15020144 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7865 BELKNAP DR CONTRACTOR:AMERICAN PERMIT NO:15020144
RESIDENTIAL SERVICES OF CA
OWNER'S NAME: BENNETT MICHAEL A ET AL 965 RIDGE LAKE BLVD STE 201 DATE ISSUED:02/25/2015
OWNER'S PHONE: 4084465297 MEMPHIS,TN 38120 PHONE NO:(408)982-0405
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
/+ p TRENCLESS CLEAN OUT
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License Class C-� 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
Vperformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:
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:36208034 00 Occupancy Type:
permit is issued.
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 180 D F 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 F A T CALLED 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: ,4 a sy
granting of this permit. Additionally,the applicant understands and will comply y'
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
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
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. 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 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 agen Datelai�r
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
918.
Signature Date
GENERAL PERMIT APPLICATION ,l
MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �1
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408).777-3228•FAX(408)777-3333•buildingCcDcupertino.org V MISC
CUPERTINt7
PLUMBING MECHANICAL ❑ELECTRICAL [—]MISCELLANEOUS
PROJECT ADDRESS / O APN#
OWNER NAME aG EPgzJ (* E-MAIL
STREET ADDRESS CITY T ,S�1I ((� ^1 �r G/ FAX
CONTACT NAM PHONE Y E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NA L1,_'__ LICENSE ER5_ LICEN E E BUS.LIC#
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COMPANY NAME E-MA I, , r C FAX
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STREET D SS CIj ,SuTATF�,ZIFHONE t�
ARCHITECT/ENGINEER NIME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD u DUPLEX ❑ MULTI-FAMII.Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO /EICHLE9R HOME? ❑ NO
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DESCRIPTION OF WORK V f^ ^-6
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TOTAL VALUATION: -r RECELVED BY '
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By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property e)]alf. 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 relating to building construc' authorize representatives of Cupertino to enter the above-identified
9 property for inspection purposes.
Signature of Applicant/Agent: Date: 2—
Supp4gNtZINFORMATION REQUIRED ; { oF�ICE usE or%Y y`�
�� D OVER THE COUNTER
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LARGE II
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MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7865 belknap dr DATE: 02/25/2015 REVIEWED BY: Mendez
APN: BP#: *VALUATION: $8,774
xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY PENTAMATION 1 RPSS
USE: SFD or Duplex PERMIT TYPE:
WORK prop rty line clean out trenchless
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $25
TOTALS: $25.00
:bl�ch. l'lcrn('heck Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check
Alech. Perwil Fee: I Plumb.Permit Fee: IPPERMIT Ele.c. Permit Fee.,
Orlwr Hech. Trap. Other Plumb Insp. 0.0 hrs L$48.00 Other Elec.Insp.
,1,tech.Insp. Dire: Plumb. tush. Tree: Elec.Imp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.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 Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff 11/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
.Suppl. .PC:'Fee
PME Plan Check: $0.00
Permit Fee:
suppl. MST')Pee
PME Unit Fee: $25.00
PME Permit Fee: $48.00
Corastr•uction T OX:
Administrative Fee: IADMIN $45.00
Work Without Permit? ®Yes (j) No $0.00
,ldvanced 111tirming Fees:
Travel Documentation Fee: 1TRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $1.14 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$168.14 $0.00 AL FEE:: $168.14
.�, .. .. _, SER I _
Revised: 02/14/2015
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
C U P E RT I N O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(ftuaertino.org
p Permit No.
Address / 6 fDe l k naL n"lDr �I SO« #of Alarms Smoke: y- Carbon Monoxide: 1
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE
HAS BEENSIGNED AND RETURNED 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 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 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 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: (,
1v` `J Gte 7C rt riC sign ture... ..... ....... .. ..................... .................. .. ........................................Date:
Contractor Name:
Signature..................................................................Lic.#......................................Date: ...................
Smoke and CO form.doc revised 03118114