14120063 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21075 RED FIR CT CONTRACTOR:ONE DAY COMPLETE PERMIT NO: 14120063
REPIPE
OWNER'S NAME: LEDESMA GINO JOACHIM LOPEZ V 617 N 12TH ST DATE ISSUED: 12/12/2014
OWNER'S PHONE: 8186808608 SAN JOSE,CA 95112 PHONE NO:(408)603-0554
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
/� � COPPER AND PEX REPIPE
License Class Lic.# — �°I 1 C //
Contractor Date —
I here irm 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:$5300
d 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:35905024 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is FERMI ORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT 180 D S 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 DA F M LAST 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 Issued b Date:
granting of this permit. Additionally,the applicant understands and will comply y'
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
�f RE-ROOFS:
Sig ,,!- (nature 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
1,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 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. , ,'9`/
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Dater, `-
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 CONSTRUCTION LENDING AGENCY
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 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 MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 misc
(408)777-3228•FAX(408)777-3333•building
CUPERTINO a(�cupertino.orp
[:1 PLUMBING ❑MECHANICAL [:]ELECTRICAL —]MISCELLANEOUS
PROJECT ADDRESS i Pei I I— I APN#
OWNER NAMEG `• L6 PHON V AIL
STREET ADDRESS ITY, STATE,ZIP FAX/
CONTACT NAM , PHONE E-MAIL
STREET ADDRESS CITY,STATK F
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❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT iC PTREF9 �❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBEROS/ LICENSE TYPE G BUS.LIC#
COMPANY NA E-MAIL (a FAX
0,642
DD E CITY,STATE,Z �— PHONE
L
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF El SFD or DUPLEX - -Y PROJECT IN WILDLAND ❑ YES
❑COMMERCIAL PROJECT IN YES IS THE BLDG AN EI YES
El URBAN INTERFACE AREA ❑ NO FLOOD ZONE NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK — %
TOTAL VALUATION: �RECEIVEDBY n_
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on e property owner's behalf. I 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 remg to b g construction. es of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
PPLEMENTAL INFORMATION REQUIRED OFFICE Us'E`ONLY,
Q ,OVER THE-COUNTER,. '
0,
EXPRESS
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CII;STANDARD
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MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 21075 red fir ct DATE: 12/11/2014 REVIEWED BY: MENDEZ
APN: BP#: EVALUATION: $5,300
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPRP
USE: p PERMIT TYPE:
WORK �co er and pex re i e
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $14
TOTALS: $14.00
Plumb.Plan Check 0.0 hrs $0.00 f' r
Perm;i Fee: Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $48.00 Oiho't a•r'.Msh.
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees 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 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS
Plun C:'lwc l- /F c>e:
81,1ppl. PC.`I°e"
PME Plan Check: $0.00
Stppl, jusl?IFee
PME Unit Fee: $14.00
PME Permit Fee: $48.00
Administrative Fee: IADMIN $45.00
Work Without Permit? ® Yes 0 No $0.00
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $0.69 F0 # Revisions
Bldg Stds Commission Fee: IBCBSC $1.00 $0.00 IREVRESADD Addition
$156.69 $0.00 �` TOTAL FEE:` $156.69
Revised: 10/01/2014
12-11-' 14 17:02 FROM-ASRW 1-408-938-4177 T-724 P0001/0001 F-862
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333-building(o_cupertino,org
T J vl 11 I I 1 , t Permit No.
Address V {-t ea41k.QY �;07 Or• #of Alarms Smoke: �/ Carbon Monoxide: �
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEEN SIGNED AND,.RFTCTRNED TO.THE BUILDING DIVISION
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 8314 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 bx=ediate 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 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.
I have head and agree 1p comply with the terms and conditions of this statement
Owner(or Owner Agents)Name:
c 7'fSI� I , � J��G�.UlY10` Si nature... ........."tA
.............................. .m �.
Contractor Name:
cros0
4-W Si nature..................... .......................................... c. ..�.�''.J`. .gG.��........Date: ��..�� .�. .
Smoke and CO form,doc revised 03118114
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION \�
TORRE AVENUE•CUPERTINO CA 95014-3255
CUPERTINO 10300
(408)777-3228•FAX(408)777-3333•buildingacupertino.org
Permit No. O d D,4
Address �.�U e 0Zbwr' Dr #of Alarms Smoke: Carbon Monoxide:3
6
sal
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 Agent's)Name:
2451���....... .... ......................................................Dat ...................
�;ontr ctor Na�
V Sin ture.... ............ .. ........ .............Lic.# k...4.�.. .. ......Date:' 1. .�..
w. qv
• Q(� Smoke and CO form.doc revised 03/18/14