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14080278 (2)SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building (5)cupertino.org Peru Address l o-3 q q `-_ 1 / # of Alarms Smoke: (a /410 /0 o 6 PURPOSE a 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. / have read and agree to comply with the terms and conditions of this statement Owner (or Owner Agent's) Name: � L/ v! /V C( (Lr Si nature............................................................................................ Date: �..��.�7.. ........... :.. ... Contractor Name: Signature................................................................... Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03/18/14 CAPEX ENGINEERING INC. P.O BOX 14198, FREMONT, CA 94539 Tel: (510) 668-1815 Fax: (510) 490-8690 Project No. 8753 December 11, 2013 Building Department City of Cupertino 10300 Torre Ave. Cupertino, CA 95014 Subject: Chong Residence at 20668 Sunrise Dr. Cupertino, CA (Permit No. 13060213) SPECIAL INSPECTION SERVICES FINAL AFFIDAVIT FOR STEEL WELDING FOR STEEL FRAME AT FRONT ENTRY CANOPY Dear Sir: CAPEX ENGINEERING INC., has provided testing and special inspection services at the subject site in accordance with section 1704A of the California Building Code (2010 Edition) as listed below: • Visually inspected fillet welds on connection plate to steel channel and 3" square steel column to base plate using FCAW process with NR 232 wire by one qualified welderat front entry canopy Personnel under the general supervision of a registered Civil Engineer performed these inspections. Based on the inspections performed and upon our substantiate reports that the inspected work was performed, to the best of our knowledge, in conformance with the approved plans and specifications and the applicable workmanship provisions of the (� California Building Code.\ Sincerely, C�PEXE N GINEERING ING, G su, P.E � Principal Li L Em aq�L J, • � r`5�: ;moi,, , , ' ✓� Cl1PERRTIN. 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(Qcupertino.org l �� O� cJ-�V Permit No./ q0 ;-c>1,) (0 Address # 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 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: �ftjAr_-V-1v -�- Y Signature.......... .C�,cC�- , `'.r ..... ............................................................ Date �.` t.!-.. ... Contractor Name: 4 ga A.. 3.0.� �1... fvM4f Signature ..... .... ..................Lic.# .... ....... Date: Smoke and CO form.doc revised 03118/14 low Address SMOKE I 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 alcupertino.org /� ,- (/�, t r Permit No. 1 " 1 �/ U l/ �- r oG / S 1p COLL I Lai # of Alarms Smoke: 4 Carbon Monoxide: oZ 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 CSC 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 whicho not contain Wel-burning appliances and that do not have an attached garage. Carbon monoxide alarms cym7ined 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. 1 have read and agree to com ly wiM the terms and conditions of this statement Owner (or Owner Agent's) Name: t , ! .`.. . Signature. ................................................................ Date: ......... Contractor Name: Sinature................................................................. Lic.#...................................... Date: ................... Smoke and CO form.doc revised 03/18/14 K1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10120 N DE ANZA BLVD CONTRACTOR: ROMAN CATHOLIC PERMIT NO: 14080220 WELFARE CORP OF SAN OWNER'S NAME: ROMAN CATHOLIC WELFARE CORP OF SAN 10110 N DE ANZA BLVD DATE ISSUED: 08/21/2014 OWNER'S PHONE: 4082526441 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ TEMP POWER FOR 3 DAY CARNIVAL License Class Lic. # Contractor 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: $3000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 31626097.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 1 AYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS LAST CALLED INSPFPTION. 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: 2-1 U 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. RE -ROOFS: Signature Date 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. 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 owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE onstruct 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. [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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: n ,,,r Dated 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 become subject to the Worker's Compensation provisions of the Labor Code, I must 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 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 9.18. ( Date D Lit �1 Signature CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(a)-cugertino.ora F-1 PLUMBING n MECHANICAL n ELECTRICAL n MISCELLANEOUS MEP misc POJECT ADDRESS B 1 Vd ' Cu e.4iM 9 0# OWNERNAMEop C'a'�,"b E"hMj PONE �- L/9FkriasA kr-fcu STREET ADDRESS,�yi I0& MG (-V 1 ' �nIf STATE, ZIP FAX ONTACT N rl 11 e r- i feur�nan e r' PEU STREET ADDgESS C.ro Drive TY, STATE ZIP 9 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO RACTO NA , e r LICENSE NUMBER 7 I ICSE YPE ENr r BUS. LIC # - COMProt o ,+ E-MAIL Qr d GbI I. `CA FAX STr6D �S� Uy)j e r P 1 a ce TY> STAeTE, ZI .