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14060103I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 10307 DENISON AVE I CONTRA RESIDENTIAL SERVICES AMERICAN CA I PERMIT NO: 14060103 I I OWNER'S NAME: IDE ITSURO AND KAY A 1965 RIDGE LAKE BLVD STE 201 1 DATE ISSUED: 06/16/2014 1 OWNER'S PHONE: 3233146337 ❑ LICENSED CONTRACTOR'S DECLARATION License Class A i A i. Lin. #�� Contractor Date I hereby affirm that I am licensed under the provisions of 41pter 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 abor Code, for the performance of the work for which this permit is is 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. J Signature Dat ! ❑ 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 MEMPHIS, TN 38120 I PHONE NO: (408) 982 -0405 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] REPLACE DRAININAGE PIPING UNDER DWELLING & INSTALLED CLEANOUT Sq. Ft Floor Area: I Valuation: $8055 APN Number: 31629056.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN A'QS'OF PERMIT ISSUANCE OR 180 DAY M LA�T CALLED INSPECTI N. 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 2 505 5533, and 25534. / Owner or authorized agent: Date: / 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 he 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. Signature Date Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional a 0 GENERAL PERMIT APPLICATION � MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (4,08) 777 -3333 - buildinana cuoe rtno.orq M I S r7_1Trn.iurnTr. MM7r�9A- .'Rrai. MPT- F- CTRICAL 73,USCELLANTEOUS PROJECT ADDRESS APN L(P Q 1DZQj OWI'-.R NAB PHOh e - E-N °.II- u- STREET ADDP.ESS I CITY STATE, I FAX cO.rrACT NAB L.Qbi iu, 13��1 _ �33 I Ea ✓� u ST- ?,MADDRESS jVJIJ`t�Q/��0�/L- CITYSTATB, I� �,f I•Arc FAX ❑ o `lit ❑ 0(W!.�.BLAIAER ❑ owi\—EkAGEt.T 911CCO17,ACTOP, ❑ COI\MACTORAC —r)\T ❑ ECT ❑ ENau,=.R ❑ DEVELoPrR ❑ T.\,4-NT CONTRACTORI\T LICr.NSEI�UI ER COA2"AI�Y NAME Ala, I E -}vLAII I LICrT'SE E BUS.LI R - FAX I STRbETADDRESS X711 I .CITY.STA7E 2 f3 I PHOTE�T)O{j� (pZ' 6f�� ARCFBTBMENGLR'EER NAME ( LICENSE I MSER I BUS. LIC n COMPANY NTTAJJiB F-MAM FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX 12"—MULTI-FAMILY PROJECT LN WILDLAND ❑ Y FS BL=ugG: ❑ COY VIERCW I URBAN N ERFACE AREA PROTECT A ❑ YES I FLOOD ZOIM IS TFM BLDG AN ❑ YES FIC=HOIJ'? v_<O DESCRIPTION OF WORK) TOT %L VALUATION; -.,,.` ax..."•. -° 4 -,�. `^sue t ; 7�CEI�ET3 By my signature below, I certiry to each of the following: I am the property ov mgr or authorized agent to act on the property ovmer's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verity it is accurate. I agree to comply vrith all applicable local ordinances and state la-wS relating to bluildine nstrtiction. I authorize representatives of Cupertino to enter the above -ident ied property for inspection purposes. Si_Tatureof Applicant/Agent. Date: 1 - 0a SUPPLER TAL INFORMATION REQUIRED of cE Ts �-, EM 10—M ° z° = -� UN 0 �� IMS Iv2EPI✓isc,4pp_2011.doc revised 06121/11 CITY OF CUPERTINO TiTF. F.CTm/fATnR — RITH.DINf nIVIgION APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Drainage 1PREPPIPE 1 # $47 TOTALS: $47.00 NOTE: This estimate does not include fees due to other Departments tt.e. rtammng, ruoac works, rlre, aunuury aLwer "imuici, of_nuut mt .. t:. .. x,. ,.d .... ♦G.. „l;.k. .�£ .w,nf;n niln6to and nro nnly nn actimnta_ rantact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11 -053 Eff.' 711113) ADDRESS: 10307 Denison Ave DATE: 06/16/2014 REVIEWED BY: Sean Plan Check Fee: APN: BP #: *VALUATION: 1$8,055 FPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Multi - Family Dwelling Buildin4 is >3 Stories 0 Yes (E) No PENTAMATION 1 RPDP PERMIT TYPE: WORK lace drainage piping.under dwelling and installed cleanout. SCOPE �Re APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Drainage 1PREPPIPE 1 # $47 TOTALS: $47.00 NOTE: This estimate does not include fees due to other Departments tt.e. rtammng, ruoac works, rlre, aunuury aLwer "imuici, of_nuut mt .. t:. .. x,. ,.d .... ♦G.. „l;.k. .�£ .w,nf;n niln6to and nro nnly nn actimnta_ rantact the Dent for addn 7 info. FEE ITEMS (Fee Resolution 11 -053 Eff.' 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: Fee PME Plan Check: $0.00 P'er'm! /;'Ce PME Unit Fee: $47.00 PME Permit Fee: $47.00 �.Ci }2`rfJ'LICCtf)fZGX.;". Administrative Fee: IADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $0.81 Select an Administrative Item Bldy, Stds Commission Fee: 1BCBSC $1.00 ..h4 $1 86.811 $0.001 TOTAL FEE: 1 $186.81 Revised: 04/01/2014 CUPERTIN SMOKE 1 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 -9333 • building(@cupertino.org Permit No. Emoto_L Address # of Alarms Smoke: 3 Carbon Monoxide: 1 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 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. l have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agents) Name: 1 �d i nature:....... .......................................... ............................... Date: Contractor Name: Signature.... .............. ........--- ...............Lic.# ....... ............................... Date: .. .l!({.... PI Smoke and CO form. doe revised 03118114 ocK