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B-2016-2414
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2414 10190 LOCKWOOD DR CUPERTINO,CA 95014-2614(342 14 042) ECONOMY ROOTER INC SANTA CLARA,CA 95055 OWNER'S NAME: KIM IVAN HAND CAROLINE Y DATE ISSUED:07/29/2016 OWNER'S PHONE:415-562-5662 PHONE NO:(408)249-4922 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class PLUMBING Lic.#892045 Contractor ECONOMY ROOTER INC Date 05/31/2018 X BLDG —ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing _MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: REPLACE 50 GAL WATER HEATER(GARAGE) 1. I have and will maintain a certificate of consent to self-insure for Worker's dCompensation,as provided for by Section 3700 of the Labor Code,for the `d 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. Sq.Ft Floor Area: Valuation:$800.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 342 14 042 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City inconsequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,th licant understands and will comply with all non-point source regulati, ` e Cupertino Municipal Code,Section 9.18. 180 DAYS T CTION. Signatu, Date 07/29/2016 Issued by:MELISSA NAM Date:07/29/2016 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:07/29/2016 3 hereby affirm under penalty of perjury one of the following three declarations: AL •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 6.95of 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. I 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 I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the rtino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code, tions 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date:07/29/2016 1 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 07129/2016 Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION MEP 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(cDcupertino.orgCUPERTINO MISC , I' T3- Z,0 (6 - z�l c U PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS1APN 0l go '0 Ck"Pd Pk OWNER NAME F-' j I P- mssC3 h_^ / a r jJ,,.M P"V/3 S-0—Z - J66Z E-MAII �C STREET ADDRESS 11 p� �n ^ ©� CITY, S FAX VUZ CONTACT NAME ,c}� t� e� Z PF[Dye"V 2 Z 9 d Z E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 1L1 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER Q DEVELOPER ❑ TENANT CONTaCT`O9R NAME LICENSE LICSE zo Y BUS.LIC#3 o P 7e gM COMP NAME Al.. ® C C/t AIL FAX VE DRQ S CITY,STATE,ZIP (OPT ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: O Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORK A CSJdd'jf r� > , TOTAL VALUATION: ®� 7tE Y, O a By my signature below,I certify tact oftfollowing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I hav ovided 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 g construction. I authorize representatives of Cupertino to enter the above-identifiedp/ro erty for inspection purposes. Signature of Applicant/Agent: Date: 0 T'2 l'1 SUPPLEMENTAL INFORMATION REQUIRED o - x.TxE cauNz�I� F, . ExpjiEss ❑, STANDARD 0'T AI2GE .:w ❑'�gAJox�", MEPMiscApp_2011.doc revised 03116111 1. S'M t r,C O MONOV I:D:E AI ARMS FILE f( na OMER CMnnC "'OF COMPLIANCE COMMUNITY DEV ELOPMENT'DEPARTMEh1T►BUILDING DIVI510N j 10300 TORRE AVENUE,GUPLRTIND CA 95014-3255 (408)777-3228 FAX`CNB)777.3333 m?buildimQ.l�cupertno.org Q t 0 Ceck-v0ecC 19r _ H ' _ 016 "Le-t --- - ..4 PURPOSE Tl=ris affidavit i8-a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with X013 CRC Section 1314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access.for inspections areae wired. Existing single= and multi-family dwellings shall be provided with Smoke Alarms and Carbo n Mulct-,oxide alarms. W,heft the valuation of additions,alterations,or repairs to existing dwelling units exceeds $1090100 CRC Sectrort R,314 and CBC Sections 907.2.11.5-and 420.6 require that Smoke Alarms acrd/or Carbon Morro-xide Alairm be installed in the following locations: SUAATRARA AMO) \r, - Outside of each separate sleeping area in the