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14080251 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7603 HOLLANDERRY PL CONTRACTOR:THOMAS PLUMBING INC PERMIT NO: 14080251 OWNER'S NAME: GLEN SAKIMA 16305 A VINEYARD BLVD DATE ISSUED:08/26/2014 OWNER'S PHONE: 4087784340 MORGAN HILL,CA 95037 PHONE NO:(408)736-3050 ❑ LICENSED CONTRACTOR'S DECLARATI JOB DESCRIPTION:RESIDENTIAL COMMERCIAL �� REPLACE MAIN WATER LINE License Class Lic.# Contractor_TADate 1- '— Ihereby affirm that I am licensed u der 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 K ce of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1500 will maintain Worker's Compensation Insurance,as provided for by 00 of the Labor Code,for the performance of the work for which this APN Number:36226064 00 Occupancy Type: ssued. 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 DAYS 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 77kST CALLED INSPf CTION. 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-poi ource regulations p 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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(See.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 th Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' 255 ,25533, d 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent Dat 06A/ 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 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 GENERAL PERMIT APPLICATION ION ` MEP :9 Jr... COPJMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 408 777-3228 FAX 408 777-3333 buildingCcDOUDe rino.ora m I S eUP'�r'iTthtt3 '�\ PLUIJ,BING ❑MY-CE LAICAL []ELECTRICAL ❑I'm . EOUS 03 � I P� �!Cl '�� O I E t✓4II. STREETADDP.ESS I CTIY, STATE,ZIP. FAX COItiACT N 1116 P-ION TF E 1✓-kms STP.Lc,ADDRZSS CITY,STATE, ZIP FAX 13 O'Aw ❑ OWE-BUII.DM-L ❑ mmAC-mrr ❑ comm4Ci0R ❑COTTRSCTORAGENT ❑ 1.R=,-CT ❑ENGR7—ER ❑ D1--LOPML ❑ i'E?:AA'T CMm.1/,CTO „ I LICENSE I LICEN rF / I BUS.LIC R ( F1 X STR_cT D?' i ,STA ® r A_RCAiTECT GII� RN.UJi I VAR LICENSENL-1✓00ER BUS.LIC' COIJ,PA�Y N.41JE E-1J,AIL FAX STREET ADDRESS CITY,STATE,ZIP PHOjOE USE OF ❑SM.,DUPLEX ❑ MULTI-FAMILY PROJECT IDI wnmLAND ❑ YES I PROJECT A ❑YES I IS THE BLDG AN ❑ YES BL-u.DA'G. ❑Comf' cmL URBAN NZTERFACE AREA p NO FLOOD ZOI T- ❑NO BICHLER HOMM? ❑ NO DESCRIPTION OF WORK w TOTI-1 ON: i By ny s' atue below,I certify to each i the follo- u e property owner or authorized went to act on the properly owner's behalf. I have read this application an ro' ed is correct I h read the Description of Z�rolk znd ve,'" s zec -ate. I agree to comply vrith all applicable local ordinances and state law atL-1-to b 1 c0 u Tion. thorlZe replesentatoN es of cupertin0` enter the abov--Identi led prope;:y for inspection pL'rpOseS. 5 i�1€pare of.-`-ppli^.,t'Aeent: Date: PL _ ' O-Rt4ATION RE UJ=D R>;�zs — : s� .41E?A isc,4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7603 hollanderry pi DATE: 08/26/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$1,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPR USE: PERMIT TYPE: WORK re lace water mainline SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $14 TOTALS: $14.00 ti.,..h�T " s r hi c;1r. I'.Tuyl Cher- Plumb.Plan Check 0.0 hrs $0.00 /te��•1'i'm Check Jc>: I'>r„tif Fee: Plumb.Permit Fee: IPPERMIT �t�:E I�. ��rsf� F-1 L Other Plumb Insp. 0.0 hrs $48.00 0 he'-, c: .I,r;s -. irk'-c r? i?3Ji. J'`�'Z: l�ldwlh. h7sp. Fee: J"tGC.Z�a 7.J';'d: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E�"7f /1/13) FEE QTY/FEE MISC ITEMS f',cin (.hEc;l P 4nf, A'_,1'b e PME Plan Check: $0.00 lc't7Ytii�`8C?.' PME Unit Fee: $14.00 PME Permit Fee: _T_T $48.00 (onsirl'Iction 7,OX: Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 t v Ce.'� LFtf7ZFY1 r P'e3es: Travel Documentation Fee: ]TRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldp,Stds Commission Fee: IBCBSC $1.00 "O "LSA $156.50 $0.00 TOTAL FEE: $156.50 Revised: 07/10/2014 CUPERTINO Address 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 alcupertino.orp �O X425/ Permit No. 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. d t m 1 with the terms and conditions of this statement t have read an agree o co p Owner (or Owner Agent's) Name: �,:.; •, Si nature ........ ...... .... .... ...... ................................... ............................... Date: .. ..... Contractor Nam DG(1/J� p/ ? S`v�..1.(� Date: . �.................. Si nature .................. ..........................Lic.# .4.?............ ............. .Y...r.. Smoke and COform.doc revised 03118114 I