� j P ONE _ 17-2.4. ARCHITECT/ENG NEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD.rDUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK cimparocccial6m D 6 es el C9e erf__- -1-OoLkA Cacnival TOTAL VALUATIO O RECEIVED BY: By my signs a below, I certify to each of the following: I am the property owner or authorized agent to act on the property o s behalf. I ve 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 com th all pplicable local building construction. I authorize representatives of Cupertino to enter the above -identified property for+ inspection purposes. ordinances and state laws relating to < � Date: " �7 `^ ZO I Signature of Applicant/Agent: (1�/�,.,�...,, _6—. `"1 SUPPLEMENTAL INFORMATION REQUIRED Co ac S n� rrrn L (, ein - ///p'��'��e��-� tc_�'rnit �dMV `' (i �` jo r - 7�O sepV, e t' tI n O C 6 rc/G;O1r� IJV' IAO - D;Z - b 14 C C/L 1 K- 9 "O - G ^�/ 0 �J 3 11 n a ri t`+\ OFFICE USE ONLY W E3OVER-THE-COUNTER ❑ ,EXPRESS V ❑:.:'. STANDARD a w ❑ LARGE ❑` MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FFF. ESTIMATOR — BUILDING DIVISION im,ADDRESS: 10120 n de anza blvd DATE: 08/21/2014 REVIEWED BY: Mendez UNITS APN: BP#: *VALUATION: J$3,000 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: p Amps PENTAMATION 1REAP14 PERMIT TYPE: i WORK tem ower for 3 day carnival SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Temporary Power 1 ERT<200 Plumil, Pcrmir T,`ee: 100 Amps $48 Other EleaInsp. 0.0 hrs $48.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 77 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITR,4VDOC $48.00 Stronp, Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Fewer District, Scnoot District etc These foes are based on the nrelimina information available and are on1v an estimate. Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE Plumb. Plan Chcch Elec. Plan Check 0.0 hrs $0.00 i7c>c, M,rofil Fee: Plumil, Pcrmir T,`ee: Elec. Permit Fee: IEPERMIT PME Plan Check: othe,•Plumb 7ra�,r{.E3 Other EleaInsp. 0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Fewer District, Scnoot District etc These foes are based on the nrelimina information available and are on1v an estimate. Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 77 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 !t(.t vf.%: ri�.:::i�f'.1 f{C �t �`{'✓� 1�e:�, Travel Documentation Fee: ITR,4VDOC $48.00 Stronp, Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldy, Stds Commission Fee: IBCBSC $1.00 G} U� N UP $190.50 $0.00 TOTAL FEE: $190.50 Revised: 07/10/2014 ISI I OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 GUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building Ca)cupertino.orp Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS OWNERNAME r WNER ADDRESS DESCRIPTIQ� OF IRK' • I v l � it ' • I IMER• ■' ff1 We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the .permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS. Please read and initial each statement below to signify you understand or verify this information.) 14J, 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my � ,iinsurance coverage for injuries to workers on my property. l r' 4 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. % 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. %A 4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license M� numbers on permits and contracts. %4 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. /h 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." 1 also understand my failure to abide by these laws may subject me to serious financial risk. 119 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. /� "� 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction dizfortc in tho wnrkman¢hin nr matariale s 14 v. i unaerstana i may obtain more mtormation regaraing my obugations as an --employer- Tom the internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.govfor more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. " ►rte 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide �byy ,a/ll applicable laws and requirements that govern Owner -Builders as well as employers. Y� 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS. Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) 1 Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verifv the property owner's signature. Property Owner's Signature: Date: J'-/7- /i' --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is requirad to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. - ^ rn Scope of Construction Project (or Description of Work): J ` at, �Q fit 1 U ' S�"UD I LQ f' Q 4 W 1 t p' �L Project Location or Address: S'I".