immediate vicinity©f the b�dr©orm(s)' CYn ever leyel�©,f a dwellru unit includin basements wilihl',n each slo"e-' irii roorin _ Carbon NtonoUdEalarms are not re <uired rn dwellin�s which,d©�not coma ,t f - _,�,t;. � q g �fuel burning appliances and that do'natlnata e a att�aclzed ga+rage. Carbon monoxrde ararrns cob�zted wffi s {ole alarms sTnall cop7ly w;tk CBC Sectio�n�42'.0'.x,aF11c shall 6e app'roVecl b�the O'f�fice of tfie State��re lul�arshal. .Power Supply:Toru d�vellnlgin�ts with no>co ercial power supLl ,,allarz �s) :my be solely s,exiisfi tg d�i-d1u1g u-uts, alarms,are permitted to be solely b-ttery operated where rep>aitrs or alkeratlicaisi s`e, Trot resullt iirt the r rnovall of wall aind ce l lig frr islies ox there is no>a.ccess•by, rneams o attic;baaexm ent or crawll s.pace Refer to CIBC S:ectron T�314 a21d CBC Sections 907.2..11.4 and 420,.62rw Ain el, per:t I? ectrreaT nut is.require<<for alarzas whLeht rn �st he,eoiurected to,the Budd 2 g w hag. As owner of the ahove refexezlcad pyop.erty,,1.her,eby certify fla,at tine al ax ref6renced above hast/have.b.eel, instailed,in,,accort arlce,with thezmalnu,ifacturer''s inafre�ctiorrs andin cans 1 tliance,with:the'Cal.-foralai Burs� g p ld»�: anI CAA d nuia; ,'Q srclentrall Codes.°T!`he,alarzms+have been tested'=.air d axer operatiron)all,as;o:•f the,date sig 1ed b.elow., #h—aue,,ruadl and=a rhe;fol com,.l,' wct rms ancf condit�Qns,o fhr,�,statement G rr�3r�i 11 f� S{ tUr,� lz4/ qgfure, .................................................... L b, Date i 1 WATER-CONSERVING PLUMBING MBING FIXTURES V1�LE ,, OWNER CERTIFICATE OF COMPLIANCE CO 6 � COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �Ui'E TINt7 10300 TORRE AVENUE•CUPERTINO,CAA 95014-3255 (408)777-3228 FAX(408)777-3333°buildin4(a7cupertino oEg Owner Name' �01 m t, l Permit J' Address n 61 f? Or. 2- o eihn o C f} 9_�-o 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. 13 1�r{ No: GOto 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, ' tallation of water-conserving plumbing fixtures is not❑ technical 9 1 ea 'Yes CivilCode Sections 1101.1 through 1101.8 do not apply. Y fsable. The licensed plumber's certification has been provided to the Building Division. kip the rest of the form and sign bottom of form. -h10 oto Question 3.- 3. .3. Is water se ice permanently disconnected for your building? Lrm.El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fo �No Co to Question 4. 4. Is your real roperty built and available for use or occupancy on or before January 1, 1994? 1 ❑ No iv.y real property is built and available for use or occupancy after January 1, 1994. I Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes Yj y 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. Please check NE of the following: Myprope s a single-family residential real property, See Civil Code Section 1101.4. On and af ter January 1, 2014,building alterations or improvements shall require all non-compliant plumbing to be replaced with water-conserving plumbing fixtures throughout the building.On or be p P mg fees 17,all non- compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures J(rega(regardless anuary Oof 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 1 plumbing fixtures to be replaced with water-conserving plumbing fixtures.- On or bef e January 1,2019,all non-compliant plumbing fixtures shall be replaced with w a-ter- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). ❑' Mypropery 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 tures 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). 1,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 Oreen Building Standards Code,and manufacturer's 1 installation re uirements,and that the water-conservi Bing fixtures comply with the requirements as indicated in the table on the fo l2wiM page. Owner or Owne Agent's Signature r` I UpoDate: 26 ,F6 n comp eting and signing this Certificate,please return it to the Building Division in order to final your building permit. SB4072015.doe revised 08126115