14080190 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 899 SEPTEMBER DR CONTRACTOR:MATT&VALERIE PERMIT NO: 14080190
HAYES
OWNER'S NAME: MATT&VALERIE HAYES 899 SEPTEMBER DR DATE ISSUED:08/18/2014
OWNER'S PHONE: 4089967731 CUPERTINO,CA 95014-4142 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
POOL REMOVAL
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
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36212023 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 ORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT 80 DAYS OF P 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 DAY FROM LAS ALLED 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 /F /
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.
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
c nstruct 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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:/� 2 Date: ��rl
permit is issued.
certify that in the performance of the work for which this permit is issued,I shall
of 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 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. 1(f r
Signature Date
CONSTRUCTION PERMHT APPLICATION A
0
COMMUNITY DEVELOPMENT.DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
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EUPERT11:10 (408)777-3228• FAX(408)777-3333• buildino(cJcuoertino.oro
❑NEW CONST�RJUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERFF-.D /0PJGD,1A1,PERI'4IT r
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Q4t'N7t ❑ OWI�R-BL-D.DER ❑ OWKEERAGT-r ❑ CONTRACTOR 13 CONTRACTOR AGEN ❑ ARC UrECT ❑�GII.�R ❑ DEV-APER ❑ TENANT
ILICENSENUA4BER I LICENSE TYPE I BUS.LIC m
COMPANY NAME E-MAIL I FA
STREET ADDRESS CITY,STATE,ZIP I PHONE
A.RCHITECTIENGiINEER NA14E I LICENSE NUMBER I BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP' I PHONTE
DESCRIPTION OF WORK / /A/
EXISTING USE I PROPOSED USE CONSTR T]TE STORIES
USE TY-PE OCC. SQ.FT. V?-I,UATTONT(S)
EXIST G NEW FLOOR DEMO TOTAL
AREA AREA AREA NEI AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCRAREA I DECKAREA TOTALDECK/PORCHAREA GARAGE AREA: DETACH
❑ATTACH
m DWELLING UNITS: ISA SECOND UNrS ❑YES SECOND STORY ❑YES
BEDiG ADDED? E)NO ADDITION? ❑NO
—PR$--/3PL-iC�TdON-01'-ES�a=eS,-FAOaIDErOP\'nF r
STHE BLDG. rl 5 rS EIb'F BY=* -�-3s,T - TOTAL\%ALU.4TION:
PLAX NTINGAPPLm ❑NO PLAN'N\TGAPPROVAL LETTER ICHLER HOME? ❑NO `- � ^
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. T have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to uilding c uthorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: f Date: y •�� •j
✓ SUPPLEM\ TTAL INFORMATION QUIRED `"' _ Ror
4L3 CHECKC TYPE 3
Ne-%v SFD or Multifamily d\vellings: Apply for demolition permit for
OSERTCOUI�TER
existing building(s). Demolition permit is required prior to issuance of buildings Tr
permit for new building. I`i�GrL��x � —z _
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0-1 svoRksb
fo_rm if any Hazardous Materials are being used as part of this project. V§l INT
_Copy of Planning Approval Letter or Meeting with Planning prior t0 ME
gfi7fl5 i�3TARI SSii�R DIST RTCTE
submittal of Building Permit application.
Bld&4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO D
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 899 september DATE: 08/18/2014 REVIEWED BY: Mendez
APN: BP#: "'VALUATION: 1$3,000
nPERMIT TYPE: Demolition Permit
PRIMARY PENTAMATION
USE: Swimming Pool, Res. PERMIT TYPE: 1 SFPOOLDE
WORK I pool removal in sfdwl
SCOPE
FEE ID #POOLS
1DEMOPRES
fdr<uk I'lun t u(:e ;ie�.
tf>cl,. ?'2;7tttl 1•ea>
Corm ila:ch Iris,>- (?tlTes Plus b 1rrsP.
14c�"/a. Inv) I','taO. hasp. Fee-
NOTE:
ee NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 L . 7f 11113) FEE QTY/FEE MISC ITEMS
Permit Fee: $329.00
Suppl. Insp. Fee: Reg. 0 OT 0 0 hrs $0.00
I'�?!rtJl7.i:;�,FeCrt.i1`�li'C° /�f'?"Yt771 Fee:
C:or7strucCzr�,a 1trt:
�Idvanccd l'lurm.ing Fees:
1 1)oc rarac?s2fizfirrrt Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
tSIYB OTS SLS $330.50 $0.00 TOTAL FEE: $330.50
Revised: 07/10/2014
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CA ZP Code.95014
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Patio
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Master Bedroom
Family Room
Bath
Kitchen
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COP,,IhI NITY D VEL PMENT DEPARTMENT Entry
13 L ILDINO.D11/f O( JPERTINO
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job site uring construction ft ls= make any
chang s or alteratiois on.-same,or to deviate
therefror i,withoutapproval From the Building Official.
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SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
I
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
l
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building cDcupertino.org
Permit No.
Address � '/ ��i�. QtZ, #of Alarms Smoke: Carbon Monoxide: /
y 4
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 X X
bedroom(s)
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.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner A ent's)Name:
to S- Si natur .. ............ ......... Date: ..'•2 Z-
..............
Contractor Name:
Signature...................................................................Licl......................................Date: ...................
Smoke and CO form.doc revised 03118/14