�oswk C_li�P Ir'1(� gaol �-10I Z.(O N. QeA ai Gi &yJ- Cupe+oa Name of Authorized Agent:I= r F d em - Pe rm`& Caord In� No WS -930 -7.0 5 Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. , Property Owner's Signature: Date: `g" T n „tea i w Access f Restricted'5 Public Access Ball Generators Field unused r 4 1) Beer, Wine, Soda, Margarita A) Prizes &Tickets �v S 2) Carnival Foods B) Dart Throw g Sftlp IVelf -1 3) International Foods 4) Pizza & Sausage C) Roll Down D) Fat Cats (Tip the Cat) = 5) Sodas and Water E) Five Pin/Hoop Le 6) Tri -Tip Sandwiches F) Pan Game Rainbow Toss H) Football Throw/ Basketball :UtrI 09/10/2011 09/10/2011 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10310 BONNY DR CONTRACTOR: CUPERTINO ROOF, INC PERMIT NO: 14080233 OWNER'S NAME: LAWVER DARELL J AND DIANE J 1052 KELLY DR DATE ISSUED: 08/25/2014 OWNER'S PHONE: 4082428199 SAN JOSE, CA 95129 PHONE NO: (408)973-9427 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] // RE-ROOF 30 SQ- TEAR OFF SHAKES INSTALL OSB CLASS License Class C q Lic. # LAS A Contractor L U 1 a YU �C4 Date I hereby affirm that I am licensed undd 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: $12000 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: 35914046.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITnn "v a" F PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY OM LAST CALLED INSP C ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, 4 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- i ource regulations per the Cupertino Municipal Code, Section 9.18. RE-ROOFS: Signature Signature Date 2t — Z—T— All roofs shall be ins ected prior to any roofing material being installed. If a roof is installed rt out first obtai i an inspection, I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Z S (C f Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of F the following two reasons: ALL RO COVERIN4'GS TO BE CLASS "A" OR BETTER 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 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. 1 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Co tions 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date .51 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 become subject to the Worker's Compensation provisions of the Labor Code, I must 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 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 9.18. Signature Date n _ REROOF PERMIT APPLICATION 2J COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 . (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.ord PROJECT ADDRESS t(/ OWNERNAME Q� PHONE /� ` Q MAIL STREET ADDRESS 1 ` 0 ti. h CITY, STATE, ZIP FAX CONTACT NAME • Q� PHONE EMAIL STREET ADDRESS. CITY, STATE, ZIP FAX ❑ OWNER' ❑' OWNER -BUILDER ❑.owNERAGENT ❑ CONTRACrOR ❑ CONTRITECT El AGENT ❑ ARCHENGAIEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME • \ ^ LI:(ENSE NUMBER S_ /V S . `-(/ J � -y� LICENSE TYPE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAMELICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE ofSFD or Duplex ❑ Multi -Family STRUCTURE: ❑ Commercial ROOF AREA: 3 b VALUATION: - ' Z b , v EXISTING ROOF'TYPE:. ❑ BUILT-UP ROOF -❑ ASPHALT SHINGLES—tEl WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE/REPI�tCE-9YES ❑ NO iFNO, 1 #LAYERS: '1 PLYWOOD ❑ .w. ❑ GS3 THICKNESS: ❑ 5/8 �' PLYWD_© OSB TYPE: ❑ CDX PITCH: 12 ROOF CLASS: A PROPOSED ROOF TYPE: EIBUILT-UPROOF 13ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT # . 1 DESCRIPTION OF WORK R r C"S �� S S C\ S By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this have provided is correct. I have: read the Description of Work. and verify it is accurate. I agree to comply with all applicable local application and the 71aws ordinances and statlating to- ding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applict: Date: SUPPLE AL INFORMATION REQUIRED If building is associated with a Home Owner's Association, provide letter' Of approval from HOA. — Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. Provide signed copy of Gupertino's Tear -Off Policy. E"rte" 1_ i ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO -V'VU Tc'TTMA'1`n1D _RITTT.I1INf 11IVNION imADDRESS: 10310 bonny dr FEE DATE: 08/25/2014 REVIEWED BY: Mendez APN: BP#: "VALUATION: $12,000 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Du lex P Fee: PENTAMATION PERMIT TYPE: 1SFDWLROOF USE: 1' t T ' , t er nril Fee: WORK re- roof 30 sq- tear off SCOPE $0.00 _.. ° f771' rit PeT: FEE ID ROOF AREA s.f. 1REROOFFRES 3,000 11!,w;th. 11.10 ! (. �hcoA lhvanh, ? e tni; ET01h,'e'AIsamu; s'n P1wub, %73ti)7. Fee NOTE: This estimate does not include, fees due to other uepartments (ie. r unning, ru���� .. �•��, . �••••••••• r �• - •� ___ Ulstrict, etc.). mese ees',ure uuseu o a .•.c •nun..•. u• FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE - QTY/FEE -- ---- --- MISC ITEMS / pA of t? "l�. 