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14050090CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19787 LA MAR DR 1lFTF� CONTRACTOP PERMIT NO: 14050090 OWNER'S NAME: MAX AGOSTON p C L L DATE ISSUED: 05/14/2014 OWNER'S PHONE: 4082532343 PHONE NO: JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION PANEL UPGRADE 200 AMP Q r - License Class Gl u # 15 T2-1 i U ,,,,�`` ''Lic. Dd600 1,4)c/ Contractor " Vim ,r Date 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: $4000 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 APN Number: 36910026 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXP/WES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18q DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F LAST CALLED INSPECTION. upon indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 918. RE- ROOFS: �� � tf Signature Date 7 All roofs shall be inspected prior to any roofing material being installed. If a roof is �!i��%` 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 1, 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 ownef 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25J33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I I I hereby affirm that there is a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code, must work's for which this permit is issued (Sec. 3097, Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 918. Signature Date �g4.lsss... GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 - buildina(cDcupertino.ora I— IDTTrn,runTM 7M- pr'ttaxv al. FRT.FCTRtCAL nMISCELLANTEOUS PROJECT ADDRESS i 0'. Y^O_.V I APN # U OWNTERNAME i� os r PHOTVZ y) Z5�~ Z3 73 E -MAIL STREET ADDRESS QV1v e_ CITY, STATE, ZIP. _ _ (_100, (_N A � � I FAX COINTTACT NATVIE j oce Fj� PHONFj M.A gVt) 355cl E -II, 111 STREET ADDRESS , �j( U CITY, STATE, Z �� 3 l 'p, 15 1) Z) FAX(7 OS) Z j 7_ ❑ OVVtTR ❑ OuR.'ER- BUILDER ❑ ONMER AGENT AONTRACrOR ❑ COTTRACTORAGEA'T ❑ ARCHITECT ❑ ENGiNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ` �! ` `� LICENSE TYPE/ LICENSE NUMBER �-i� BUS. LIC #j q 157 COMPANYNAN,E boat , 4 i V \^ `_ E4.1-.6,11, ��A�to^e\td� x;c' i/i 1 •C &` FAX / STREET ADDRESS 13 i -s� CITY, STATE, ZIP f (/ 1 / PHONE�vi + 11�- J ARCHrfECUENGINEER NAME LICENSE NUMBER. BUS. LIC # COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF FD or DUPLEX ❑ mmn- FAMII,Y PROJECT IN wHALAND ❑ YES PROJECT IN ❑ YES BUILDING: ❑ COMMERCIAL URBAN nTrERFACE AREA NO FLOOD ZONE 5r No IS THE BLDG AN ❑ YEs EICHLER HOME? NO DESCRIPTION OF WORK �O p� / TOTAL VALUATION: v/� �!� V VDDE s�.�_..�"' ^yam � t,�` ,u�: � c�'3'•f,.� By my signature below, I certify to each of-the following: I am the property owner or authorized agent to act on the property 's behalf. I hav read s application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comp i#4I all a licab e local ordinances and state laws relating to building construction. I authorize rep entatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEIA fENTTAr nTFOKMATION REQUIRED of usEt3 is � 1 Et q 90_0= Sig _� MEW x aft T.Am�I3RD�; ffs"am— m MEPMiscApp_2011.doc revised 06121111 CITY OF CUPERTINO lemm UWU V crrTna A rrnu _ RTTTT .ilTN(_' D_tVTCTnN ADDRESS: 19787 Lamar dr we v.•sus.vs .. »..» FEE DATE: 05/14/2014 REVIEWED BY: Mendez Elec. Plan Check 0.0 hrs $0.00 APN: BP #: EVALUATION: $4,000 *PERMIT TYPE: Building Permit t1ri,��r Plump IraSp. PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex 0.0 PERMIT Ty ON 1 REAP2 PERMIT TYPE: i USE: P17011b. hi p. Fee: k7cr, la l� :e: $0.00 WORK panel upgrade 200 am Suppl. Insp. Fee :Q Reg. () OT 0,0 hrs $0.00 SCOPE L9��<ar J'lcrrz t:'/,E.rk we v.•sus.vs .. »..» FEE . —• .- -- QTY, Plwplb.. Plan Chec A Elec. Plan Check 0.0 hrs $0.00 Ll;>clt. M" Writ F,et,, PI imb. fermi" Pee, Elec. Permit Fee: 1EPERMIT C r1ru, alr colt. Ire �,r� t1ri,��r Plump IraSp. Other Elee. Ins,. 0.0 hrs $47.00 Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs 1t:cb. Ir::st. F e: P17011b. hi p. Fee: k7cr, la l� :e: $0.00 NOTE: This estimate does not inctuue fees aue to orner uepartments (i.e. rtutatat5, tsuu1 •• 1 ------- , . t_- _ ! * . s tl.o n..f f— nitt/n't inin_ Ulstrict, etc). inese fees are ouseu un the retaiuttu• FEE ITEMS (Fee Resolution 11 -053 Eff. 711113) we v.•sus.vs .. »..» FEE . —• .- -- QTY, -- -__ _._ ---- ______ MI5 'ITEMS Plan Check Fee: $0.00 200 amps Electrical $47.00 IBELEC200 Services Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee :Q Reg. () OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 �r,��rr•rrcrir�t� 1'rt.: Administrative Fee: IADMIN $44.00 E) Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion. Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $139.50 $47.00 . TOTAL FEE: $186.50 meviseu: u4/u u/-u 14 C VPERTINQ 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 ancupertino.org Permit No. I Li O 50© 10 Address lci IS-1 Lo;r,ar <� . # of Alarms Smoke: Carbon Monoxide: 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 withjthe 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 Agent's) Name: „t MA X 14. k �� S�fd I T Si nature ............... .............................. ......... ............................... Date: .................. Contractor Name: Signature.................................... ............................... Lic.# ....... ............................... Date:................... Smoke and CO form. doc revised 03118114