14100089 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21194 LAURETTA DR CONTRACTOR:MORELAN ASSOCIATES PERMIT NO: 14100089
INC
OWNER'S NAME:
SAN JOSE,CA 95128 PHONE NO:(408)247-3322
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
—��--���� ��47INSTALL(4)CANNED LIGHTS,(4)SWITCHES IN LIVING Lic.# ROOM
License Class 11
ContractoAMA*Y
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:$2400
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:32654018.00 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 1 0 DAYS 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 AST CALLED INSPECTIO
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: v l
with all non-p ' t rc regulations r the Cupertino Municipal Code,Section
9 18.
nRE-ROOFS:
Signature Date �`✓ 1�7 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(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 Wnicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety
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 pe��.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 nKEP
GENERAL PERMIT RPPLIGA T ION �.
1�rwy-�-
CONifViUN}TY DEVELOPMENT DEPARTId�i_t�iT• BUILDING DIVISION
50300 i ORRE AVENUE• CUPER i INO, CA 85014-3255
(408) 777-3228•FPX(!08)777-3333•buildinoC.cuoetno.ora X M I s
etJ���►tfld ,�
❑PLTJj S. N-G ❑=I 1 -CaL ni. CE LA]\�OtiS
PR O��ADDR=SS 21 I q u
G -
�ti c-I fJDP Ss I CiiY,b rA;n,7r?-. I FAX,
CO vihCT I[t r
?'.lox:- I =]JAS
SiP � ,DRi°s I CrN,STATB, Zi? I FAX
OCrI�. OP =r-3LT�rZ f❑D'vi1Z f C�.°I ❑ COA?kC-03Z ❑CDAi?SC C OR 4G?.i ❑ c_.0—CT ❑ CA ❑ Deli O?_tee ❑ -Ku T
3CrSET P= BU S. 1�
r/f ti �l
CO1�ci.1'Ncyr I _-W°a I FAX
s L---zT ADDP.=SS ( =1 Y,STAT:,Z2 I P?OhL
�2Cs11ECIUDME2.h4.1�' I u=xSENJAC;ER I BUS.UC
CO2J:Pf��TYldAur I Filf�k.TL I V
S n& Z ADDF Ss I CTrY,STAis,21? I PHONE
USE OF ❑Sr-7- oz DUPTIMC ❑ l r.JLTI-FA LY I PROTECT DT W MDLAI.'D D YES I PP.OTnCT N D YFS I IS Y_^BLDG/IV ❑1 S
3UIIDL;G: p Col✓;=-,CL'.L IMBAA BM= ACB-APP,BA p No /",MOOD ZOI- ❑No s aAl—Vk 3 ?
o1,s? ❑ .o
a=scP>PTioN or woRx
1
Gve' S Lf Vr CIU/
1GT4T`.TiJATIO?�: •//�T/�p/��. c"r�t,L��.u_ _—„-, c_. �.-
3y my si s tz-e below,Ice dj'to each of the iollo Lnz I an'he property o inin r or author iwd agent to act on t:e mope:: o�; er`s beha-l£ I have read sis
a:.aplicrdon and the info::?;anon I h 'e PrOYid �C=tCt I have -d 41ie Descr iPtion of Work and;'eri y it is acc ate. i agree to co;-�ply A ith all apalicable local
ordinances and smote l€„vs relati,�Q to b _ c : I *h ;' represenLati;es of Cope ino tD enter uhe a5�'e-ice e pr y t FL�oecaon P�_rpeses.
Si-1atareo=:_Palican,t"esera: Da=e:
Q _ -
SLPPLE_�K ,-.L?�YOFZ���'�O?v�• U�.�
• -%��t'I�lisc�'�p_2011.doc re��ised 06/21/71
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21191 lauretta ct DATE: 10/15/2014 REVIEWED BY: Mendez
APN: BP#: VALUATION: 1$2,400
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 REAP1
WORK install (4) canned lights, 4 switches in living room
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixtures, Lighting 1BREMFIXT 4 # $72
Recep/Switch/Outlets 1BREMRECEP 4 # $47
TOTALS: $119.00
1 ? �y, n
r!!!
