2016-3025 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3025
10792 ALDERBROOK LN CUPERTINO,CA 95014-4604(369 20 041) ODOM ELECTRIC INC
SAN JOSE,CA 95126
OWNER'S NAME: ANDERES STEPHEN C AND DEBORAH M TRUSTEE DATE ISSUED:11/02/2016
OWNER'S PHONE:408-252-7153 PHONE NO:(408)821-2421
T ICFNSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-10 Lic.#945359
Contractor ODOM ELECTRIC INC Date 06/30/2018 X BLDG X ELECT _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 Sr Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
UPGRADE PANEL(200 AMP);SAME LOCATION
I hereby affirm under penalty of perjury one of the following two declarations:
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
Alf s performance of the work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as provided for by
10Section3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$2000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 369 20 041
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 in consequence of the granting of this permit. WITHIN 180'DAYS OF PERMIT ISSUANCE OR
Additionally,the ap.` ant understands and will comply with all non-point
source regulati. .-rth - .ertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
OPP
Signature it Al Date 11/02/2016 Issued by:Kim Dunbar
Date: 11/02/2016
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(Sec.7044,Business&Professions Code). Date:11/02/2016
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 haveand 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. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. 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 B ea Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the super 9 no I unicipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Cod.,Sec 4 o . i 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:11/02/2016
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. I understand my plans shall be used as public records.
Date 11/02/2016 Licensed
Signature
Professional
GENERAL PERMIT APPLICATION M E P
„,,,,,,,/ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
„i„.„..,,
C,UPERTINO (408)777-3228• FAX(408)777-3333•buildin. . cu.ertino.or. I S C
p 0 ,...2 Di Co ,.....30 ps__
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PROJECT ADDRESS l G/ 72. A( APN
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OWNER NAME , , n 6PHONE O .`-5 — E_ y,�
STREET ADDRESS /o 9 92 /J j4j00.,....:
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CONTACT NAME
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STREET ADDRESS /� _
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT(' u CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME / '-� LICENSE NUMBER/45.7.3LICENSE TYP r BUS.LIC#
COMPANY NAMEE-MAIL / /� ajC
STREET ADDRESS CITY,STATE,ZIP r-- 7116
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME _ _ ___. E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF a- FD or DUPLEX 0 MULTI-FAMILY PROJECT IN WILDLAND 0 YES PROJECT IN ❑YES IS THE BLDG AN i] YES
BUILDING: 0 COMMERCIAL URBAN INTERFACE ARREEAA ❑ NO �y/"I°�JFLOOD ZONE ❑NO EICHLER HOME? 0 NO
DESCRIPTION OF WORK (�E 71 �...-. � �` �' ' (/ ��(1
TOTAL VALUATION: ct:7T67.-.)(f9- ''' ' ,-;;(4r-7-.-
'i
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 information I have provi.- ;,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 buil.. r..struction. I authorize representatives of Cupertino to enter the abov nti -,0-1 prope .or ction purposes.
Signature of Applicant/Agent: 1 _ " Date:
SUPPL MENTAL INFORMATION REQUIRED
;y QFFLCE L7SE ONLY
W 0 ,OYER-TIME COUNTER
It ❑ EXPRESS
u
0 STANDAI D
D LARGE
ID MAJOR'
MEPMiscApp_2011.doc revised 06/21/11
SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION FILE
-_-
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
1124:1_,(LN
(408)777-3228•FAX(408)777-3333•biaildincicupertino.orq
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of:M,YVtAgtr*2ia-gg-,Mb-n-14xk-WJ:Eki--*AtNWV,MfMKW4M-:::-T- PA.*4sreaojz14-z--- eag-v'-N--'QW%A'*;
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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 (// y 1741(
"
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 X X
the bedroom(s)
• On every level of a dwelling unit including basements X X
'Within each sleeping room . I 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 specified below have been tested and are operational, as of the
date signed below.
Address: 10 fis i Permit No.2216' '3025
Specify Number of Alarms: # Smoke Alarms: #Carbon Monoxide Detectors: J I S'
I have read and agree to c•nply with the terms and conditio s of this statement
Owner(or Owner Agent's)Name:
cDcipto Signature..... 7114I ., 11,\ Date:((
1;Le
--
Contractor Name: _
Signature Lic.# Date:
Smoke and CO f07-177.doe revised 09727/16