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14050114I CITY OF CUPERTINO BUILDING PERMIT 1 BUILDING ADDRESS: 7521 DE FOE DR I PCONMRA CONTRACTOR: GREAT AMERICAN I PERMIT NO: 14050114 I INC OWNER'S NAME: EILEEN LIN I P O BOX 26942 I DATE ISSUED: 05/19/2014 I OWNER'S PHONE: 4088651538 ❑ LICENSED CONTRACTOR'S DECLARATION License Class t` —�J�? Lic. # CEO 16 V S- Contractor Co Date S( 1 al' I if 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. permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will com with all non -point s ce regulations per the Cupertino Municipal Code, Section 9 18. Signature Date S 14 (y' ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. SAN JOSE, CA 95159 1 PHONE NO: (408)279 -1515 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL (N) PROPERTY LINE CLEANOUT (CUPERTINO SANITARY) Sq. Ft Floor Area: I Valuation: $3500 APN Number: 35924021 00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D ISSUANCE OR i INSPECTION. RE- ROOFS: All roofs 45111b, 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. Signature of Applicant: Date: ISignature Date I ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Ba Area Air Quality Management District I will maintain compliance with the p tino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 255 5, 25533, and 25534. Owner or authorized agentDate: 5 i9 / CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C ) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional g4.ISS: GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPlrEiTIN� ZT- (408) 777 -3228 - FAX (408) 777 -3333 • buildino(o7cunertino.org 1� T n_ I­7.AM- WArTT!'AT nFT VrTPICAT. 001 o� n MTSCF_LLANEOUS Al2'EPA4iscApp_2011.doc revised 06121111 PROJECT ADDRESS (r ^ I APN # -1 Z_ I � TD C � Y i V'e— 7 OWNER NAME 04 IA- 1.e.e_ �• � L STREET ADDRESS CITY, STATE, ZIP . FAX C '9 SO 1� L 2 -rl0 COIN'TACT NAME PHONE E M�II STREE'TADDRESS CITY, STATE, ZIP FAX ❑ OWNER El OWNER- BULDER ❑ OkTrERAGE1\7 11 CONTRACTOR U11510 *IRACfORAGENT ❑ ARC-rIITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �I LICENSE ER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL, FAX STREET ADDRESS 1 �' C'1rGInew, /4-t, -r_ CITY, STATE, ZIP SGT, Sb% C PHON o ARCHITECT/ENGINEER NAME LICENSE NUMBER. BUS. LIC # COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ W1,71-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUILDING. ❑ COMMERCIAL - URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK -r T— C7 r) S rk C (-e G n O(,c•.. -F- �r, PRIMA //���� VALUATION: •; TOTAL VALUATI0 : � - � - ,� - r.. ��•,. .r..._. :. By my signature below, I certify to each-of the following: I am the property owner or authori agent to e' opeTty owner's bee ead this application and the information I have pro le is correct I have read the Dtm it is accurat. I agree to c rt all applicable local ordinances and state laws relating to buildi g c nstru orize enter the above- identified property for inspection purposes. T SignatureofApplicant/Agent: Date: SUPPLE NTAL INFORMATION REQUIRED of cs�JS rLY _' —SO - OiERTH]rCOULiTER g9� ' zrTZ> SSA R zISTAfiDARI W` 'IVJAJO Al2'EPA4iscApp_2011.doc revised 06121111 • CITY OF CUPERTINO VV 117. 1PQTI1%4ATnR _ RITII.11ING DIVISION 61' ADDRESS: 7521 DE FOE DR DATE: 05/19/2014 REVIEWED BY: MELISSA MISC ITEMS APN: 359 24 021 BP #: hrs *VALUATION: 1$3,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Du lex p $0.00 Ofhc- llcch [!,v' PENTAMATION 1 RPSS USE: $47.00 Imp. 1d<>-csz. /as .p' 14,'e: PERMIT TYPE: WORK INSTALL N PROPERTY LINE CLEANOUT CUPERTINO SANITARY I Irx .Ti /'cc: PME Permit Fee: $47.00 SCOPE (..onslrr.clion 1Cix APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 TOTALS: $24.00 NOTE: This estimate does not include fees due to other Departments (i.e. rtannang, ruauc works, rare, aamiury .3ewer Uistricy ounoat _ —_ _ z_ _J .. s/ .. ..1:...,. ..! ..,,ns:n., nvnilnAle rrd Ora nnty nn octimnt0_ rnntact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E(: 7f 11113) FEE QTY/FEE MISC ITEMS ?k'; /r. Plumb. Plan Check 0.0 hrs $0.00 7M,rntrt Fce: Plumb. Permit Fee: IPPERMIT $0.00 Ofhc- llcch [!,v' Other Plumb Insp. 0.0 hrs $47.00 Imp. 1d<>-csz. /as .p' 14,'e: 1'latrnbf hisp. Fee: PME Unit Fee: I Irx .Ti /'cc: NOTE: This estimate does not include fees due to other Departments (i.e. rtannang, ruauc works, rare, aamiury .3ewer Uistricy ounoat _ —_ _ z_ _J .. s/ .. ..1:...,. ..! ..,,ns:n., nvnilnAle rrd Ora nnty nn octimnt0_ rnntact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 E(: 7f 11113) FEE QTY/FEE MISC ITEMS +S'allvi, PC.' Fcc PME Plan Check: $0.00 Permit F' e: suppl. lied > Fe"', PME Unit Fee: $24.00 PME Permit Fee: $47.00 (..onslrr.clion 1Cix Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 /16/11017t:'e!d 111urnzing F'L'?eS: L A Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 BLS $163.50 $0.00 TOTAL FEE: $163.50 Revised: 04/01/2014 SMOKE / CARBON MONOXIDE ALARMS FILE OWNER CERTIFICATE OF COMPLIANCE > _ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 1 CUPERTINQ 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 - building(a)cupertino.org Permit No. Address 75-2-/ Foe ©r % ✓e # 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 wifl�e 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 comniv with the terms and conditions of this statement Owner (or Owner Agent's) Name: I j1 Z4 K/� Si nature ................... . ....,.r.: ............. ........................... Date: ../:?..��.� .. C ntractor Nam. e: . . .............."Cul. �-.Licl ... `O .Qli 5........... Date:'S ?4.... Si nature ....... .... .. Smoke and COform.doc revised 03118114