1. f (.g* Fee Fee: $510.00 $$Permit 1' t T ' , t er nril Fee: Work Without Permit? 0 Yes (F) No $0.00 , Fees. Strong Motion Fee: IBSEISMICR $1.56 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC --RH $1.00 TAIL iSUZQ� $512.56 $0.00 TOTAL FEE: $512.56 Kevisea: un iu/_u i4 CUPERTINO REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingna.cugertino.org PROJECT ADDRESS APN # OWNERNAME �n t� v "1 PHONE f -MAIL J STREET ADDRESS CITY, STATE, ZIP FAX CONTRACTOR NAME LICENSE NUMBER / C� LICENSE TYPE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS) Z r�1 D ^ CITY, STATE, ZIP T PHONEVO �Z _ (,li I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re -roof project shall comply with all applicable provisions of the 2013 California Codes. 2. An inspection request can be scheduled up to one business day before the requested inspection date. Please schedule inspections online or call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30- 2:30pm (Friday) to. schedule inspection. For Tear -Off and Nailing Inspections, you must also call on the day of the inspection only after that phase of the work is completed. The building inspector will be available within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs) and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window. 3. Tear -Off Inspection is required. Any and all dry -rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked -down or removed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 6. A Final Inspection and approval shall be obtained from the building inspector when the re -roofing is completed. To receive a final sign -off, the following items will be verified: a. Flat roofs'shall have a minimum of I/" per foot of slope and demonstrate there is no ponding. b. Listings from approved testing agencies for all pre -manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed. 7. NOTE: If you call for a tear -off or plywood nailing inspection and the work is not complete, you will be charged a re -inspection fee. The re -inspection fee _shall be paid before another inspection can be scheduled. By my signing below, I c the following is true: I am the property owner or authorized agent to act on the property owne ' 'ehalf. I understand an a to comply with the re -roof policy stated above. I also understand that smoke dete ors and carbon monoxide detectors required to be installed in accordance with Sections R314 and R315 of the 2013 California Residential Code. _ C Sianature of Aimhcant/AQent: _x '�' Date: ReroofPoliey_2014.doe revised 01/15/14 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19722 BIXBY DR CONTRACTOR: DE ANZA BUILDERS PERMIT NO: 14080234 OWNER'S NAME: TAI FENG JOHNSON 1129 LITTLE JOHN WAY DATE ISSUED: 08/25/2014 OWN ER'S PHONE: 4088887967 SAN JOSE, CA 95129 PHONE NO: (408) 865-0222 D LICENSED CONTRACTOR'S DECLARATION JOB ESCRIPTION: RESIDENTIAL COMMERCIAL COPPER REPIPE License Class Contractor a,r.t.. %.ikd�r'S Date 'tS 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 ompensation, as provided for by Section 3700 of the Labor Code, for the p rformance of the work for which this permit is issued, Sq. Ft Floor Area: Valuation: $7000 ave and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 36909020.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is pERlyII IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT 180 DAYS ERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY LAST CALLED INSP CT N. 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 sou a ulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date — La 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. ❑ 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 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 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 equi ment 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 A ea Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cup t o Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 5 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: I�'"Zs"1`� 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 become subject to the Worker's Compensation provisions of the Labor Code, I must 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 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 herebyauthorize 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 9.18. Signature Date GEENERAL PERMIT APPLICATION MEP COMMUNIT Y DEVELOPMENT DEF'P"%P,-1 MENIT - BUILDING DIVS101,41 10300 TORRE AVENUE - CUPERIT INIO, CA 95014-3255 (408) 777-322:8 - FFAX ;'08) 7777-3333 - buflding. 