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15110073E71 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6127 SHADYGROVE DR CONTRACTOR: A & A PLUMBING PERMIT NO: 15110073 OWNER'S NAME: JIAO LONG AND MA LIHONG 1030 E EL CAMINO REAL STE 248 DATE ISSUED: 11/12/2015 OWNER'S PHONE: 8052595105 SUNNYVALE, CA 94087 PHONE NO: (408)738-8878 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIA 1, EJ REPAIR (E) PROPERTY LINE CLEANOUT License Class 3 Lie. # 580) 3—U Contractor X Y,4 Date // t 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 Sq. Fa ea: Valuation: $1500 performance of the work for which this permit is issued. ave 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: 37540011.00 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 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 FROM LAST 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 `` Z !�� 1 Issued by: Date: 1 granting of this permit. Additionally, the applicant understands and will comply with allnon-point sou atwns r the Cupertino Municipal Code, Section 9.18. Signatur Date f, 42 RE -ROOFS: 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. 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: I 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 C mo unicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Secti 25505, 533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agen Date: > i 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 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 indemnify;and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 Id CUPERTI[-t0 PROJECT ADDRESS GENERAL PERNII i APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 T ORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildinoCcDcuoerino.oro 'LUI iNG LiMECNkl\TICA.L LELECTRICAL bQISCELLA TEOUS �5(1Db�3 n 07)-1- — c4 n— Pt I I Oak 1TiR 140 I PHONE E•N�d IL C.- 0 sJ J t%� ZS S1 Q STREEET ADDRESS I CITY, STATE, ZIP 5-0 1Y Com.&CT NA_mE I PHON E-ViAIL Vl STREET ADDRESS O CITY, STATE, ZIP FAX ❑ 0); -NM ❑ OR'1.' R-BUMDEt ❑ 0W\TEtAG-L11'T ❑ COATIRACTOR ❑ CO!.nACTORAGDTT ❑ ARCHE ECT ❑ DvGAwR ❑ D_�YcLOPL1t ❑ TEti4TT CONTRACTORN.p.ME ir/ ' LICFNSEN'UASER -7 I LICDn'SE TIME I BUS. LIC: /✓ZLi L CON,PYN � ' I E•AIATL F.AX STR�ETADDRESS I J I CITY, STATE, IP �/ ( PRONE 73 V-88 ARCIETECTIENGNTEER NAME I LICENSE NubSER I BUS. LIC n COWANYKkbmi I E-MAIL FAD': ---- STREET ADDRESS CITY, STATE, ZIP I PRONE USE OF ❑ SFD or DLPIFX ❑ MULTI -F A.MMY I . PROJECT LN WILDLANM ❑ YES PROTECT IN ❑ YES IS THE BLDG AN ❑ :S B= NG: ❑ COMARE -R' CIAL URBP?d A'TERFP.CE AREA ❑ NO FLOOD ZONE ❑ NO I EICEI ER HOME? ❑ NO I DESCRIPTION OF WORK 2 �G TOTlI VALUATION: �tECEIti`'ED B � � E _, , .;. �x,�� „ • ., .`L _ 's` S .:S:x'f`4-eh'['§' 3 .n``'S"_g•: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's _ a I have read this application and the information I have pro ' ' I have read the Description of Work and verify it is accurate. I agree to com 'ith all applicable local ordinances aad state laws relati g to ding construc I authorize representatives of Cupertino to enter the above-' entified property forinspe'don purposes. Signzure ofApplicaaUAgen Date: UJPPLEl IENTAL, INFORMATION REQUIRED � _ I 1,1y00R - -- -- - - A,fEF iSCApp_2011.doc revised 06121/11 (l � CITY OF CUPERTINO INS Y/�I FEE ESTIMATOR -BUILDING DIVISION im,ADDRESS: 6127 Shady Grove Dr DATE: 11/12/2015 REVIEWED BY: Phuong UNITS APN: 37540-011 BP#: *VALUATION: 1$1,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # PENTAMATION 1 RPSS PERMIT TYPE: WORK Repair a property line cleanout SCOPE "s'Zfppl' Irtsp ./`ee APPLIANCE / EQUIP TYPE FEE ID Plumb. Plan Check 0.0 1 hrs $0.00 QTY UNITS BP FEES I'irc. 1'er'14f Sewer, Sanitary 1 PRSEWER €3rher I:i«. lush. 1 # $25 %'ermit T'ee: "s'Zfppl' Irtsp ./`ee PME Unit Fee: $25.00 PME Permit Fee: $48.00 ("(.-Instruclion 1 crx: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes No $0.00 TOTALS: A Travel Documentation Fee: ITRA VDOC $25.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These tees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 ;i9eci . flan Check Plumb. Plan Check 0.0 1 hrs $0.00 151rec. Plan (.,'heck Fwe,h. llermii l Plumb. Permit Fee: IPPERMIT I'irc. 1'er'14f 3h<; _%Itych..l;rsla, Other Plumb Insp. 0.0 hrs $48.00 €3rher I:i«. lush. tech Insr1. 1'c1t" 1'll?Mh 111:?f'. $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These tees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS Flan Check lf'c e: SttppL I'(.` "Cle; PME Plan Check: $0.00 %'ermit T'ee: "s'Zfppl' Irtsp ./`ee PME Unit Fee: $25.00 PME Permit Fee: $48.00 ("(.-Instruclion 1 crx: Administrative Fee: IADMIN $45.00 Work Without Permit? Yes No $0.00 t x=uncecl.l'lcrranirt fiees, A Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: F$167.501 $0.00 TOTAL FEE: 1 $167.50 Revised: 10/01/2015 CUPERTINO SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org 15►1 0o-73 BILE /i2 Sl c ovC ✓Y-. 1u lha. (A ISv/y. Permit No. Address Q 7 r # of Alarms Smoke: 5 _ Carbon Monoxide: / PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED 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 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 bedroom(s) X X 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. t have read and aqree to comply with the terms and conditions of this statement Owner,(or Owner Agent's) Name: �, ' ......►1..�.....7..�...i..vL( signature ............ ....:............................................................................ Dae. ... . Contractor me: Signature................................................................... Lica...................................... Date:................... Smoke and CO form.doc revised 03/18/14 S_