14080184CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20945 HANFORD DR
CONTRACTOR: TBD"TME
PERMIT NO: 14080184
DBT- vlilaED
OWNER'S NAME: J FREDERICK & MARY DONAHOE
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DATE ISSUED: 08/18/2014
OWNER'S PHONE: 4088886049
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PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
PROPERTY LINE CLEAN OUT
License Class 4f Lic. # 7fS 7S=/ 7
Contractor 4'A1+s0,-,&.) 1�L,,w,3r-J7Date
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: $7500
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: 32630081 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
WITIIIl� 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
J
180 DAA. O CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
it/
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Signature, ��t��Pi"�%� Date �''� S'—� �y
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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date-
atethe
I hereby affirm that I am exempt from the Contractor's License Law for one of
thefollowing 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. 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 Code, Sections 225505 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: '47 Date: 9-.
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
GEENER.'-�L PERMT JA-,%.PPLICA c ION
COMMUNITY DEV=LOPMENT DEPART MENT • BUILDING DIV1S101-,g(4
10300 70RRE AVENUE • CUPERjpsd
CA 95014-32515 v
408 t r-3228 • FPX 1,403 177-3333 • building.® ;uDe -tno.orm-
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By -,y SiSMILtOre belOW, Ice j/ to each ff _he folio; ine: I am he prope-ty e;;• -ger or authoriu,d _gent to act on the p. pert• o�,,,ler' _- zi` I hart rcad en's
apalica ion and the in o -nation I have provided iS co-ect. I have ad the Description of -W`ork and t/er y it is acLc,. rat - _ ...o co__mly u h ail pplic it ie local
Or and and st e 1-7;'5 rela.LlE tO builaine const.lction I a/umhorizt reDresenta:lves OL Cuper:lno to �.:,,ll./'.r Lrle above-;dnitl ed D'0.0el), I�r LSD�G:l dill p�_rpeses.
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ST-PPLEI�NTA-L �tORT LikTION REQUJ ^D
:4.1.P./41 SwDD 20I1.doc revised 06/21/11
CITY OF CUPERTINO
FM__7 FEE ESTIMATOR — BUILDING DIVISION
20945 hanford dr
FEE ID
DATE: 08/18/2014
REVIEWED BY: mendez
IlaADDRESS:
APN:
BP#:
"VALUATION: 1$7,500
'PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY SFD or Duplex
USE:
$25
PENTAMATION 1 RPS
PERMIT TYPE:
WORK
Property line clean out
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Sewer, Sanitary
1PRSEWER
1
#
$25
tt.,tr>i i P ce,
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Con,,maction 7'6n:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
TOTALS:
A
Travel Documentation Fee: ITRA VDOC
$25.00
.
9e-cra /,"an C h �. k Plumb. Plan Check 10.0 1 hrs $0.00 L. r'ec. Yr n ('beck
11 . h, Fee: Plumb. Permit Fee: 1PPERMIT M -c'
(/rir 1Ac h. b""v,Other Plumb Insp. 1 0.0 1 hrs 1 $48.001
I'llaab. hisp. Vee: t_7ce 13 st . 1�.-<".
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Di.ctrirt etc )_ The.cv fvve ary haeed an the nreliminary infnrmatinn availahh, and ary nniv an vctimat,,_ f'nntart thn Dant far addn'I infa_
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
`txr,r 1. 'C if",e
PME Plan Check:
$0.00
tt.,tr>i i P ce,
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
Con,,maction 7'6n:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? ® Yes 0 No
$0.00
A
Travel Documentation Fee: ITRA VDOC
$48.00
Strom Motion Fee: IBSEISMICR
$0.98
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
'u�
$167.981$0.0
0 TOTFAL FEE;
$167.98
Revised: 07/10/2014
Address
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b BCC��
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 acupertino.org Q t
10 g�(6- h�vlrfl �. P« T�n�o Permit No. j
A# 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. "LlE
GENERAL INFORMATION
Existing single - family and multi- family dwellings sh be r ed 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 shallbe 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 8314 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.
t have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
r. -DO�df z__
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........................ ...............................
Sign ature .................. ........................ Date:
...................
Contractor Name:
Signature.................................... ............................... Lic.# ....... ............................... Date:.,.................
Smoke and CO form.doc revised 03118114