15100070 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10554 RED FIR CT CONTRACTOR:PELLE HEATING&AC PERMIT NO: 15100070
INC
OWNER'S NAME: HUI FREDERICK KWAN-SING AND MARY TO 3751 D CHARTER PARK DR DATE ISSUED: 10/08/2015
OWNER'S PHONE: 4082210456 SAN JOSE,CA 95136 PHONE NO:(408)978-7060
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPLACE(E)FURNACE AND(E)A/C UNIT,SAME
License Class II l LOCATIONS
Contrac _ Date
I hereby affirm that llaittfieens nder 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.
hereby affirm under penalty of perjury one of the following two declarations: sq.Ft Floor Area: Valuation:$4000
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 0N Number:35905005.00 Occupancy Type:
performance of the work for which this permit is issued.
4 2 1 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 is issued. PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is 180 DAYS FROM CALLED INSP C ION.
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 Issued by: Date: U w✓
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 r Ceyupertino Municipal Code,Section 9.18. RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
5i2nahue Date
�_r installed without first obtaining an inspection,I agree to remove all new materials for
�- o
inspection.
❑ OWNER-BI'ILDf:RDECLARATION Signature of Applicant: Date:
I hereby affirm that 1 am exempt from the( untractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
r 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 HAZARDOUS MATERIALS DISCLOSURE
sale(Sec.7044,Business&Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the
2. I,as owner of the property,am exclusively contracting with licensed contractors to California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
construct the project(Sec.7044,Business&Professions Code). compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(x)should 1 store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations: Additionally,should I use equipment or devices which emit hazardous air
t. 1 have and will maintain a Certificate of Consent to self-insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will
Compensation,as provided for by Section 3700 of the Labor Code,for the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
and 25534.25533
Sections 25505, ,
performance of the work for which this permit is issued. Health&Safety Code,
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by Owner a o 'zed ent: -1 /
Section 3700 of the Labor Code,for the performance of the work for which this �--- Date: '—
permit is issued. �-
9 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
Compensation laws of California. If,after making this certificate of exemption,I I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.)
must forthwith comply with such provisions or this permit shall be deemed Lender's Name
revoked. Lender's Address
APPLICANT CERTIFICATION ARCHITECT'S DECLARATION
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 I icenced 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 ' ��1 M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 misc
CUPERTINO (408)777-3228• FAX(408)777-3333•budae
ding cupertino org
PLUMBING MECHANICAL ]ELECTRICAL (MIISCELLAANEOUS
EL ��
PROJECT ADDRESS 4 A1",++ D`--Y /' I' )5
OWNER NAME U >v PHO p L-!vL\II
V
STREET ADDRESS G Cl"F N', S'rATE.ZIP FAX
1-405
CONTACT NAME C HONE E-MAIL
S IREET ADDRESS CITY,SI"ATG ZIP AX
-p0Mffift&PNA, C* Y. 609,4S Logo
��//
11 OWNER 13 OWNER-BUILDER 11 OWNER AGENT KIONTRACTOR ❑C'ON'TRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEvELOPER ❑TENANT
('ONTRACTOR NAME HISE NU BFR LICENS TYPE BUS.LIC M
('OMP.ANYNAME �� A _ P.-�lAll FAX UPS-51449 O
STREET ADDRESS �(,J STA E.ZIP PHONE
5 - > C�- o�+IF 5 G' `}O
ARCHITECTfENGINEER NAME LICENSE:NUMBER BUS LIC a
COMPANY NAME. F-MA;L FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ kit 1.1 I-FAMILY PROJEC I'IN W ILDLAND ❑ YES PROJFCT IN ❑YES IS THE BLDG AN ❑YES
BUILDING ❑COMMERC'IAL LRBAN INTERFACE AREA ❑ NO FLOODZONE ❑NO EIC'HLERHOME? ❑NO
DESCRIPTION OF WORK -
= U 5 Fvvu
TOTAL VALUATION 4 V vb L RECEIVED BY. /{J f J
13% my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr erty 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 relating to ns c I a rite representatives of Cupertino to enter the above-iddeeptified property for inspection purposes.
Signature of Applicant/Agent: Date: '16)/ b-c--
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
a. —
❑
EXPRESS
❑ STANDARD
U
❑ LARGE
a
❑ MAJOR
MEPMisc;ipp_2011.doc revised 06121111
CITY OF CUPERTINO '5 .
