B-2016-1900CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1900
20617 PARADISE DR CUPERTINO, CA 95014-2915 (359 15 012)
AFFORDABLE WATER
HEATERS AND
PLUMBING INC
28358
CONSTELLATION RD
VALENCIA, CA 91355
OWNER'S NAME: JONG KYOO LEE
DATE ISSUED: 05/06/2016
OWNER'S PHONE: (408) 316-8027
PHONE NO: (855) 345-9087
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class PLUMBING Lic. #627368
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date
X BLDG —ELECT —PLUMB
09/30/2016
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.
REPLACE 50 GALLON WATER HEATER SAME LOCATION IN
GARAGE
I hereby affirm under penalty of perjury one of the following two declarations:
1. 1 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. 1 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
Sq Ft Floor Area•
Valuation- $1400.00
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 ordinances
359 15 012
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 CALLED INSPECTION°
source regulations per the Cupertino Municipal Code, Section 9.18.
Issued by: Susan Winslow
Signature Date
Date: 05/06/2016
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:
2. I, as owner of the property, am exclusively contracting with licensed
Date:
contractors to construct the project (See.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
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
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 by
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
3. 1 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, 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 authorized agent:
be deemed revoked.
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
1 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
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
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GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
CU P ER'TINt
(408) 777-3228 • FAX (408) 777-3333-buildingc5-cuoertino.org MISIC
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❑ OWNER ❑ OWNER -BUILDER
❑ OWNERAGENT ❑ CONTRACTOR CONTPILCTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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❑ MULTI -FAMILY
PROJECT IN WILDLAND ❑ YES
PROJECT IN [3 YES,
IS THE BLDG AN [3YES
BUILDING: ❑ COMMERCIAL
URBAN INTERFACE AREA ❑ NO
FLOOD ZONE ❑ NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
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TOTAL ALUAfLON:
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By my signature below, t 6rtiry to each of the following: t am the property owner or authorized agent to act on the property owners behalf. I have read this
application and the information I have provided is correct. 1 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 buildjng construction. t authorize representatives ofCupertino to enter the above -identified property for inspection purposes.
Signature of ApplicenUAgent:
Dale_ S
SUPPLEMENTAL INFORMATION REQUIRED=
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t11EPN1lscApp 2011.doc revised D6/21/11
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PERMIT FEE RECEIPT
Case # B-2016-1900
cLa �s�Tt�to
Date Printed: 05/06/2016
CITY OF CUPERTINO - FEES RECEIPT
Case Number: B-2016-1900 Permit No:
Project Valuation: 1400.00 Date Submitted: 05/06/2016
Permit Type: Building
Address/APN: 20617 PARADISE DR CUPERTINO, CA Receipt #: 204089
95014-2915 (359 15 012)
Scope of Work: REPLACE 50 GALLON WATER HEATER SAME LOCATION IN GARAGE
Contact Type: Applicant
Company Name: AFFORDABLE WATER HEATERS AND PLUMB
Full Name:
Address: VALENCIA, CA 91355
Contact Type: Property Owner
Full Name: JONG KYOO LEE Primary Phone: (408) 316-8027
Address: 20617 PARADISE DR CUPERTINO, CA 95014
Email: BUILDINGAPPLICANT@CUPERTINO.ORG
Administrative Fee
$45.00
Bldg Stds Commission Fee
$1.00
Plumbing Water Heater Fee
$29.00
PME Permit Fee
$48.00
Strong Motion Category 1
$0.50
Travel and Documentation Fee
$48.00
Plumbing Water Heater Fee
05/06/2016
KAITIE VOELTZ
Credit Card
$29.00
Strong Motion Category 1
05/06/2016
KAITIE VOELTZ
Credit Card
$0.50
Bldg Stds Commission Fee
05/06/2016
KAITIE VOELTZ
Credit Card
$1.00
Travel and Documentation Fee
05/06/2016
KAITIE VOELTZ
Credit Card
$48.00
Administrative Fee
05/06/2016
KAITIE VOELTZ
Credit Card
$45.00
PME Permit Fee
05/06/2016
KAITIE VOELTZ
Credit Card
$48.00
FEE TOTAL
AMOUNT PAID
BALANCE DUE
$171.50
$171.50
$0.00
05/06/2016 - 8:12:03 AM - Generated by: suew
SMOKE / CARBONMONOXIDE ALARMS
19 OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(7a.cupertino.org
ro' _Perin
Address L1 VAa # of Alarms Smoke:
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`ALARMM_
Outside of each, -separate sleeping area in the immediate vicinity of the
bedroom(s)
X,
X
On eveEy, level of a dwelling unit including basementsX
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 hasihave 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.
I have read and agree to comply with the terms and conditions of this statement
OOwwne`�r (or Owner Agent's'))Name:
s�® "�`� (
*6a '' V f,-- Signature .................. ..... �......... f............. ........... Date:7.��... (4.
Co^tractor Name
• - - _,: _. Signature ............. •......... ........... Lic.# ...................................... Date: ...................
Smoke and COfonn.doc revised 03118114
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
�GWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT+ BUILDING DIVISION "
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
FAX (408) 777-3333 • building (a"cupertino.org
r j3_.2o(�—iq
Address a," 0 %'T
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 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.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
Yes Civil Code Sections 11-01.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of foml.
VNo Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January1, 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.
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. PI ase check ONE of the following:
�d 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. Ori 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).
0 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
�'--� lunb`irr fi�ctures-throw "out�th`-ebuildi3i re aidless of-w�e�lier roe un er��mtioes alterations or nn rovements .
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Ij as the owner or -owner's -agent `of this property,- certify `under penalty of perjury thaf non-corripliant plumbing fixttu es 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-cgR�nserving plumbing fixtures comply with the requirements as indicated in the
table on the following pane. ; /L
Owner or Owner Agent's Signatur6- Date-,
Upon completing and signing this Cm tifica e, p ease return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15