l)c r. rrfrr< tr atir;a Fees: Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $SiTB®IS..3 $1.50 $557.00 TOTAL FEE: $558.50 Kevisea: u4NltLu-i4 M Address 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 aacuoertino.orp � 2 GAL � l�z.✓�t. � �;►� �y�Soo32 lve2 ©WJ_L_ This affidavit is a self - certification forthe 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 agree to comply with the terms and conditions of this statement Owner (or Owner A nt's) Name: - oat Si na . ` ................ ......................... ............................ .......... . Contractor Nam :r 6GI .. .................................. Lic.# 3 73,5 ............... Date: �....!../...J•.. Smoke and CO form.doc revised 03118114