B-2016-1208CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1208
21087 RED FIR CT CUPERTINO, CA 95014-4252 (359 05 027)
(CUPERTINO
PLUMBING INC)
SAN JOSE, CA 95124
OWNER'S NAME: YANG JUNJIE AND CHEN RE
DATE ISSUED: 01/19/2016
OWNER'S PHONE:
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERNHT INFO:
License Class Lic UmContractor (CUPEO PLUMBING IN Datep� / _ /�j — l[
X BLDG _ELECT X PLUMB
i�
MECH X RESIDENTIAL COMMERCIAL
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.
JOB DESCRIPTION:
COPPER RE -PIPE THROUGHOUT INTERIOR AND REPLACE (E)
I hereby affirm under penalty of perjury one of the following two declarations:
WATER HEATER IN CLOSET
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.
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
Sq. Ft Floor Area:
Valuation: $4000.00
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county
3 59OS 027
359
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
PERMIT EXPIRES IF WORD IS NOT STARTED
expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
180 DAYS CALLED INSPECTION.
Code, Section 9.18.
\
Signatur Dar// _ ��
5
Date: l / �`
OWNER -BUILDER DECLARATION
RF -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of the
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without fust obtaining an inspection, I agree to remove all new materials for
i. I, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Sec.7044, Business & Professions Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Secflons 5 4.
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
OwnerrA r authorized ag
be deemed revoked.
Datel /—%y�1�
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
ARCHITECT'S DECLARATION
understands and will comply with all non -point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
Professional
Signature Date
._.._r__. GENERAL PERMIT APPLICATION
MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 9501!-3255
CUP BRT [l`l0' (408) 777-3228 - FAX (408) 777-3333 • build ina(8)cupeliino.orq m I
PLU�\,BITG ❑1✓iEC1i-N71C.AL ❑=Li-CTRICA.L ❑I,IISCELLfiNEOU-S
PROP:CT?.DDRESS! I APIA ���
OS
Otw'TiRN??✓i±. -lw � �� - - �� � � I P'r'01�= .. ✓'7` � 3 `r ��
S
I E-I✓=SL
STR=cT?-DDRFSS A^ I CITY, STAT=, Z t
I F?
CONTACT NALME 'Y/�,6 /� �
� �C�
H
P'gt1
t t.7
E -.J
G l
L1'F—
STREET 6..DDRESS
I CITY, STATE, Z2
FAx
❑ O N -M ❑0\'1-3L-ti�=R ❑ 0w:^ --,a AcF.? L7 C-0 SCTOR ❑ C0?,71T4C T OR AG=NT ❑ ?.RC' CT ❑=?vGi`•= R ❑ Dz-�HLOPE ❑ -K,. jqT
CONTR{ TORI k],4'
LICEQSEIgU S�r.P
I LIMENSETYPE
I BUS. LIC-
COmmNY N? tJ E-NL41T.
p a,;,
STREET ADDRESS CITY, STATE, ZIP
(�
PH ON
A -RC:-DTECTF_t;Gi,EER 1-A ,,M LICENSE NUMBER
EUS. LIC r
CO]✓PAhY _IJP
E -IJ 1L
FAX
STREET ADDRESS
I CITY, ST.kTE, ZIP
I Pi:Oh.
S, DUPLEX flE I,I�LTI-FA1,'=Y . PROJECT NN WI DI -A- D
US -HE OF S7 o ✓ v,S PRO>E--CT LN
Ys
❑=
i ^
I5 SLDG A.N ❑ � _g
BUMD2,1G: COl'c'� r--.CL4-T L?B/--X2\-i EtFACEAPEA. NO FLOODZO>-S
� I �
❑ I.O
=ICF?=R?iOW.E7 ❑ O
I
DESCRIPTION OF PrORK
o
ek.e__
TOTAL V -LUATION:
By my sigaztzie��below, I certify to each of the f ollovrinne: I zm the prope<-Ly owner or autborized aaenY-Lo act on the .. � owner's behalf. I have read this
applicztth
on and e L--iforl ation I have provided is co:;ect. I have re Des - 'en of fork and verify it is accurate. I agree to comply yvi h E-11 ap-plicable local
y
Ordinances and state laws relating to Eu- _ i n 2ti\' ume~ino to enter the above -identified proper y for inspec ioa purposes.
Siyature of,?.oplican /Agent: .� Date:
� ��S °- d 4,
STJ-'t PL LI\I �t _ TION REQUI_R.ED
OFFSCE LSEONLIs
_
WAR
•
R.i
JT3.�"D3-RJ �
3V'
Ell Y
3 Z��CR'.:...'......._'
AlER-V'isc,4vp_2011.doc revised 06/21/11
CITY OF CUPERTINO
Fw---"7 FF.F. FSTIMATOR — -R'IJII,DING DIVISION
21087 RED FIR CT
TDATE: 01/19/2016
REVIEWED BY: MELISSA
liaADDRESS:
APN: 359 05 027
1 BP#:
*VALUATION:
$4,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Dulex
PENTAMATION P
1 RPR
I
USE:
PERMIT TYPE: A
WORK
COPPER RE -PIPE THROUGHOUT INTERIOR & REPLACE (E) WATER HEATER, SAME LOCATION
_T
SCOPE
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Re -Pipe Interior 1PRREPIPE 1 # $14
Water Heater 1PRWHEATR 1 # $29
TOTALS: $43.00
VOTE: This estimate does not include.fees due to other Departments (i. e. Planning, Public Works, Pire, Sanitary Sewer District, school
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for aaan't info
FEE ITEMS (Fee Resolution 11-053 Aff. 711113)
FEE
QTY/FEE
MISC ITEMS
Phm ("'heck .1 '€
Suf
A
PME Plan Check:
$0.00
permil Tee.,
Suyy.d, Insp.1"Yee
_T
PME Unit Fee:
$43.00
PME Permit Fee:
$48.00
(`Onsl I ruction Tax:
Administrative Fee: 1ADMIN
$45.00
Work Without Permit? 0 Yes (j) No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.52
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS
$185.52
$0.00 TOTAL FEE
$185.52
Revised: 01/01/2016
4MOKE 6 CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION _
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 —
(408) 777-3228 n FAX (408) 777-3333 • buildinq(c)cupertino.ora
PERMIT CANNOT BE I;INALEM AND COIIIPLETED UNTIL TRIS CERTIFICA E,
. ► ,, , � 1 r T- "rll� B JfLDY G 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 manufacturers instructions and in compliance with the California Building
and Cal fonrda Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
t have read and-- aq,-ee to, comply with. 6he, terms. andl rnn&Hnn:c of this-Oniarnant
Smoke and CO form.dbc revised. -03/18/1'41
1v\ Pi
fe........ ................................... .. - U i
....... Da_fe:
Coniracfor Name:
..........................................................Licit{'::.......... .......... .....
Smoke and CO form.dbc revised. -03/18/1'41
WATER -CONSERVING PLUMBING FIXTURES FILE
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE - CUPERTINO, _CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 o buildin cu ertino.or
Owner Nam /* 4w n, 1 �.�. i� L,v�r'g� �i i ci X_- �O L l Z® C
Permit No
Address =� �? °7 F,. C_ -i-
1.
-i-
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.
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 110 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.
El® 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.
LJ Ig 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 f6llowing statements and sign
bottom of form..
5. Please check ONE of the following:
7 K 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).
❑ My property 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 non-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 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 plumbing fixtures comply with the requirements as indicated in the
table on the following age.
Owner or Owner Agent's Signature __ 11'140W__ Dat e U i , C 10l
Upon completing anct signing tins uertiticate, please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126/15