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B-2016-2674 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2674 10290 IMPERIAL AVE-CUPERTINO,CA 95014-5947(357 19 053) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS,TN 38120 OWNER'S NAME: ROBSON MARY L ET AL DATE ISSUED:09/07/2046 OWNER'S PHONE:408-253-6270 PHONE NO:(901)271-9700 LICENSED CONTRACTOR'S UC TI N BUILDING PERMIT INFO: License Class CC-36 Lic.#765155 Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INCX BLDG —ELECT X PLUMS Date 07/3112018 _MEECH 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. TWO WAY CLEAN-OUT 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. rt f 2. 1 have and will maintain Worker's Compensation Insurance,as provided for by 1 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area;, Valuation:$38280.00 permit is issued APPLICANT CERTIFICATION certify that 1 have read this application and state that the above APN Number: Occupancy Type: information is correct.1 agree to comply with all city and county ordinances 357 19 053 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:Kim Dunbar Signature Date 09/7/2016 Date:09/07/2016 OWNER-BUILDER DRATION 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. 1,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: /709 /2016 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 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 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. 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 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 shall not employ any person in any manner so as to become subject to the air contaminants as de£med 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 authorized agent: �--" be deemed revoked. Date:09/7/2016 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 mentionedproperty 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. Licensed MEPGENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 Ct. PER"i INO (408)777-3228•FAX(408)777-3333•build'€n cu ertino.ar MISC J�JFPLUMBING ❑MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS �r`q�_. ( �' ..... _. APN# l �1 3 OWNER NAME � PHONE _ a QCLM 3O C 1�8 l�� q^ C ! EMAIL STREET ADDRESS CITY,LALTE,ZIP _.. _. FAX - CONT NAME (,*/�- _ (J V'W\ ie�5 3`ViC%1 PHO E MAII, (�l(S ! STREET�f�R � J CITY, FATE,ZIP FAX ❑OWNER 0 OWNER-BUILDER ❑ OWNER AGENT M-CONTRACTOR ❑CONTRACTOR AGENT 11 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTO Y AME- LICEN E NUMBER „� LICENSE TYPE BUS.LIC# f r-Lo 126( COMP NY DAME _ �° C4 ee-SCW STREE ADDRES,S� CITY,STATE,ZIP PHONE rA ARCHITECT/ENGINEER NAME LICENSENUMBER BUS.LIC COMPANY NAME E-MAIL - . - .. . FAX -_ STREET ADDRESS - CITY,STATE,ZIP - - PHONE USE OF " W IFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING ❑COMMERCIAL. URBAN INTERFACE AREA ❑.NO FLOOD ZONE -❑NO EICHLERHOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the informatio 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 vela g to building construction. I authorize representatives of Cupertino to enter the above-identifi d property for inspection purposes. Signature of Applicant/Agent: /� Date: SUPPLEMENTAL INFORMATION REQUIRED NMI I w7LttOIrIT�T2, x a m - Q VJAdt3i r MEPMiscApp_2011.doe revised 06/21/11 FILE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE - y COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION +fit PERTIINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333•building(fcupertino.org I k7q Permit No. Address_, r--#-of Alarms—Smoke, Carbon Monoxide: t u PE1t11 IT CAI ISI©T 3E FINALFID�COMPt ETED UNT ,THIS CERT1FIC TF au A BEELRN + Nn TiED T E BALD I _B " �N 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 420.6require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: Y AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vidnity of the bedroom(s) P On every level of a dwelling unit including basements X-11, .• 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 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 Owner(or Owner Agent's)Name: Si nature _ Date: ....... .... Contractor Name: r1a Si natures _. ......... .........Lic.# 1.(. . .........Date: .. .. Smoke and COform.doc revised 03118114