0=uDsffmo-v a 7 LT DT T --?N-OUS 7- 0 l 020, ou 011;7i KHONE S —1Rz--T tazZz tt-llt��s o AX 3 COfiiACT NAIS PnO a I B -111A —IT ADMPBSS f s TA: r. p -;Ax 0-71 ---, km'u❑ ❑10 D 1:3 S 7 M ul'a Z 7-n BU S. III C 11 S -L= I AI?D?,E:- S F—L i -ZA L" Zi er, < -Z A- PHONB lqo5 TUCEIRSE BUS. CoMMUNly NWM_-- STR= 'ADDP,:-,-S I MY, STAT ZIP I PHOTS us -B OF JB--tz-,D DIPLEX E3 t,UL-11-FATSOJECT BT WILM-A-IM 0 yzs I BUUMN.a. ED C014,mp MAL PIROMECr IN, ❑ Y=- FLOOD Z01,=- El *o=."M I is --Z BLDS.Ou" 0 12 No DESCRIT-FION. GF-Wolu C> 707. f -T VA LUAM04, Dab D �-s) MIT - By my s if gnaanrt blow, I c--,-E� to each of the foil owinz I Lm the prop f, -,y 0-,�m tr or L,:h azt, it to act on thl�ropt --ty uv, -i itr! s behalf. ,Nke: t rtad &-,' s application and the: infom � ati on I have ,,,i co- 5ct i have .-tad the Description of Wo:k- and v c it "S a= rate. rrmly 'Arith v licab] a local 0 1- LIP nce s Emd sta-te 1, -,YS lel L0 b D d in o., truc-6 on. I Puthor r,-D-.esente-vees ffCuptnino -.o --ntcr zhe --hove-ident td : Si --n-aturt dApplic-Mv, -Z D e.. tq ST -YF PT -"F' -'NE :',',-L FO RIMLALTI ION REQTJ=IE D mass, ON I WE I&M revised 061-71111 CITY OF CUPERTINO SUV Ti cTTIUf A rrn12 — RITII .IANC_' 'n1VT4RTnN 19722 bixby dr FEE ID DATE: 08/25/2014 REVIEWED BY: Mendez ladADDRESS: APN: BP#: "VALUATION: $7,000 xPERMIT TYPE: Plumbing Permit 1PRREPIPE PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex # PENTAMATION 1 RPRP PERMIT TYPE: USE: WORK copper re -pipe PME Unit Fee: $14.00 PME Permit Fee: $48.00 SCOPE -F7E: APPLIANCE / EQUIP TYPE FEE ID - -- ------ --- - QTY/FEE QTY UNITS BP FEES Re -Pipe Interior 1PRREPIPE 1 # $14 PME Unit Fee: $14.00 PME Permit Fee: $48.00 -F7E: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 TOTALS: i Travel Documentation Fee: ITRAVDOC $14.00 Strom Motion Fee: ]BSEISMICR gym. Ft'c Plumb. Plan Check 0.0 hrs $0.00 Plumb. Permit Fee: IPPERMIT h It<Permit 1�£J Other Plumb Insp.0.0 �hrs�$48.00 Psl:.Lj NOTE: This estimate does not include fees due to other ueparrments (i.e. manning, rttunc rr urna, a 11., — .... ...y ___ i'nntnrt the Dent for addn'l info. Llstrtet, etc. mese CCS n/e OWJ GK oro L/.c FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE - -- ------ --- - QTY/FEE - MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $14.00 PME Permit Fee: $48.00 -F7E: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes 0 No $0.00 i Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: ]BSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 � f,'iT�,� s 6 ' — $156.91 $0.00 TOTAL FEE: - $156.91 Revised: 07/10/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19721 BDMY DR CONTRACTOR: NELSON PLUMBING PERMIT NO: 14080237 OWNER'S NAME: TAMBLYN COLIN D AND VIRGINIA T 2071 MAIN ST DATE ISSUED: 08/25/2014 OWNER'S PHONE: 4082532278 SANTA CLARA, CA 95050 PHONE NO: (408)280-5311 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ C �(l/ COPPER REPIPE, REMOVE AND REPLACE WATER License Class Lid. # (� HEATER Contractor Date I hereby affirm that I am licensed under he 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 bf 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 Sq. Ft Floor Area: Valuation: $13000 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 36909046.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT 180 DA PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA S F LAST CALLED INSP CT N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and exp s which may a e against said City in consequence of the granting of is p rmit. Additi lly; the applicant understands and will comply Issued by: Date: with all n-poin source reg ions per the Cupertino Municipal Code, Section 9.18. `1 s_/C1 Si ature Date Com`" l All roofs shall be inspected prior to any roofing material being installed. If a roof is any roofing 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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner 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. 1 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 equipme t or d ices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by t ay Are it lity Management District I performance of the work for which this permit is issued. will maintain compliance wit a uperti M i pal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, ctio 25505 55 , nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this �� S — Owner or authorized a nt: 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 9.18. Signature Date I GE NEPA- L PERMIT zPPLIGATION MEP COMMUNI T" DEVELOPMENT DEPARTMEN''T • BUILDING DIVISION' 10300 TORRE AVENUE • CUPERTINO, CA 95014-3288 (—:08) 777-3228 • r?Y. ;408) 777-3333 • buildinal�cuDe r)o,Dra �11 A / r: ALL? rn,rar:r� 7T�r"r.Awir .T. I Ir CQT I�J C 1�`OUJ F ADDRESS 9 72- I ' b 12 - f'N r�to q boL4(P,O(j V ,rI-O ,Q Tam6fyn I P30Iv_ 2 2 2� 8 �- ;f=.;✓ COhZACf N 1,r�� ( PHO ? c rO 5 r�� SO / ( I _ STr-1 faD? 3 I Cli TA n C 'f O'vl ❑ Ov?� r -3L'_ DER ❑ Ovr% .S! —N-CC?7?-ACTOR ❑ COh?r SCTDR f M\ ❑ L?. -!--CT ❑SCA_? ❑ D_VE110M, ❑ '=? =�I CC)NmkCORNA-M e )UW3 2 I 3 BIUS. UC 2^ 2 So.ea Il��WO L h (= l" r S ZE f�DP s I CI--, d a �S 2 fi�CvlsC' iCiT=µ�NfN� I Lica-SSEWL�J rt2. I BT:S.I.ICr COIJyf��TYlT4 I ✓1✓�=II I •A S -1?S—T ADDPMS I Cr Y, STAR, ZIP I ?HMS TJSi O -rD o: DU?Ts.. ❑ NJLi7-FAh9LY I PROrr.0 PfiWMDL.A->\M ❑ YES BT- T�D \1C. ❑COl�,CLAI T3R346.NIIN-17ERFAC=AREA ❑ h0 I P&OjeCi IN ❑ Y S ZOOD?Ola ❑ NO I IS T=- BLDO ANZ ❑ 1:$ z1G�1- HO1Js? 1 O DBSCRIPTION OF FORK h )VIA ley To-.fT �:f�UAiiON: /3 t' D.V LL B V y siEnsn : 1y. 