14060040 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1450 JAMESTOWN DR CONTRACTOR:WESTERN ROOFING PERMIT NO: 14060040
SYSTEMS
OWNER'S NAME: WONG EDMOND Y AND LEE CRISTIN 1328 WHITE OAKS RD DATE ISSUED:06/09/2014
OWNER'S PHONE: 4089308984 CAMPBELL,CA 95008 PHONE NO-(831)278-1837
❑ LICENSED CONTRACTOR'S DECLARATION "
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BUILDING PERMIT INFO• BLDG ELECT PLUMB'
License Class Lic.# ,
MECH F- RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION TEAR OFF WOOD ROOFING AND INSTALL,A METAL.
(commencing with Section 7000)of Division 3 of the Business i&Professions SHAKE
Code and that my license is in full force and effect. ROOF PER ER 3098-27SQ
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area:0 Valuation:$16000
permit is issued.
APPLICANT CERTIFICATION APN Number:36610081 00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
Signature Date Issued by: Date:
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(See.3097,Civ C)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
GUPERTINQ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building aC�.cupertino.org }U / (�
Permit No. / 7 0(�00 T�
Address COPS/ � �Y' #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 INFORM-ATION
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 dwell' ch do not contain fuel-burning appliances and that
do not have an attached garage. Carbon;opno * rmscombined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved ce *State Fire Marshal.
Power Supply:In dwelling units with no commas power su ly,alarm(s)may be solely battery operated.
In existing dwelling units,alarms are permitted to be solel attery operated where repairs or alterations do
not result in the removal of wall and ceiling finishe ere 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 ele cal permit is e uired for
alarms which must be connected to the building wiring. E
As owner of the above-referenced property,I hereby certify that the alarm(s)ref a edvalfffornia
has/have been
installed in accordance with,the manufacturer's instructions and in compliance with e 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 w he terms and conditions of this statement
Owner(gr Owner Agent's)Name:
1 rl S�h L e� Si nature................ . .............................................................................................Date: .�..�1.. ....
Contractor Name: (1�f /
Signa ure... ... .. .... ... ...Lic.#Ll1j ..........Date:W..........
Smoke and CO form.doc revised 03/18/14