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15090036CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10365 DEMPSTER AVE CONTRACTOR: PLUMBING TECH SEWER PERMIT NO: 15090036 AND REPIPE INC OWNER'S NAME: KWOK RYAN L AND ANGELA L 278 E GISH RD DATE ISSUED: 09/04/2015 OWNER'S PHONE: 4087184455 SAN JOSE, CA 95112 PHONE NO: (408) 437-6207 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ License Class C Li,. # R F O '11 — COPPER RE-PIPE THROUGHOUT ENTIRE SFD Q� p �y dI'1y Sl/W a �/ r Oct 0N Contractor � G�1 IU+3fel I hereby affirm that I am licensed under the provisions of ChapLr 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. Sq. Ft Floor Area: Valuation: $12400 I hereby affirm under penalty of perjury one of the following two declarations: APN Number: 32647078.00 Occupancy Type: i 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 PERMIT EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 DAYS FRO ALLED INSPEC 10P. 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 I---- upon the above mentioned property for inspection purposes. (We) agree to sav 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 with RE-ROOFS: all non-point so rce regulations per the Cupertino Municipal Code, Section 9.18. 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 Signature Date d� inspection. Signature of Applicant: Date: ❑ OWNER-BUILDER DEC1 ARATION ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 1. 1, as owner of the property, or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale (Sec.7044, Business & Professions Code) California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain 2. 1, as owner of the property, am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & construct the project (Sec.7044, Business & Professions Code). Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I Hill t. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation, as provided for by Section 3700 of the Labor Code, for the Health & Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. Ow r or uthorized agent: 2. I have and will maintain Worker's Compensation Insurance, as provided for by ?, ; ' Date: O Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION ``N 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinacd ouoertino.org M I euP>�RTrNo /I-D,�Fp(�3,6 Ltll SING ❑ 1,ECHANIC.AL ❑ELECTRICAL ❑ MSCELLANEOUS PROJECT ADDPFSS t �j C I / APN' '3 �� ONVNER NANib PHONE LS E-1✓SAIL STREET ADDRESS CITY, STATE, ZIP .AX CONTACT NAME I I /I PHO F IL STREET .ADDRESS CITY, STATE, FAX ❑ OVN-_,R ❑ ORR.'ER-BUILDER ❑ OWNERAGENT017RACTOR ❑ CONTTRACTORAGENT ❑ ARCHITECT ❑ ENG=.R ❑ DEVELOPER ❑-i7N.AT."T CONTRACTOR NAJ,,M 9 LICENSE NUMBER 1 LICENSE 1 PE / BUS. LIC r of COMP. V EMAIL ' FAX UAl I% LG W tCG� C IMAJ STREET ADDRESS } CITY, STATE, ZIP n/ PHONE toF 1 q Za ( N, C/ 7 J J ARCFETC/EGLNTER NAME ETN LICENSIE UMBER ' BUS. LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAffi.Y PROJECT IN wJLDL.AND ❑ YES PROTECT IN ❑ YES IS THE BLDG AN ❑ c5 BUI _DDG: ❑ C0119,1ERC1AL URBAN IIQTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK ' TOTP.LVA.LUATION: EIVEDB - By my signature below, I certiffy to each of the following: I am the property owner or authorized a� t to act on the property ow s behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and veru it is accurate, to comply with all applicable local ordinances and state laws relating to b'Vildinmtotruction. I authorize representatives of Cupertino to enter the ab ti ed prop for inspection purposes. Signature of Applicant/Agent: Date: Y K PLEMENTAL II\'FORMATION REQUIRED ,OFFICE L'SE ONuLl , < - � rw A � t MEPMiSCAPP_2011.doc remised 06/21/11 N!W��CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10365 DEMPSTER AVE DATE: 09/0412015 REVIEWED BY: MELISSA UNITS APN: BP#: 15090036 "VALUATION: 1$12,400 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: SFD or DuplexL_ PENTAMATION I PERMIT TYPE: 1 RPR WORK COPPER RE -PIPE THROUGHOUT ENTIRE HOUSE SCOPE Suppl. Insp Fee APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES Elec. Permit Fee: __[_ Re -Pipe Interior 1 PRREPIPE Utlter Elec. Insp. —1 1 # $14 Perinit Fee: Suppl. Insp Fee PME Unit Fee: $14.00 PME Permit Fee: $48.00 Construction Tax:T7_ Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes O No $0.00 TOTALS: Travel Documentation Fee: 1TRAVDOC $14.00 Strong Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt otn )_ Thorn fooc aro hacod nn tho nroliminary infarmadnn availahle and are anly an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) fc-c•h. Plan Check Plumb. Plan Check 0.0 1 hrs $0.00 F'lec. Plan Check Mech. Permit Fee: Plumb. Permit Fee: 1PPERMIT Elec. Permit Fee: __[_ Other Mech. Insp. Other Plumb Insp. 0.0 hrs $48.00 Utlter Elec. Insp. —1 Mech. Insp. Fee: I Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt otn )_ Thorn fooc aro hacod nn tho nroliminary infarmadnn availahle and are anly an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Perinit Fee: Suppl. Insp Fee PME Unit Fee: $14.00 PME Permit Fee: $48.00 Construction Tax:T7_ Administrative Fee: 1ADMIN $45.00 Work Without Permit? ® Yes O No $0.00 Advanced Planning Fees: Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: 1BSEISMICR $1.61 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $1.001 SUBTOTALS: $157.61 $0.00 TOTAL FEE: 1 $157.61 Revised: 07/02/2015 CUPERTINO Owner Name f `f t WATER -CONSERVING PLUiiiING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building &-cupertino.org �•.%0(C/ Permit No. Address 1S 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. RL No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom of form. No Go to Question 3. r . 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. [K No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes My real property is built and available for use or occupancy on or before January 1, 1994. /\ Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign bottom of form.. Please check ONE of the following: My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: Date: i'1 '�X l Upon completing and signing this C;erttticate, please return it to the buuamng Livision in oraer to nnai your ounumg peruu L. SB407 2015. doc revised 08126115 SMOKE / CARSON MONOXIDE ALARMS L OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION j .�-v 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) Signature................................................................... Lic.#...................................... Date: ................... 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. 11 .. .,h. Wi fho fnrmo onrl rnnrlitinnc of this statamant Owner (or Owner Agent's) Name: .......................................................................................... ................... signature ........ ......1 Date: Contractor Name: Signature................................................................... Lic.#...................................... Date: ................... Smoke and CO folwi.doc revised 03/18/14