'R'v loll E: ILL - 1- : G t O wm— or aunhw z5d Pz--TaL lG act on the property O•A;rler 'S behalf. I hay -e read tins -j' e belo;;r, I ce j� la e_ -c" = P p' pe -'y _ L l• > ir4 }. �--. 1 .t l a' - - Lle I]'' - i• iIGn of -Wor and ve—,f ]t 's F=uzGle. i autl- to comply ;;�_t.'1 all applicable local �L)a IC'cli G'] G7� LR. G:�iatlan I _'aZ� prG I_v $ Garre�+t :.ad p [!: G.L�fiila.$ 4�d � .�. ia;;�$ lel<l�ng ` buil re cars�_cfi:G� I :i Llan ....'. !e $eillalive$ Gl CLpe�iao rG e:�l�.r Lle abJ�lv�].7�.�jG:.i7L� 'P.d J:G]/.�/.Ji�y 1a! i-'C:1.F.r.:: tom. 1 p�-I�a$.'.$. S I -e OLA F IiLLIU) f. ei1L. Dal : S TFT�/F?�lrT ,TIOT! �QUlI D arF �.c �N W —EN IES? i�isc�ap_201_7.doc r<vised 06121/11 CITY OF CUPERTINO FM --7 FEE ESTIMATOR — BUILDING DIVISION ,19721 bixby dr DATE: 08/25/2014 REVIEWED BY: Mendez jVd1ADDRESS: APN: BP#: *VALUATION: 1$13,000 rPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 RPR PERMIT TYPE: WORK co er re i 'e remove and replace water heater SCOPE PME Plan Check: 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 nreliminary information available and are only an estimate Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eft. 7/1113) k' i;. Plan Che(, -4, Plumb. Plan Check 0.0 hrs $0.00 f CC % 1' v? Check Pe,,;rrd Fee.. Plumb. Permit Fee: IPPERMIT Tb2'c t't«rarfr i� cJr7re= ech.Inv) Other Plumb Insp. 0.0 hrs $48.00 Plumbing IPRREPIPE I Re -Pipe Interior Numb, Iusp. F(,e: I.%CC. li 4p>. Fec_ 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 nreliminary information available and are only an estimate Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eft. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $14.00 Plumbing IPRREPIPE I Re -Pipe Interior Suppl. PC Fee: E) Reg. C) OT0.0 hrs $0.00 PME Plan Check: $0.00 = # $29.00 Plumbing IPRWHEATR Water Heater Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 (",onsov,icfion T�1_11'.' 1 _T_r Administrative Fee: IADMIN $45.00 Q E) Work Without Permit? ® Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G i Travel Documentation Fee: ITRAVDOC $48.00 Strom; Motion Fee: IBSEISMICR $1.69 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 t�5 " : $143.69 $43.00 TOTAL FEE: $186.69 Revised: 07/10/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19503 STEVENS CREEK BLVD UNIT 328 CONTRACTOR: GARZA ELECTRIC INC PERMIT NO: 14080238 OWNER'S NAME: ERIC ELIAS 2423 KLEIN RD DATE ISSUED: 08/25/2014 OWNER'S PHONE: 4087056395 SAN JOSE, CA 98148 PHONE NO: (408)238-2739 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ � tU Z3 � ) ADD (2) 220 V CIRCUITS IN KITCHEN AND FURNACE LicenseClass Lic. # CLOSET; (1) 110 V CIRCUIT IN BATHROOM ,, Contractor ,ry, W,22_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 certificatelof consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $15000 performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by ction 3700 of the Labor Code, for the performance of the work for which this APN Number: 31649096.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT E WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 AYS OF RMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR M LAST CALLED INSPE IO . 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 Issued by: Date: with all non -point source reg ulaf ns per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date U yJ l 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. ❑ OWNER -BUILDER DECLARATION _ Signature of Applicant: Date: 1 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 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 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino unicipal Code, Chapter 9.12 and 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 the Health & Safety Code, Sections 2 5, 2731 3, and 25534. C� v 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 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 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 9.18. Signature Date ii I P -ii co';in;rINO rw r via Alff E V GE N E R A L P ERMI I T A PPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVIS1011,41 eq 10300 70RRE AVENUE - CUPERIT INO, CA 95014-3255 (40B) 777-3222--B - FAX (408) 7777-3333 - buildinoO=uDastlno.oro ST 7=1 CON -11 AICT \-UIIS CT❑❑ -r C. -Vic UCENin- -1-r:;,- :t 2 1 Bis. I -IC FA x ADDRSESST==, Z:P tt EIPINI riya BUS. UC CON°i�QYj�ki� I �IfkJZ ( FAX STI P,=zr, ADDR=-S I MY, STATE, M? I 2:10is OF Msm or DIPL-Ex CON_ —� pplo:= W, WILDLAINM ❑ YES I I;RB4kNZ R, -=MF ACE APaA. ❑ NO PROMELT DII ❑ Yz-s ?Al`CLA�L ❑ No I IS T ME= BLDG AN ❑ Yzs M(MMER HOME? ❑ ),;o 3DESOU'rION, OF WORK 0-) v C flov 70T.k•T VALUATION: . . . . . . . . . . . . . . . . . . D ONI �-,-Iy ILIS EcMJ7F%-. with 1�1 ble local Cor: 5ct T2---UdthtDesc7i i ff-W-,ork-and-ve' r L tiom tht Pbov---I�'5- -T '-IDOSCS. �)z to din O,zs�mc h,*,— 7" Ofcupt'uno - 1 t� D..,Op t, ordffiances md stzlt !a-c,,s rtl:tirg SUPPLEMENTAL D�TOIR2,IATITONI- -REQLJ-:IP:--D wzg z ®R vim WIN revised 06121111 CITY OF CUPERTINO 9W FEE ESTIMATOR — BUILDING DIVISION 19503 scb FEE ID DATE: 08/25/2014 REVIEWED BY: Mendez jimlADDRESS: APN: BP#: `VALUATION: 1$1,500 PERMIT TYPE: Electrical Permit 1 BREMPOWER PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or Duplex # PENTAMATION PERMIT TYPE: 1 REAP 8 WORK add 2 220'v circuits in kitchen and furnace closet 1 110 v circuit in bathroom SCOPE ; cr 7j?l. 1r-Isl / Ve, ' APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Other Power Devices 1 BREMPOWER 3 # $215 ; cr 7j?l. 1r-Isl / Ve, ' PME Unit Fee: $215.