14060129CITY OF CUPERTINO BUILDING PERMIT I
I BUILDING ADDRESS: 21930 BYRNE CT I CONTRACTOR: ALLSTAR PLUMBING I PERMIT NO: 14060129 I
I OWNER'S NAME: VINCENT JOHN V AND LINDA M 1 326 PHELAN AVE I DATE ISSUED: 06/19/2014 I
I OWNER'S PHONE: 4082516040 I SAN JOSE, CA 95122 I PHONE NO: (408) 230 -5569 I
❑ LICENSED CONTRACTOR'S DECLARATION
License Clas6___ Lic. # -3 Z
Contractor Gil (J% 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.
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. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
918.
Signature Date —��
❑ 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.
Date
JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL
REMOVE AND REPLACE WATER HEATER
Sq. Ft Floor Area: I Valuation: $1000
APN Number: 35716081 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DA + OM LAST CALLED INSPEC�jTION.
Issued by: Date:
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 Applicant: 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 Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: -- Date: 4 1
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
•
GENERAL PERMIT APPLICATION E P
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O`�
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 - buildinona cuoerino.oro
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USE OF ❑ SFD or DUPLEX ❑ MULTI- FAMILY I PROJECT IN WILDLA1\TD ❑ YES I PROJECT IN ❑ YES
BT=1NG: ❑ COMMERCIAL URBAN n\'TERFACE AREA ❑ NO FLOOD ZA1,M ❑ NO
I IS Tit BLDG AN ❑ YES
EICHLER Hold? ❑ NO -
DESCRIPTION OF WORK /
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By my signature below, I certify to each of the following: I am the property ovmer or authorized agent to act on the property owner' ehalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state Iays relating to building consiuction. I authorize representatives of Cupertino to enter the above iddinntttii ed proper jy for inspection purposes.
Si=7atureofApplicant'Agent: _T Date:
SUPPLE- -NMNTAL INFORMATION REQUIRED
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�Phrisc�,4pp_2011.doc revised 06121111
CITY OF CUPERTINO
1w— ffl—W FFF. F.CTTMATnR — RITII.DING DIVISION
LN,
ADDRESS: 21930 byrne ct
DATE: 06/19/2014
REVIEWED BY: Mendez
Pla,1 Crtcck /°cu:
APN:
BP #:
*VALUATION: j$1,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: P
$0.00
PENTAMATION PRWHEATR
PERMIT TYPE:
WORK
remove and replace water heater
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $28
TOTALS: $28.00
1�r
v9i °c11 t��' <<,; t. r,o r Plumb. Plan Check 0.0 hrs $0.00 -'� ��- Mar,
Plumb. Permit Fee: 1PPERMIT
?rtrc r L rcc Ii. ;. Other Plumb Insp. 0.0 hrs $47.00 o wr 1 e( h sj).
1-171( , Imp, ; :<~ I,A < h, / 11h+rith. hasp. Fez;
1VnTF• Thk octimate does not include fees due to other Departments (i.e. Planninz, Public Works, Fire, Sanitary Sewer District, School
D' tr'ct etc These ees are based on the relimina information available and are on1v an estimate. Contact the De t or addn'l in o.
rsr,
FEE ITEMS (Fee Resolution 11 -053 Eff 711113)
FEE
QTY/FEE
MISC ITEMS
Pla,1 Crtcck /°cu:
PME Plan Check:
$0.00
hiss 1'C�'
PME Unit Fee:
$28.00
PME Permit Fee:
$47.00
i�171.i "tl','tt.'Ltf3t1 /ct�;
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes 0 No
$0.00
,1c%Ui7C:'C "{ P/L7f ?PI 117g ' €'YS:
Travel Documentation Fee: ITRAVDOC
$47.00
Strang Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldp, Stds Commission Fee: IBCBSC
$1.00
ME NO
$167.50
$0.00 TOTALFEE:�
$167.50
Revised: 10/01/2013
CUPERTINO
Address
SMOKE / CARBON MONOXIDE ALARMS ,
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION G ,
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(abcupertino.org
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.
ORMATION
Existi and multi- family dwellings shall be p ed with Smoke Alarms and Carbon
Monox s. 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 operate here repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access ans of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. 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 gent's) Name:
'/
®
Si .. ... ... ............................... Dat�.......1... ..
Contractor Name:
nature.......... ............................... .......................... Lie.# ................. ................. Date: ...................
Smoke and CO form.doc revised 03118114