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B-2016-1814 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1814 21900 WOODBURY DR CUPERTINO,CA 95014-1148(326 19 066) ALERT PLUMBING INC SAN JOSE,CA 95132 OWNER'S NAME: CHOW RUTGERS LEI-GEE AND STEPHANIE LEE TRUS DATE ISSUED:04/21/2016 OWNER'S PHONE:408-551-4341 PHONE NO:(408)272-1423 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class PLUMBING Lic.#853062 Contractor ALERT PLUMBING INC Date 02/28/2017 X BLDG —ELECT X PLUMB 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: ABATE SEPTIC SYSTEM(COUNTY OF SANTA CLARA)REPLACE IfUebyffirm under penalty of perjury one of the following two declarations: SEWER&INSTALL 2 CLEANOUTS 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 + . 'AJ All of the work for which this permit is issued. > a z. AI have and will maintain Worker's Compensation Insurance,as provided for by ! t4+ !a }: Section 3700 of the Labor Code,for the performance of the work for which this �� permit is issued. Sq.Ft Floor Area: Valuation:$4000.00 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 26 Number: Occupancy Type: 3 and state laws relating to building construction,and hereby authorize 326 19 066 representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree a indemnify and keep harmless the City of Cupertino against liabili' s, Ju ents,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against saidCit in conse ence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,th p is nt derstand and will comply with all non-point source reg tions per he upertino unicipal Code,Section 9.18. 180 DAYS FROM LAS D INSPECTION. Signatur Date 04/21/2016 Issued by. ISSA ES Date:04/2 16 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(See.7044,Business&Professions Code). Date:04/21/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should a or handle hazardous material. Additionally,s�cdby I use equ a or devi es which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as de the Bay Ar Air Quali Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain complian 'Wit the Cuperti o Municip 1 Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Secti s 25505,2 533,and 25534. - Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revolted. Owner or authorized agent: APPLICANT CERTIFICATION Date:04/21/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 04/21/2016 Professional GENERAL PERMIT APPLICATION ImAl E rvjgmk COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333• huildinct(d-)cupertino.orcl CUPERTIPEO L; e- Zoll - /�/ I S ❑PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN n OWNER NAME Ci/) 'a / PH00 MAIL STREET ADDRESS W�p j�� ," CI ..�..ST T 7P�t}— e— } FAX ,(-�vI �fnot CONTACT NAME ,, ^ PHQ ' ` 6s -MAIL STREET ADDRESSZ,62�� C TY,S E ZIP �� J FAX OWNER. ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �r � �` l , V i LICEN NU L-1. '2 LI 'S E BUS.LIC n COMPANY NAME l• V t �lJ E-MAIL FAX L J STREET ADDRESS e �A ZIP 0- -3 C N Z7 2 /�2-- ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC n ` COMPANY NAME E-MAIL. FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD orDUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INFERFACE AREA ❑ NO FLOOD ZOAE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK 91 ' 7�1 - TOTAL VALUATION: VO CEIVED B By my signature below,I cert�hI each of the follo in.- I e pro erty owner or and orized agent to act on roperty o er's behal ave read this application and the informati ave provided is orrect. I ave read e Description of Work and verify itis accurate. I a e to c y with al]applicable local ordinances and state laws re] to bui]ding c struction. authoriz representatives of Cupertino to enter the bove=ide property for inspection purposes. Signature of Applicant/Agent: Date: 2— Z O 1 SUPPLEMENTAL INFORMATI �D OFFICE USE ONLY--:'. n, ' HE COUNTER ❑ EXPRESS L ❑ ST?;NpARD U, ❑ LARGE ❑ 1\ 70R MEPA1iscApp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N® Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# -z— ADDRESS: 42-5 56 Iq N5,91 9D tL> CITY/ZIPCODESs'g?v )(1)56 ()4 '�S% 3Z *Our municipal code requires all businesses working�in��city to have a City of Cupertino business license. NO BUILDING FINAL OR FINA C INSP CTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AN ALL SUBC N RACT RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 2 r- Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date SMOKE / CARBON MONOXIDE ALARMS FILE OWNER CERTIFICATE OF COMPLIANCE -- �L� i COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 +CUPERTIIr O (408)777-3228+ FAX(408)777-3333 building(Wcupertino.org "fA car--ems- 1900 () fn`J0 LV_y e_iV6 #6f-WSaxa 3QAVMZ V011 C 0 13Ia + T C�tT ITII� CST + T T 13 fl PURPOSE Tizis affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for ection R314,2013 CBC Sections 420.6 and 907:2.11.2 where no interior access.for compliance with 2013 CRC'S 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 j 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. 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 alanns which must be coulected to the building,wiru-ig. 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 a�,td in compliance with the California Builduzg, and California Residential Codes.The alarms have been tested and are operational, as of the date signed below. t have read and agree to:corn PIYI with the terms and conditions of this statement r e I----iuc . w � pafci