14050150CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20640 RODRIGUES AVE I CONTRACTOR: ALLSTAR PLUMBING PERMIT NO: 14050150
OWNER'S NAME: SULAVER PETER J AND MARLENE M ( 326 PHELAN AVE ] DATE ISSUED: 05/27/2014
OWNER'S PHONE: 4082450988
❑ LICE ED CONTRACTOR'S DECLARATION
License Class ,_ Lic. #
Contractor Affga&,�l ` IhC..Date
I hereby affirm that I am licensed r er the provisions of Chapter 9
(commencing with Section 7000) ivision 3 of the Business & Professions
Code and that my license is in full force and effect.
SAN JOSE, CA 95122
JOB DESCRIPTION: RESIDENTIAL El
FOUNDATION CLEAN OUT
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:
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.
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 artionally, the applicant understands and will comply
with all non - points c egulations per the Cupertino Municipal Code, Sec ion
9 18.
Signature Date c
❑ 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
APN Number: 35911016.00
PHONE NO: (408) 230 -5569
COMMERCIAL E]
Valuation: $2500
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN I PERMIT ISSUANCE OR
180 DAYS FR LAST . ALLED CT
INSP ION.
Issued by: Date: 7 L/
RE- ROOFS:
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.
Signature of
Date:
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 Bay Area Air Quality Management District I
will maintain compliance with the Cuperti unicipal Code, Chapter 9.12 and
the Health &Safety Code, Sections 5533, and 25534.
Owner or authorized agent: Date: �7
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must I 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
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.
Date
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
_Z
r
GENERAL PERMIT APPLICATION E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 t,�V
(408) 777 -3228 - FAX (408) 777 -3333 • buildino(cD-cuDertino.org I �,v\ MISC
T n.)ra rrrr. n T.,IFru a I.TTr A T. n FLFCTRICAL n MISCELLANEOUS
PROJECT ADDRESS
_y I APN # —
OWI,rERNAME WI L'w/`I
�� {i
I P l -5-l/ ` E -MAII
STREET ADDRESS
o
I CITY, STA , ZIP % I FAX
COhTTACT NA.�/Ei �
EIIvLAII,
STREET ADDRESS
CITY, STA , ZIP
FAX
❑ cnwaL ❑ ON;NTER- BUIIAER ❑ ON;WM Aawr ❑ CONTRACTOR ❑ COATMACTOR AGwr ❑ ARCr cT ❑ ENcm,,EER ❑ DEVELOPER ❑ TEI:AhTr
CONTRACromI,,A1Jm
5[,
LICENSE NUMBER 73 76 % 1 LICRTSETYPIC-M
BUS.LIC'N
A j�
COMPANY N_'ME 1I1 ,
J
E -MAIL
FAX
STREET ADDRESSn �/?
I CITY, ST Z �/
G
PHONE
ARCHr=/ENGR=NAME
LICENSE NUMBER.
I BUS. LIC R
COMPANY INrA1,M
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI - FAMILY
BUILDING: ❑ COMMERCIAL
I PROJECT LN WI DLAND ❑ YES PROTECT IN ❑ YES
URBAN BTERFACE AREA ❑ NO FLOOD ZONE ❑ NO
I IS THE BLDG AN ❑ YES
EICHLEP HOME? ❑ NO
DESCRIPTION OF WORK
C•
TOTAL VALUATION:
By my signature below, I certify to each of the f w . ing: I am the property ovmer or authorized agent to act on the property o-,amer's behal ve read this
application and the information I have prov' Is correct. I have read the Description of Work and verify it is accurate. I a ee to co/ply'Mth all applicable local
'
ordinances and state laws relating to b construction. I authorize representatives of Cupertino to enter the above-id eefj pr fgr ection purposes.
Si gnature of Applicant/Agen Date:
SUPPLEMENTAL INFORh4ATION REQUIRED
r
of CE I sE �L�
�
-�
z
D�o�I�co��s�IZ- ��.��.
,:
��3 0
� RT3 —.,
` um
Y1FPb1isc,4pp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE / EQUIP TYPE
ADDRESS: 20640 rodrigues ave
DATE: 05/27/2014
REVIEWED BY: Mendez
UNITS
APN:
I BP#:
"VALUATION: 1$2,500
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION 1 RPSS
PERMIT TYPE:
WORK
clean out
�foundation
SCOPE
J
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
$0.00
Sewer, Sanitary
1PRSEWER
plumb. Permit Fee:
1
#
$24
Other Plumb Insp. Fo-ol hrs
$47.00
ofhel, Ins o,
J
Phlwh' hap.
Plt"( Insp.
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
Cousn'tict,,on 7'Ux. T-1
Administrative Fee: ]ADMIN
$44.00
Work Without Permit? 0 Yes C) No
$0.00
TOTALS:
Travel Documentation Fee: I TRA VDOC
$24.00
Strong Motion Fee: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the Dreliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
"h-c/1' 11L n Cp""(k
Plumb. Plan Check 0.0 hrs
$0.00
Efec' Ch' ?c
F i c h Pe�'wi Fee:
plumb. Permit Fee:
IPPERMIT
Pern;;
licch, lrtv
Other Plumb Insp. Fo-ol hrs
$47.00
ofhel, Ins o,
J
Phlwh' hap.
Plt"( Insp.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc.). These fees are based on the Dreliminary information available and are only an estimate Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
J
—1
PME Unit Fee:
$24.00
PME Permit Fee:
$47.00
Cousn'tict,,on 7'Ux. T-1
Administrative Fee: ]ADMIN
$44.00
Work Without Permit? 0 Yes C) No
$0.00
Travel Documentation Fee: I TRA VDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee:. IBCBSC
$1.00
0,04 M
0�z
$163.501
$0.001 TOTAL FEE:
$163.501
Revised: 04/01/2014
Address
'0
P't
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!, buildinoacupertino.org
.� Permit
. I VA z"
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 multi4amily 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 8314 and CBC Secdons, 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 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 withthe 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 comDlv with the terms and conditions of this statement
Owner (or Owner Agent's) Narm
Of
-Sic-A OE4 4!LA
Signature. ........ ........... — Date:
Contractor Na e:
Signature............................ ......... ....... ............... — Lic,# ............. ........ ....... Date: ...
Smoke and Wform.dbc revised 103118114
^14 Ke,