B-2016-0422CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2016=0422
10411 STOKES AVE CUPERTINO, CA 95014-1233 (326 47 033)
NQECON
ALVISO, CA 95002
OWNER'S NAME: LAU HENRY H AND BETTY H TRUSTEE
DATE ISSUED: 11/10/2016
OWNER'S PHONE: 408-373-5199
PHONE NO: (650) 630-5967
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class A Lie. #253M
Contractor NOECON Date 10/31/2018
—BLDG _ELECT _PLUMB
I hereby affirm that I am licensed ander 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:
DEMO POOL (800 S.F.) - USE FOR LANDSCAPE PURPOSES ONLY
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
performance of the work for which this permit is issued.
-1 z: 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: $8200,00
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
and state laws relating to building construction, and hereby authorize
326 47 033
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.
Additionally, the applicant understands and will comply with all non-point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations plV114aLuDertiunicipal Code, section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 11/10/2016
Issued by: PAUL O'SULLIVAN
Date: 11/10/2016
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. 1, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 11/10/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
L 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. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. 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 Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cup tiro Mould al C de, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, S c 3, and 2 4.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
i
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 11/10/2016
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 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.)
3o 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
ARCHITECTIS DECLARATION
1 understand my pians shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 11/10/2016
Professional
SWIMMING POOL / SPA PERMIT APPLIC
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING D1VIS10.
10300 TORRE AVENUE CUPERTINO, CA 95014-3255 D
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
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❑ OWNER ❑ OWNER -BUILDER
❑ OWNER AGENT
.ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHrFECT 1:1 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER % 5 -3 Y9
LICENSE TYPE
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ARCFIITECT/ENGINEER NAME
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PHONE
DESCRIPTION OF WORK
{ZIP
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USE of ❑ SFD or Duplex Multi -Family
STRUCTURE: ❑ Commercial
POOL/SPA MATERIAL TYPE CODES:
V - VINYL -LINED
F - FIBERGLASS
G - GUNITE
P - PREFABRICATED
By my signature below, I certify to each of the following:
application and the information I have provided is o a�tc
ordinances and state laws relating to building cons c .o
Signature of Applicant/Agent:
TYPE
POOL
SPA
DEMO
MATERIAL TYPE (CODE) I AREA (SQ. FT.)
0 1 -8-0 (T)
y
VALUATION ($)
am the property owner or authorized agent to act on the property owner's behalf. I have read this
have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
u prize representatives of Cupertino to enter the above -identified property forinspectionpurposes.
I(
Date: N —r(7
SUPPLEMENTAL INFORMATION REQUIRED
Commercial or Multi -Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
SwimPoolApp_2011.doc revised 03116/11
1 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
UP RTINO � 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3225 • FAX (403) 777-3333 a buildingrcDcupQrflnQ r
] RMIT C i�3l'CiT BE I+"iNALE1]_ I;TNTIL TSS CPitTIFICA E HAS BEEN- -
cvlr NU r<� ? �` xa T sl >r>r D T1IVISI 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 907.2.1 1.2 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
SMO
KE ALARM
CO ALARM j
Outside of each separate sleeping area in the immediate vicinity of
_
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# .....`T..S...P....(.. U....... Date:
X
X
the 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 el -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with srnoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marsh fl.
Pourer 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 rri eans 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 sighed below. P
Address: /6// /( G�"Y Permit No7__a.2�_
Specify Number of Alarms:
# Smoke Alarms:
# Carbon Monoxide Detectors:
I haves raart ani nnraa to rmmn/v wth tha harms anr1 r_nnriitinn.cl of this .ctatamant
Owner (or Owner Agent's) Name: /
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Signature...........
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..........................Date:
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ontractor am
Signature........ .. Lic
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....................... ................................................
Smoke and CO form.doe remised 09/27/16
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Owner Name
Address
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIV1SION
'i0300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777;.322.8 • FAX. (408) 777-3333 • buiidin coertina o�
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.
KNo Go to Question 2.
2. Does your weal property have a licensed plumber certifying that, due to the age or config ration 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 Di iision.
Skip the rest of the form and sign bottom of forin.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of
K No Go to Question 4.
4. is your real property built and available for use -or occupancy on or before January 1, 1
❑ No My real property is built and available for use or occupancy after January 1, 1
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the
'Lp Yes My real property is built and available for use or occupancy on or before Jam
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three R
bottom of form..
Please check ONE of the following:
My property is a single-family residential real property. See Civil Code Section 1101
On and after January 1, 2014, building alterations or improvements shall require all
to be replaced with water -conserving plumbing fixtures throughout the building. On
compliant plumbing fixtures shall be replaced with water -conserving plumbing
property undergoes alterations or improvements).
❑ My property is a mzdtifancily residential real property. See Civil Code Section 1101.'
On and after January 1, 2014, specified building alterations or improvements shall rec
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced 1
conserving plumbing fixtures throughout the building (regardless of whether propert}
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 re(
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be reg
plumbing fixtures throughout the building (regardless of whether property undergoes
and sign bottom of form.
a and sign bottom of form.
1, 1994.
✓ing statements and sign
non-compliant plumbing fixtures
r before January 1, 2017, all non -
fixtures (regardless of whether
non- compliant
,rth water -
undergoes alterations or
non- compliant
aced with water- conserving
Iterations 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 110 1. 1
through 110 1.8, the current California Plumbing Code and California Green Building Standards
Code, and manufacturer's
installation requirements, and that the water-conser in plumbing fixt •es comply with
e requirements as indicated in the
table on the following page. _ -Date:
Owner or Owner Agent's Signature:
1/ 7117
Upon completing and signing this Certificate, please return it tithe Building Division, in rder to Final your building permit.
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