Lfiz?r_ �'lra;r t.'leec6� Phonb. Man Cheek Elec.Plan Check 0.0 hrs $0.00
Mc"e r. Pc°rwil Fee: Plramt>, Permit Fee: Elec.Permit Fee: IEPERMIT
Ic?t. IY�,� Or);e�r Plr mb Ink, Other Elec.Insp. 0.0 hrs $48.00
J
Uc" hsys . 1'e F71urr1b. Insp. Pepe: t>rec:.Ins <:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the prelimina information available and are onl an estimate. Contact the Dept-for addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/131 FEE QTY/FEE MISC ITEMS
SvPpl. PC Fee F7
PME Plan Check: $0.00
I'e°rjna Fee:
Siq T)1. Ir sp F*c�
PME Unit Fee: $119.00
PME Permit Fee: $48.00
("em.,"Irilction 71Ta.•
Administrative Fee: 1ADMIN $45.00
Work Without Permit? ® Yes 0 No $0.00
Travel Documentation Fee: 1TRAVDOC $48.00
Strom,, Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC 1 $1.00
$261.50 $0.00 '. . TOTAL FEE: $261.50
Revised: 07/10/2014
Morelan Associates Inc.
1101 S. Winchester Blvd.
Suite G181
I
San Jose, CA 95128el-
0 ; ICE
w ,
,a
x de
ED
Lail
I3uil4
di�Wen 'fir _..` � MUST be kept at the"lob site o - � ""' 3�0n. It i; u„la,rful to make any
OCT 1 _ changes or alhraii En
me,on �
5 2014- ..��,�e,�r .o deviate.
the w pout a pr,,-al fron7 the Building Official.
tREVIEVVED FOR-L ODE COMPLIANCE iv, r.. ing t1is plan and Specificasions S"HIA L NOT
R
e b' o -
CitX Ord narlce or Stafe L .311
`
- l
S
a a
A
1 ,
•
t -
i l
{_'vr.:.mwnuaam:+wam»mim .w vx....v.,,,a:mvxo+..v..,fi Nrczr um s,meaarm,-,ami n�u.vxz..:n.mee a, ttxr.,s-.,. { ,..uenx..n,n , :.:..:a�,w..r.,� ,r. .-.^•mr.z:r�c,a .•r,. ,.raawaww,u>
L 6 wwwAidw
r
CONTRACTOR WE
w 12
�� FULL
R CITY STATE
mss�loelE i 1 It w m**&i 1 //
SPS LOCATION PRICE PER EXTENSION
cm
3
mv-� t
Vt `
Li �V
I HEREBY D�� MERCHANDISE I
OFFER AS INDICA
Ga w Lighting,hV-- ACCEPTED: SALES TAX
Neecw By SHIPPING CHARGES
special buwuctlo m awe TOTAL
DATEIlntlw wi e0t bo dcuptld.
Twaarr* •�v�N�ora ot30'Awitbem�de
IareUimrn'UloNawcormtrt.A « part.
oa do 30
CONRRACTOIi A atrite tM t YEA P�nordh wilt cwwpd on ar bahr�ees pat
OporMOM
DATE ATNMIIEY=�
*�7i7T'Mpyap�intl�dMnNMrtiaMawlhepurd >d�
r' FAb 1 M oRDM onbd111nq�d�p1�
RMFU4 NOT Au offm
tMMOM bpNWYAwoa dIma*dw-ft�IKmYb60byUroWUM
. IN,
TV
l(' 4
l
r
Y ♦ HIMR-M51 NV O17M ♦ Genera!Comactur CA#413297
�-� -C
SMOKE I CARBON MONOXIDE ALARMS FILE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228 FAX(408)777-3333•buildin-Wacupertino.org
Permit No. 141 ®c o
Address 1 LA LJ1MT1-A #of Alarms Smoke: 3- Carbon Monoxide:
PERMIT�tNOT$E FINALED.AND.COMPLETED UNTIL THIS CERTIFICATE
� ����T�R�TO THE BUILDING DIVISION
. _.,..... ,..-..... �+u�:m:.m..:.-+-.mm-..,mna+....---r.".—...n...._.;..a-rte..,w......,..,.__. -.._.._.�.,_-_•... . .
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314,2013 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 induding 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,alarms)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 agrae-W06aly with the to s nd coditfons of this statement
Owner(or Owner Agent's)Name.
Rt Ct-t Ar+� M�(LtLO C we. nature_:.— d i a J"
..------- ...••..•. .............. ... ............................------Date: ... .............
Contractor Name:
Signature...................................................................Lic.*......................................Date: ...................
Smoke and CO form.doc revised 03/18/14