B-2016-3202CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-3202
11154 LA PALOMA DR CUPERTINO, CA 95014-4773 (356 16 041)
AFFORDABLE WATER
HEATERS AND
PLUMBING INC'
28358
CONSTELLATION RD
VALENCIA, CA 91355
OWNER'S NAME: KE WUUDIANN AND LI CHEN
DATE ISSUED: 12/02/2016
OWNER'S PHONE: 408-916-7472
PHONE NO: (855) 345-9087
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C_W Lic. #$
Contractor AFFORDABLE WATER HEATERS AND PLUMBING INC Date
X BLDG —ELECT X PLUMB
09/30/2018
_ 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 40 GAL WATER HEATER 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
performance of the work for which this permit is issued.
2(1 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
Sq. Ft Floor Area:
Valuation: $1300.00
permit is issued.
APPLICANT CERTIFICATION
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
35616 041
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 again s said City in consequence of the granting of this permit.
Additionally, the aptsa"nt understands and will comply with all non-point
180 DAYS FRO SPECTION.
source regulation per the Cuperti Municipal Code, Section 9.18.
Issued by: MELISSA NAMES
Signature �' II Date 12/02/2016
Date: 12/02/2016
OWNEI
- ' i '
4
I hereby affirni t I at I am exempt from the Contractor's License Law for one of the
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two i asons:
installed without first obtaining an inspection, I agree to remove all new materials for
t. I, as . er of the property, or my employees with wages as their sole
inspection.
corn 3 nsation, 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: 12/02/2016
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. 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
z. 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
Health & Safety Code, Section 25532(a) should I store or handle hazardous
permit is issued.
material. Additionally, should I use equipment or devices which emit hazardous
s. I certify that in the performance of the work for which this permit is issued, I
aircontaminants as defined by the Blay 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 upertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Cod to s 25505,iO3. 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: 12/02/2016
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
I hereby affirm that there is al co truc ior� lending agency for the performance
correct. 1 agree to comply with all city and county ordinances and state laws
of work's for which this perms is issue ec. 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
DECLARATION
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S
I understand my plans shall be used as public records.
and will comply with all non-point source regulations per the Cupertino Municipal
Code, Section 9.18.
C PERTINO
GENERAL PERMIT APPLICATION
MEP'
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 •FAX (408) 777-3333 building(cDcupertino.orgmisc
1-6
PLUMBING MECHANICAL. ❑ ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS
/ / ) %1,54 �y %�ay�y APN n
OWNERNAME ► „,( f m yJ PHONE ^MAIL
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STREET ADDRESSJ
u ^ CITY, STATE, ZIP
CONTACT NAME Cc PHO E�7nI "a
STREET ADDRESS �j g 7 CITY S A ZIP ��
/��/ llL il�h"nl ' FAR
❑ OWNER. ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR El CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER O TENANT
n
CONTRACTOR NAME LICENSE NUMBER LICENSE TI E S BUS. LIC 4 6 65-6 J(�
x
COMP NAME
�,1 FAX
ST T ADD SS CITY, ATE ZIP V " PHON
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
USE OF ❑. SFD .,DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES
BUILDING:. ❑ COMMERCIALS URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑: NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: 1 ()o RECEIVEDHY `
By my signature below, I certify to eac 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 rovide correct. I have read the Description of Work and verify it is accurate. I a ee to or ply with all applicable local
ordinances and state laws relating to b ilding truction. I authorize representatives of Cupertino to enter the ab v�de 2 d pr, p or inspection purposes.
Signature of Applicant/Agent: Date: ��
LEMENTAL INFORMATION REQUIRED ,n,, , ...<:
MFPMisc ipp_2011.doc revised 06121111
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
Mon- ox -de alarms: Wheni the valuation of additions, alterations, o repairs to ex stffg dwell ng'ufals-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
Outside of each.separate sleeping area in the immediate vicinity of
SMOKE ALARM CO ALARM
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 iLot 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 A.Ze Office of the State Eire Marshal.
Dower Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery. operated.
Ili existingdwelling 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
----;--.- alarxms.which-mus t -b e-con—n-ePd_to
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 'v dth the California Building
and California Residential Codes. The alarms specified below have been tested and are operational, as of the
date signed below.
Address: I—a- to, d MOL �}° i 1�C' � ��frt7 r� -CA `( Permit No. 2®/_6 ?2,0'
Specify Namber of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors:.m jl
/have read and agree to comply with the terms and cconditions -of this statement
Owner (or Owner Agent's). Name:
I�� yk'�.
4-
ji //'
Signature.....`.;? ., C��, � ..................................................Date:
..................................................................................................................
Contractor Name:
Signature.................................................................. Lic.# ........,.............................Date:
Smoke ants' C'Oforna.doc remised 09/27/16
CUPSRTIN
Owner Name Z.1- i
Address
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org
'I Permit No.
E
_J,ot L
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.
'R�No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the properly 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.
- leo - GG to Quest3en 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 the form and sign bottom of form.
LSI No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 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.
9 -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. Please check ONE of the following:
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. On 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).
❑ 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.
— ----Ori ofbefore nu�ary 1; ZQ19; 7 nori=comp ral'-nfpluin mg rxtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or'
improvements).
❑ Myproperty 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-conselving 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).
I, 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 1101.8, the current California Plumbing Code and California. Green Building Standards Code, and manufacturer's
installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the
table on the following pale. f P a i
Owner or Owner Agent's Signature- .`162 Date:
Upon completing and signing this Certificate, please return it to the Building Division in order to tinal your building pennit.
SB4072015.docrevised08/26/15 =