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B-2016-3305CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR:� 948 BR OKGRPERMIT NO: B-2016-3305 OVE IN CUPERTINO, CA 95014-4668 (375 39 031) I PALO ALMO, CA 94$03 OWNER'S NAME: CHEN CHRISTINE HAND TEOTIANEERAJ P I IDATE ISSUED: 12/20/2016 1 I OWNER'S PHONE: 408-805-2874 I I PHONE NO: (650) 520-8718 1 License Class= Lic. #826797 Contractor E.J P UMBING Date 01/31/2019 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 license is In full force and effect. I hereby affirm under penalty of perjury one of the fallowing two declarations: 1. I have and will maintain a certificate of consent to self -insure for Worker's INFO: X BLDG _ ELET X PLUMB MECH X RES ENTIAL _ COMMERCIAL JOB DESCRIPTION: RE -PIPE SFD (COPPER) PARTIAL - PLANNING REQUESTED PIPES BE PAINTED TO I4ATCH HOUSE Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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: $7500.00 APPLICANTT CFRTIFICATION 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 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 City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting -of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I� �F'al+£iTili hereby affirm that I am exempt from the Contractor's License Law for one of the Hawing two reasons: 1. 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three 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. 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. 3. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person`in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of 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 be deemed revoked. APPLICANT 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 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 City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 12/20/2016 APN Number: I Occupancy Type: 375 39 031 PERMIT E IRES IF WORK IS NOT STARTED WITHIN 18 DAYS OF PERMIT ISSUANCE OR 180 DAYS F OM LAST CALLED INSPECTION. by: RE-ROOFS.- All E,-ROOFSAll roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first gbtaining an inspection, I agree to remove all new materials for inspection: Signature of Applicant:' Date: 12/20/2016 It A it HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health #r Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain complia�ce with the Cupertino Municipal Code, Chapter 9.12 and the Health 8{ Safety Code, Sections 25505, 25533, and 25534. Owneror authorized agent authorizedl 12/20/2016 �� r A = +.N,CY hereby affirm that there is a constr tion lending agency for the performance of work's for which thi permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans) shall be used as public records. Licensed CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq()a.cuDertino.c 1 DT T TAT- I -I ..T �1 •� 1 — – ,_, — 1 I KIUAL I_ I MISCELLANEOUS PROJECT ADDRESS 14" ' rte/ FN # D sy— ¢� -3 1( OWNERNAME �- eo PHONE �Q ` E-MAILL STREET ADDRESS CITY, STATE, ZIP B FAX CONTACT NAME ,� t ✓1 PHON� to U,t1 E-MAIL STREET ADDRESS CITY, STATE, Hf FAX w / �9 v ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENTCONTRACTOR ElCONTRACTORAGENT ❑ ARChITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME p LICENSE NUMBER � LICE SE TYPE to BUS. LIC # f+ COMPANY NAME r E-MAIL FAX STREET ADDRESS c CITY STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SET) or DUPLEX ❑ MULTI -FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES L4 THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK D w v TOTAL VALUATION: 7 ^ RECEIVED Y By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on he property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is ac urate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicantlAgent: e-- Date: Z_ Q –/4 SUPPLEMENTRfINFOUL770N REQUIRED " OFFICE us ONLY P4 © OVER-THE-COUNTER ❑ EXPRESS ❑ STANDARD �V Q ❑ LARGE F, ❑ MAJOR MEPMiscApp_201 Ldoc revised 06121111 Z_- CUPERTINO i SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aakupertino.om PERMIT CANNOT BE FINALED UNTIL.THIS CERTIFICATE HAS BEEN. COMPLETED, SIGNED AND RETURNED TO THE BUILDING DIVISION 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 420.6 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 the bedroom(s) X X 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 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: q-lb9Yr-,,j!c, v -o GLVie',Jj CA < CU 0ijermit No. Specify Number of Alarms: # Smoke Alarms:_,,_// # Carbon Monoxide Detectors:, t 1-- rater! Jnr! —roc fin Amply moth tha ter' AGIC]' Conditions of this statement Smoke and CO fotni.doe revised 09/27/16 ®!1 Owor (or Owner Agent's N me: % LII 'f/lrj Signature. .... ... ........ .... .......... ................... ................... J ............Date:l2 12/ l ................................................... Contractor Name: Signature.................................................................. Lic.# ......................................Date: Smoke and CO fotni.doe revised 09/27/16 ®!1