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $215.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Divirirt etc )_ Thave feev are havod an the nroliminary infnrrnatinn availahlo and are nnly an estimafn_ Cnntart the Dent for addn'l inia_ FEE ITEMS (lee Resolution 11-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS Mon Ch(Y L � 1'c�e: F '(" FCC .� 3.i f I�i 1 � E PME Plan Check: $0.00 ; cr 7j?l. 1r-Isl / Ve, ' PME Unit Fee: $215.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes (F) No $0.00 r H ca €ai?C'c'L: Plarming l'e'es: Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item BldF, Stds Commission.Fee: 1BCBSC $1.00 Y ri v' n $357.50 $0.00 TOTAL FEE: $357.50 Revised: 07/10/2014 COivli"" "TfDEVELOPMENT DEPARTMENT W;,.DiNG DIV!,` -1"101q - CUPERTINO 6"!r711 2,: ni O'� ED Tnf and spec-ifiontions MUST be kept at the It is unlawful to make any of i same, or to deviate appvc^va! frorn the Building Official. �H, plan and s"ecifications S. ALL NOT V" in i, -i t i n n (0 W C_ U_ r'm' _n ft) En -c Elias �g563 5Tevm,5 I'A_ (,u,fe�-�nv LITI - Page 2 of 4 Switch for new 20 A line (for tater and towel warmer) Suilding Depprtnent AUb Z 5 201 REVIEWED FOR CODE (;OMPL.IANCE- -, 114'� Rev By w4ji 2�V V. C'rC4 + 7tC6fr kk"j e -D �kn 7-�V. Lo- RN &i p t- L)66atev '10 4WP NOV. Src4i4r WRI 6VW14-d 62-013 Igni CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10415 PLUM TREE LN CONTRACTOR: SERVICE CHAMPIONS PERMIT NO: 14080241 OWNER'S NAME: SAMPSON GURNEY E AND THELMA D 7020 COMMERCE DR DATE ISSUED: 08/25/2014 OWNER'S PHONE: 4082574574 PLEASANTON, CA 94588 PHONE NO: (925) 444-4444 N LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL REPLACE 5 SUPPLY DUCTS /� License Class t% Z-0 Lic: # S i'10 q 0 Contractor 1Le, l( S Date �- Zs—/C/ 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 Sq. Ft Floor Area: Valuation: $4840 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 APN Number: 31633118.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY ROM LAST CALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the g granting of this permit. Additionally; the applicant understands and will comply Issued by: Date: with all non -poi t source regulations per the Cupertino Municipal Code, Section 9.18. -u�—/ (r RE -ROOFS: Signature Date 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. ❑ 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 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 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se tions 25505, 2533, an 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner Date: permit is issued. or authorized agent 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 malting this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 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 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 9.18. Signature Date CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildingAcupertino.org �" j m- - I. ICM'1lCl+v AXMIAT I—Ii'r P,--ruTrAI 1 IMiC-'11711.ANRnI 1.1% MEP misc PROJECT ADDRESS j ®l1 1 S A ,_ ^IY11 j-te L (/ 1 "N# l.J/ 33 I QP �OWNER NAME MN�SU/ 1/ P E -MAH. r A�� / STREET ADDRESS' 6-I (� Plum [ l I v ` 1 ! 1� CITY STATE ZIP �� ` '?50(Y U V1 T FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 0176 t) b LICENSE TYPFe Zo BUS. LIC # COMPANY N - S ItZ E -MAH, FAX S T ADDRESS I✓ C � �' ZIP ARCHITECT/ENGVINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF MSFD.DUPLEX ❑ MULTI -FAMILY BURDING: ❑ COMMERCIAL PROJECT INWIIALAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIMON OF WORK (R ace 5 DfS TOTAL VALUATION: I g N I)1 00 RECEIVED BY. By my signature below, I certify to;each of the following: I am the property owner or authorized agent to act on theproperty o . I have reaXlhisl application and the information I have rovWed is correct. I have read the Description of Work and verify it is accurate. I I e oval ordinances and state laws relating b '1 ' I orize ntatives of Cupertino to enter the above -identified roperty for inspection purposes. SignatureofApplicant/Agent: Date: SUPPWWEWINFORMAT10N REQUIREDoFFi NLY z a a OVER-THE-CCOUNTER EXPRESS � STANDARD LA LARGE MAJOR MEPMiscApp 2011.doc revised 06/21111 CITY OF CUPERTINO W -w FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE 10415 plum tree In QTY/FEE DATE: 08/25/2014 REVIEWED BY: Mendez IlaADDRESS: APN: BP#: VALUATION: 1$4,840 x PERMIT TYPE: Mechanical Permit 1 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1RMAP1 PERMIT TYPE: WORK re lace 5 supply ducts SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Other Appliance/Equip 1BAPPLOT 1 # $72 PME Unit Fee: $72.