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15110096-OLCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1588 PRIMROSE WAY CONTRACTOR: BILL HAMILTON PERMIT NO: 15110096 ROOFING INC OWNER'S NAME: ENG EDWARD AND MAY G TRUSTEE 1230 HARRISON AVE I DATE ISSUED: 11/13/2015 1 OWNER'S PHONE: 4082536040 CAMPBELL, CA 95008 PHONE NO: (408)687-2540 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE 27 SQ OF SHAKE AND REPLACE WITH CERTAINTEED License Class Lie. # COMP 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: 1. 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. 2. 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 is issued. APPLICANT CERTIFICATION 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, 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 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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 is issued. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, 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 Sq. Ft Floor Area: 0 1 Valuation: $13000 APN Number: 36615010.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 11rud�12uib iu : JJ b i l i rami i ton Koor i ng krAA) SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION C U P ERT'i N O 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777--3228 - FAX (408) 777-3333 • buildino(a.cupertino.org Address 0 1-. uuZ-r uu,D IVMonoxi PERMIT CANNOT BE MALED AND COMPLETED UNTH. THIS CEHTMCATE HAS BEEN SIGNED AND REJIMNED TO THE BUILDING DWISION PURPOSE This affidavit is a self-ceztificatiory for -the insWlation of all required Smoke and Carbon lvlonoxide 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 INFORMATfON ' Existing single-family and multifamily 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: .AIi.F.,A. SMOKE ALARM CO ALARM .Outside o£each separate sleeping area -m_ the immediate vici[ruty�.ot Ihe•: X X bedroom(s) . On eve level of a dweffing unit includin 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 batter, operated_ Irk e)dsfing 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 CSC Sections 907.2.11.4 and 4`20.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above --referenced property, Z hereby eertif7 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 COMU1 with the terms and cc Owner (or Owner AgenYsl Name; _ Signature..............: ................................. ... Contractor—Name; Slanature---------------- __ ons of this statement .....................................• ✓01C . ........... Smoke and CO form.doc ren:'ised 03118114 7 12/08/2015 08:05 B i I I Hamilton Roofing (FAX) P. 003/003 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 � �(4`Os) rTr-3Z�2�8 -FAX (400) 777-333 • bvildina(c�c�pGr�IRQ_orq �� OVper Name �v Ar r.( Permit No. Is your zeal 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. R'No Go to Question 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? D Yes Civil Code Sections 1101.1 through 11.0.1.8 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. eN0 Go to Question 3 _ 3_ Is water service perxuanently disconnected for your building? 0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. ET 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.. ,-. 5," Please check ONE of the following: iii My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, buildir6 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 irnpzovemnts). ❑ My property is a muldfam.ily residential real property. See Civil Code Section 1101.5. Ori and after January 1, 2014, specified building altmmlions or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all nor -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 fix -tares. On or before January 1, 2019, all non-compliant plumbiug fixtures shall be replaced with water- conserving plumbing f cures 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 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation, requirements, and that the water-conservi u& plumbing fixtures comply with the requirements as indicated in the table on the following nage_ -'Owner or:Owner..A enfs Signature; ,,�.— • i2 - 9 9 � Date• 1 X120 �� upon compieung ana signing t_buts Certiftcate, please return it to the Building Division in order to final your building permit_ SB407 2015.doc rei;L-cd 08/26/15