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1512008101&� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20303 CLIFDEN WAY CONTRACTOR: SUPERIOR PLUMBING PERMIT NO: 15120081 OWNER'S NAME: KIM MICHELLE MEE YHUNG 18550 HALE AVE DATE ISSUED: 12/08/2015 OWNER'S PHONE: 4086212923 MORGAN HILL, CA 95037 PHONE NO: (408)528-4103 ..'i LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ��' ��`�l�iK�� License Class Lic. # � REPLACING WATER HEATER AT SAME LOCATION Contractors 6 ft �*ate o l I hereby affirm that I am licens d under the provisions of C apter 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. Ft Floor Area: Valuation: $1400 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 APN Number: 36935040.00 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 Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all n - nt source regulations per t e upertino Municipal Code, Section 9.18. Signaturn Date j 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 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, 255339 and 25534. I 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 ' e Cupertino Mun'cipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Co c, Sect' s 25505, 25533, n 25534. Section 3700 of the Labor Code, for the performance of the work for which this gent: Date: Owner or authorized agent:( - 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 malting 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 9.18. Signature Date 04 CUPERTIHO. GENERAL PERMIT APPL[GA►[ON COMMUNITY DEVELOPhIENT DEPARTMENT - BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 5501 A-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin0(a)CUDeriinO.Org �laoo� ❑ PLUjl,/,3L-+G ❑ MECHANICAL ❑ELECTRICAL ❑ AESCELLp_1\,T_: OUS PROJECT ADDRESS .SPN u Ul (j v3Lq3 D `l 1J�=iZ OW'r'-P' V A�A STREET ADDRESS CITY, STAT---, ZIP I FAX CONTACT N.4..M n n I PHONS � r� E.1 -Lk II STREET a.DDRESS CITY, STATE, ZIP I FAX ❑ Ow ❑ OVR = U T� 1t El0,;,.,, t AGENT 13 CONTRACTOR ElCO.KMACTOR.4G� T ❑ . RC:�CT ❑ EN WE_R ❑ TEKLINT CC)NTR.0.CTOR 1,7_aJL � LICH. SE?vUI,SFR I LICENSE TYPE I BUS. LIC 4 �1 -• CON3wYTLmE�V� ENAII FAX STRETFT�DRESS('��]�i \� CITY, STATE, ZIP C 1i PIiO?�EJ(�j &may /�t[� T�-lYtYl-11C ARCHITECTrTt;GLk�ER 1 .4T E I LICEi\SE XU BER BUS. LIC # C0WAI� KA ME E-IJ,AII. I Fa.Y, STREET.4DDRESS CITY, STATE, ZIP I PFIONZ USE OF'PSFD orDUP= ❑ muLTI•F.,u GZY . PRO�TCT LN R'ILDLA_�TD ❑ YFS PROi:CT N ❑ YES IS THEBLDG AN ❑ .S BUILIDNIG: COAO..fUCIAL UP NII2NTERFACEA.R.-tk ❑ 2\10 FLOODZ013 ❑ ];.0 I EICFLERHO]J.E? ❑ No DESCRIPTION OF VVORIC TOTAL VALUATI0'. : By my signature below, I cur tify to each of the following: Ian the property owner or authorized agent to act on the proper owner's beha . I have read this application and the inform tion Ili "e provided is correct. I have reaothe--scription of Work and verily it is accurate. I agree to cool ywith all applicable local ordinances and state laws relay g ` ll dnaconsullction. 1a_ horizntatives of Cupertino to enter the above-identi /dd r per for inspection purposes. Signature of Applicant/Agent: Date:VD v SUPPLEMENTAL 1—JINTFOR1vIATION REQUIRED, u zOFFSOE LSEOLI r':, ;. 3 � y v X . j. ❑� OVER'THE COL'�TrR.; `„ ,� n' jj �C� �4RG;✓� �`M. M A/EPA47se4vP_2011.doe revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20303 Clifden Way FEE ID DATE: 12/08/2015 REVIEWED BY: Phuong 0 APN: 369 35 040 BPtf: *VALUATION: 1$1,400 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: # $29 PENTAMATION PRWHEATR I PERMIT TYPE: 'A WORK Repla ing water heater at same location SCOPE APPLIANCE EQUIP TYPE FEE ID Plumb. Plan Check 0.0 hrs $0.00 QTY UNITS BP FEES Water Heater IPRWHEATR 1 # $29 permif ffle(.,"., Suppl, PME Unit Fee: $29.00 PME Permit Fee: $48.00 C' I K�x: Administrative Fee: ]ADMIN $45.00 Work Without Permit? Yes 0 No $0.00 TOTALS: Travel Documentation Fee: I TRA VDOC $29.007 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 fees are based on the Dreliminar information available and are onlV an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff.�711113 FEE Plumb. Plan Check 0.0 hrs $0.00 Ch,ck- Plan Plumb. Permit Fee: IPPERMIT 1�11ppz. N. , C-11(11 Other Plumb Insp. 0.0 hrs $48.00 PME Plan Check: h-sp-. NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminar information available and are onlV an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff.�711113 FEE QTY/FEE MISC ITEMS Plan 1�11ppz. N. , C-11(11 PME Plan Check: $0.00 permif ffle(.,"., Suppl, PME Unit Fee: $29.00 PME Permit Fee: $48.00 C' I K�x: Administrative Fee: ]ADMIN $45.00 Work Without Permit? Yes 0 No $0.00 FCCIS.' Travel Documentation Fee: I TRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOT.ALS:. $171.50 00 TOTAL FEE: $0.+ $171.50 Revised: 10/01/2015 SMOKE 0 CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION cc VPit=,-R l-6 0 10300 TORRE AVENUE D CUPERTINO, CA 95014-3255 �- 0 3 O 3 PURPOSE (408) 777-3228 o FAX (408) 777-3333 - building (cDcupertino.org .fit x�n��ade: -Z PE'RIVUT CANNOT BE FIINALED AND CO.MPL-11a;TED UNTIL THIS CERTIFICATE, 1 WON 1W DTJjN MMPJ� AND 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 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 dweIlung. 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 inaccordance with the manufacturers instructions and in compliance with the California Buildi � o' and Calliforndia Residential Codes. The alarms have been tested and are operationali, as of the date signed below. t have read an:d agree to, compIv w1th RI•ia i1Pain.4. gmrP (rnnHHinn,.c nS thi..czkPIP mont Smoke and CO farnx.doc revised 03%18%1:4 J Co�ir�cto�•Ma'r�e; .......................................... -Sinu....... ,....._,............................ ....._...._... Ld t:. .. Date Smoke and CO farnx.doc revised 03%18%1:4 J flOWNER CERTIFIC ATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION CLiPi€RT@i`dO 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 % T_/ CT _ �- (408) 777-3228 e FAX (408) 777=3333 • building cb-cupertino.ora Owner Name 6 Permit No. Address a C 1. Is your real property a registered historical site? I ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn XNo Go to Question 2. 2. Does your read 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. �l No Go to Question 3. 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. 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. i lCi` Yes My realproperty 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: 1 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). Q My property is a multifamily residential real propeity. See Civil Code Section 1101.5. On and after January 1, 2014, specified'. building alterations or improvernents shall require non- compliant plumbing fixtw. eg to be replaced witth• water -conserving plumbing fixtures. O'n or before January 1,, 2019,, all non-com pliant plumbing fixtures. shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether: property undergoes alterations or improvements),. 0 lulyproperty is a consinercial realpr•.operty. See Civil Code Section 1101.5. On and. after January 1, 2014,. specified buildiutg alterations or improvements shall require non- compliant phimbing fixtures, to be replaced with water -conserving plumbing fixtures. Ohm or before Tanuary 1, 20:19,, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). 1, as the owner or, owner's agent of this property, certify under penalty. of peijury 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.$, they current California Plumbing Code and California Green Building Standards: Code, and inanufacturer's instalflation requirements, and that the water -co ing um�in tures comply with the requ reinents as. indicated in the table onthe followinQ. pate. €:u :.. _ G� �t.�l/��f/b „ .. Owner or Owner Ag;enF"s Upon, completing and signing, this Certificate, please return it to the B'uilffing Division is order to final your building perrni.t. SB4,09 2015.doc revised 08126/15