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10554 Red Fir Ct DATE: 10/08/2015 REVIEWED BY: PAUL
AN: 359 05 005 BP#: 'VALUATION: $4,000
PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition /Repair
PRIMARY SFD or Duplex PENTAMATION FURN/AC
USE: PERMIT TYPE:
WORK Re lace E furnace and E A/C Unit Same Locations
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
A/C Units (<=1OK cfm) 1BREMAIR 1 # $72
Furnace, Forced-Air 1MFR=<100 1 # $143
TOTALS: $215.00
Mech. Plan Check 0.0 1 hrs $0.00
Mech. Permit Fee: IMPERMIT
Other Mech.Insp. 0.0 hrs $48.00 Lj Li
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public N''orks, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the relintina information available and are onit,an estimate. Contact the Dept-for addn'l info.
FEE ITEMS (hce Resolution 11-053 l:(/ ? 1 13) FEE QTY/FEE MISC ITEMS
+n Clic,k F'ec
PME Plan Check: $0.00
runt 1• <-
PME Unit Fee: $215.00
PME Permit Fee: $48.00
wstructiou !u
Administrative Fee: I,4DAHN $45.00
Work Without Permit? Yes (j) No $0.00
Travel Documentation Fee: ITRA I'DOC $48.00
Strong Motion Fee: IBSEISMICR $0.52 Select an Administrative Item
Bldg Stds Commission Fee:. IBCBSC $1.00
SUBTOTALS: 1 $357.52 $0.00 TOTAL FEE: 1 $357.52
Revised: 10/01/2015
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Oct 26 2015 11 : 38RM HP LASERJET FAX 408-978-4780 p. l
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
uh i
CUPE.RTiNQ 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
I
(4013)777-3228-FAX(408)777�.J'33,buitdinciftuDertino.org j
l C,K. Ehj i`. Permit No. '2 1 IS 60 O��
OwneaNffixte F�aeci.P,R� � {
Address :) 10554 Rem F'L.fZ. Cu2tno
Ct- C .pe � , GA 9:SG i
1. Is your real property a registered historical site?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
0 .VNo -Go to Question 2.
I
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 11101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
—/ Slap the rest of the foim and sign bottom of form.
) 4d No Go to Question 3. '
I
3. Is water service permanently disconnected for your building?
VN
es Civil Code Sections 1101.1 through 1l01.8 do not apply. Skip the rest of the firm and sign bottom of form.to Q oGo uestion 4.
4. Is your real property built'and available for use or occupancy on or before January 1, 19942
❑ No My real property is built and available for use or occupancy after January 1,1994. '
Civil Code Sections 1101.1 through l 101.8 do not apply. Skip the rest of the form and sign bottom of form. I
I/Yes My real property is built and available for use or occupancy on or before January I,1994.
Civil Code Sections 1-.101.1 through 1101.8 apply. Check one of the throe following statements andsign
bottom of form.. t f
5.. Pl a nheck ONE of the following:
VMy 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-corripliant plumbing fixtures.
to be replaced with water-conserving plumbing fixtures throughout the building.On or before.January 1,.2017,all non-
compliant plumbing fixturee shall be replaced with water-conserving plumbing fixtures (regardless of whether 3
propertyundergoes alterations or improvements).
❑ Myproperty .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 noncompliant plumbing fixtures shall be replaced.with water-
conserving plumbing fixturesthroughout 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 withwater-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 pequry 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.I
through l 101.8,the current California Plumbing Code and California Green Building Standards Code,and rnanufacturer's
installation requirements,and that the water-conserving plumbing fixtures emVly with the requirements as indicated in the
table on the fo lloiving pagp.''...t...
owner or Owner Agent's Signatiarp,'i --a, Date::.''::
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit..
SB407203.docrevised 08/26/15
Oct 26 2015 11 : 38AM HP LASERJET FAX 408-978-4780 p. 2
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
;
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
La
CV PERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228- FAX(408)777-3333- bulldina()-cuoertino.ora
:zpc>rniit.l�lo_ 5 O 00-f-0
-_ , tdtslj SmoFe: :C � Mx!0654 Rea FiR ;t 'de:
. I
PEPMIT CANNOT BE FINALED AND COMPLETED UNTEL TSIS•CERTIFICATE
- ]HAS BEE y. A�1!IR RET MMR 6.TO:;T E:EI JILD11111G DI ISIQN: r F:. I
,
!''
1. ..,,.......n .av�ir.n a...... ..
_... —�.. .. ..... :T.-fir..• .. .._..... ... .. �». � .�......- .. ..........—.... rte..--.—�...
f
PURPOSE I
-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.
t
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the vouation 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 dwellin unit including basements X X i
Within each sleeping room X
I
' f
i
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burninlg appliances and that 1
CIO 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 114 and CBC Sections 907.2:11.4 and 420.6.2. An electrical permit is required for
alarms which trust be connected to the building wiring.
As owner of the above-referenped 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
:OWlM?'( Owner A4gent's)Name:
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Smoke and CDformrdoc revised 03118114