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRAVDOC $72.00 Strom Motion Fee: IBSEISMICR NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Tliofrinf f, I Th— 1;,.. .— th ... riijitiyrtthpsant fnri7ddii'linfer FEE ITEMS OW Resolution 11-053 Eff. 7111131 FEE QTY/FEE MISC ITEMS Pian Cht�(-14- 1'ec', P( , Fc,, F—] PME Plan Check: $0.00 PME Unit Fee: $72.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Planning Travel Documentation Fee: ITRAVDOC $48.00 Strom Motion Fee: IBSEISMICR $0.63 Select an Administrative Item - Bidp_ Stds Commission Fee: IBCBSC $1.00 NMI` $214.631 $0.00 TOTAL FEET $214.61 Revised: 07/10/2014 ��uTt STAVE OF CALIFORNIA ALTERATIONS - HVAC CE nFICATE OF COMPUANCE C1`111 - ALT -03-E AI eratlons - HVAC a 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) (Page 2 of 1) Sit i Address: ( 6g15 Plum T/"'081 1-11 Enforcement Agency: Date Prepared: Permit#: Eq ipment Type Equipment Efficiency New: Ducting, Plenums, Uneset Conditioned .thermostat Required R -value Floor Area (sq ft) D P ckaged System Evaporator Coil AFUE COP I$ R-6 (CZ 1,3-7) Ducts Served by system Setback (lf not already O S lit System D Condensing Unit SEER HSPF 0 R-81 (a 16) Ducts 0 R-6 (all C s) Plenums sq ft present must 0 F mace O Uneset EER 0 R-5 or R7.5 Unesets be Installed) H RS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this fo(m is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. 0 i. HVAC ChangeoutJRapair Required Compliance Documents to be left on site for Final: include new ducting Al Equipment, CW ALT 02-E Cc denser Unit; Evaporator Coil, CF21t: MECH-01, MECH-20-HERS Al Handler/Furnace CF3R: MECH-20-HERS In taller Requirement: Duct leakage L 15%or, :S.10%to outside, or seal all accessible leaks) Exempted from dud leakage testing If. - f:1. 1.Duct system registered with HERS provider as previously sealed, or If 2. There is less than 40 linear feet of duct in unconditioned s ce, or 0 3. Existingduds ems are constructed, Insulated or sealed with asbestos (list manufacture date of building 72. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All NewDucts2 CF111-ALT 02-E CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24}HER51 Installer Requirement: Duct leakage: 6% Fan Efficacy (.58W/CFM), Air Flow a 350 CFM/ton (or Standards Table 150.0-C / D alternative) O 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: I dudes repladng or installing All New CF1R-ALT-E C ucts2 and one or more of the following: CF211-MECH-01, MECH-20-HERS, MECH-(23 or 24YHERS Condenser Unit, Evaporator Coil, Furnace CF311-MECH-20-HERS, MECH 23 or 24) -HERS Installer Requirement: Duct leakage:S 6%, Air Flow 2 350 CFM/ton (or Standards Table 150.0-C / D alternative) 0 Exempted from dud leakage testin I existing duct systems are constructed, insulated or sealed with asbestos. 4. New Ducting over 40 feet fired Compliance Documents to be left on site for Final: Adding or replacing duds in unconditioned CF1R--ALT s+ce but less than All New Ducts= CF2R: MECH-2-HERS CF31t: MECH-20-HERS Ing ailer Required to: Duct leakage (<_15% or,: 10% to outside, or seal all accessible leaks) 0 Exempted from duct leakage testing I existing dud systems are constructed, Insulated or sealed with asbestos. ' I new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This incudes in walls, between floors etc. 2A New Duct system is when the duct system Is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing dud system (e.g., registers, grilles, boots, air handler, plenums, duct material. ' �-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 Inch. Most mfg will require Suction line Diameter with insulation as the following2.5-2T-2W, 2.5-3T-2%, 3.5 to 4T -23V, ST -4%" Contractor (Documentation Author's /Responsible Designer's Declaration Statement) I rtify the following under penalty of perjury, underthe laws of the State of California: 1 The information provided on this Certificate of Compliance is true and correct. 2 l am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3.t That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Tide 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4 That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. 5�The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement i agency for approval with this building it application. Re spnsiWe Designer Name: 1 &4'i nr1�s Resp rniW Design Signature DateSned: g Zs i� a Ll v ` y j r �urvs u9n.S Address:. -t 1D(' aw/�ace/Z P: -Ft moi. iii h0q%S Zs � `p�1 _ Lf y � For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: i-avirric-ssw