B-2016-1513 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:. CONTRACTOR: PERMIT NO:B-2016-1513
7614 KIRWIN LN CUPERTINO,CA 95014-4357(359 22 018) A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS,TN 38120
OWNER'S NAME: HUIE PHILIP J AND SUN-HUIE VICTORIA YUHSHIU DATE ISSUED:03/14/2016
OWNER'S PHONE:408-892-2992 PHONE NO:408-982-0405
LI_CENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36.C-42.A Lic.#765155
Contractor R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC X BLDG —ELECT X PLUMB
Date 07/31/2016 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 JOB DESCRIPTION:
license is in full force and effect. INSTALL(N)SEWER CLEANOUT AND REPLACE MAIN LINE
UNDER HOME
I hereby affirm under penalty of perjury one of the following two 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 thisSection 3700 of the Labor Code,for the
is issued.
ce of
/ p Insurance,ce,as provided for by
V p
z: I have and will maintain Worker's Compensation
}ice of the work for which this Sq.Ft Floor Area: Valuation:$10260.00
permit is issued.
APPLICANT CERTIFICATION
1 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 ordinances 359 22 018
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 PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities,judgments,costs,and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR
may accrue against said City in consequence of the granting of this permit.
Additionally,the applicant understands and will comply with all non-point 180 DAYS FROM LAST CA D NS . CT_ ION.
source regulations per the Cupertino Municipal Code,8iection 9.18.
___ _-� _ Issued by:ALEX VALLELUNGA
Signature Date 03/14/2016 Date:03/14/2016 &VWZ2
OWNER-BUILDER DECLARATION RE-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 first obtaining an inspection,I agree to remove all new materials for
1. 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:
z. I,as owner of the property,am exclusively contracting with licensed Date:03/14/2016
contractors to construct the project(See.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOFCOVERINGS TO BE CLASS"A"OR BETTER
t. 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
z. 1 have and will maintain Worker's Compensation!Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will
Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
permit is issued.
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
shall not employ any person in any manner so as to become subject to the 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
Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner-or authonzed-a ent
P Y P __9
be deemed revoked. Date:03/14/2016
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 understands ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18.
Licensed
I
I
GENERAL PERMIT APPLICATIONMEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 n = I S A00FAL
(408)777-3228• FRX(408)777-3333 buildingCU)cupertino.org
CUPERTINO. Ivi k;
Q P4BING ❑MECHANICAL ELECTRICAL !-�MISCELLANEOUS
PROJECT ADDRESS
APN#
O)VNER NAME
STREET ADDRESS 9,�� �l e/ CITY,S��TE,ZIP CA-
tw t FAX
CONTACT:NAMEPH E-
STREET ADDRESS { CITY,ST�E,ZIP (� FAX
❑ OWNER ❑ OwNER-BUILDER ❑ OwNERAGENT I ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME a d ` LICENSF„ly�UMBF_, Le -TYr,$2 BUS.LIC
COM TYNAME �S 3Le'vVC ((Q E-)MAIbL��` � °(Qy^� FA7i
®z 4T
STREET ADDRESS , \ I CITISITErHONE
ARCHITECT/ENGA'EERNAMI LICENSE NUMBER BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF .?-SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN wILDLAIND ❑ YES PROJECT AT ❑YES IS THE BLDG AN El -ITS
BUILDLNG: ❑COMMERCIAL _ URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EIC�HL�ER HOME? ❑NO
DESCRIPTION OFtt'2) gQLI
dw
TOTALVALUATION: )ll '2 RECEIVED BI,
By my signature below,II•certify to each of the followingl; I am the property owner or authorized agent to act on the property own is behalf. I have read this
application and the information I have provided is correct. I have read the Description of'Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to build" g construction.. I au ze representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Agen - Date: J ty I C kn
SUPPLEMENTAL INFORMATION REQUIREDa3 oFt Ian osE oi;, Y,,
EM
OR
.a
a
L7 STA\I)ARD
` L_�iRGE
D MAJOR
A11EPA11isc,4pp_20J1.doC revised 06121/11
I
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: "VALUATION: 1$10,260
`PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY SFD or Duplex PENTAMATION 1RPSS
USE: PERMIT TYPE:
WORK INSTALL N SEWER CLEANOUT AND REPLACE MAINLINE UNDER HOME
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer,Building 1PRSEWER 2 # $50
TOTALS: $50.00 .
:. Plumb.Plan Check 0.0 hrs $0.00 .,t,., ,Che,,,
P .w.-f ePlumb.Permit Feer IPPERMIT s
Other Plumb Insp. [ 0.0 hrs $48.00LLJ
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the pielimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (T`ee Resolution 11-053 Eff'7/1,-13) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $50.00
PME Permit Fee: $48.00
ON:
Administrative Fee: ,IADMIN $45.00
Work Without Permit? 0 Yes (F) No $0.00
Travel Documentation Fee: ITgAVDOC $48.00
Strong Motion Fee: IBSE�-ISMICR $1.33 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTaTALS:.', $193.33 $0.00 TOTS L,FEF,:,` $193.33
Revised: 01/01/2016
SMOKE / CARBON MONOXIDE ALARMS _
OWNER CERTIFICATE OF COMPLIANCE � F'
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION q f 6
CUPERTIINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333.building(a)cupertino.org
--� .7� i �Permit_No.�)1J
�A ess 1� )/� ��� ��of Alarms Smote?� -;�CCaarbon 1Vlonoxde-?
PERMIT CANNt3T BE FINALED AND CIONTLETED IiNTJELTHIS CERTIFICATE
HAS BEEN �l\ , AND R`-E U MD- 0 THE BTJILllII G I?IVISION
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 X X
bedroom(s)
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.
Iii 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.
have read and agree to comply with the terms and conditions of this statement
Q er{ Owner enf s Name: —
3 z
I Si nature
........... ....... ......... ......... ....................... .......................... ,...............
- o�ntra_ctor.Namb
....................................................... cis................................... Date`i .................
Smoke and COform:doc revised 03/18/14
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCEl 16
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
r� (408)7 7-32-28•FAX(408)777-3333•'[uildingCa_bcupertino.org / � 10
Owner Name �� (�7J 1 L� — I,u� Permit No i ® 'J
Address Qf7� l �� ✓,`� � � C 9 �
1. Is your real property a registered historical site?
El 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 propertyor 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.
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.
Ej P, No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
171 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 110 1.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
r P,,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,(regardles's 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 page.
Owner or Owner Agent's Signature } Da 2 j
Upon completing and signing this Certificate,pleas return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08126115