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15110049-OLCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7502 FALLENLEAF LN I CONTRACTOR: T D ROOFING I PERMIT NO: 15110049 1 OWNER'S NAME: LEE DZUNG-HUNG ET AL 1 675 TULLY RD I DATE ISSUED: 11/09/2015 1 OWNER'S PHONE: 4088928872 SAN JOSE, CA 95111 1 PHONE NO: (408)892-8872 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 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: 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. 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 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE WOOD INSTALL OSB 15# FELT NEW COMP 32 SQRS Sq. Ft Floor Area: 0 1 Valuation: $14000 APN Number: 35928018.00 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) 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 CUPERT Owner Name Address WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 1 10300 TORRE AVENUE - CUPERTINO. CA 95014-3255 , w,Y j 1 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. A 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. ,1 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 NTo 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 restof 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.ase 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, 20I4, 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). O My property. is a multifamily residential real property. See Civil Code&ction 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). O 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 plu tures comply with the requirements as indicated in the table on the faUGwing DaQe. I, I Owner o"r Owner Agent's! Signature:�� Date: / / o1 Vtq Upon co pk ' and signing this Certificate,, p� return it t the Building Division in order to final your building permit. SB407 2015.doc revised 08126/15 - Scanned by CamScanne-r- fILE 77-M6 SMOKE/ CARBON MONOXIDE- ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION CUPERTINO 40300 TORRE AVENUE • CUPERTINO, CA 95014=3255 (40e)1774228 • FAX (408).7-77-3333 • i i Perm i 116 Addr.oxalie� :PL�RMIT. CANNOT NAS BEEN BCOMEED NIIS CERTIFCATEA UL'IDVISION S DR TOTHEBILDING x }1 Y..� ��•, { .s.. �.& ..r-t.d.-� .fir . .rM. ,;.�C., ( � r'�S e, a '�i+^si-h- d `�_ �M.. �.•.1- PURPOSE This affidavit is a self -certification forthe'installation of all required Smoke and Carbon Monoxide. Alarms for compliance with 2013 CRCSection`K314, 2013 CBC Sections 420.6 and 92;1.1.2 whereno interior acceas for inspections are: required'.. GENERAL•INFORMATION Cxisting 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 dwellingunits exceeds $I000.00, CRC Section R314 -and CBC;Sections 9U%2.1-15'and 420.6 require:#Oa 'is moke.Alarms and/or:Carbon Monoxide Alarms be.installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping areain the mimmediate vicinity of the bedroos . X X On -eve .level of: a dwells unit indudin basements X X. Within each slee in c+oom. Carbon Monoxide alarms are not requiredin dwellings: which, do not contain fuel-burning;appliances and that do,not- have. an, attached .garage. Carbonmonoxidealarmscombinedwith. smoke alarms shall. comply with CBC Section.420.b and shaII be approved by the,Office of the State Fite Marshal, Power Supply: Indwelling unitswith no commercial;power:supply, alarm(s);may be solely battery operated: In existing dwelling unin nits,.alas-aire. permitted'to be solely battery operated where repairsor alterations do not result in the,removal of wall and ceiling finishes or there is no access by means otattit� basement'or.,craw.l space.: Referto Section 'R314 and CBC Sections 9072,11.4" and 420:6.2. An electrical;permit is required.;for alarms; which must be, Connecte&to :the building>wiring. As owner of the:above=referenced property,1herebycertify that`the alarms) referenced above has/have been installedirt accordance with the manufacturer's instructions. and in compliance with the California Building and California Residential:Codes. The alarms have been.tesbed.and are'operational as of the. dabs signed below:' e read and 4ro`wmpW111 WWB59 �fan4cdmu".of. MIS statement Uww (ar: Apenrs) Name: nn a o� • Coector IWme:. .:.:..::........:...............:......... ........... . gate. s►;d),te aRar'cfa,.mied :o;r�xil� Scanned by Cam Scanner