B-2017-0075CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0075
10460 CASTINE AVE CUPERTINO, CA 95014-1309 (326 41 030)
WESTERN GENERAL
CONSTRUCTION INC
SAN JOSE, CA 95122
OWNER'S NAME: KUNDU KUNALAND PODDAR JAYITA TRUSTEE
DATE ISSUED: 01/25/2017
OWNER'S PHONE: 408-446-1350
PHONE NO: (408) 887-0052
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Ej Lic. #25=
Contractor WESTERN GENERAL CONSTRUCTION INC Date 09/3012018
X BLDG _ELECT —PLUMB
MECH X RESIDENTL4,L 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
license is in full force and effect.
JOB DESCRIPTION:
I ST FLOOR BATHROOM REMODEL - HALL BATH (40 SQ);
I hereby affirm under penalty of perjury one of the following two declarations:
REPLACE STUCCO (5 FT)
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.
-
a.'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: $45000.00
permit is issued.
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 41 030
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 applicant understands and will comply with all non -point
source regulations per the Cupertino Municipa ode, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Date 01/25/2017
Signature Date
Issued b A -NAME,
MEL49K
OWNER-BUILDERDECLARATLON
Date: 01/25/2017
I hereby affirm that 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 reasons:
1. 1, 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 (See.7044, Business & Professions Code).
Date: 01/25/2017
1 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
performance of the work for which this permit is issued.
HAZARDOUS DISCLOSURE
2. 1 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. 1 will
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 defined by the Day Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the HLegajJb-&.SakJX Code; Sections 25505, 25533, and 2553
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:7�
AP PLI C ANT ! C E RT I F I C A T 10 NDate:
01/25/2017
I certify that I have read this application and state that the above i . nformation is
CONSTRUCTION LENDING AGENCY
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 lawsI
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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,
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
Signature Date 01/25/2017
professional
CUPERTINO-
1\,Fw CONSTRUCTION
CONSTRUCTION- PE:RM[T APPLECAT[ON
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO,-CA 95014-3255
(408) 777-3228 • FAX (408} 777-3333 - buiidino aPoupert'no.ar r
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By illy signature below, I certify to each ofthe following: t 211) the property Owner or authorized agent to.act on the property owner's behalf. I have read this
application and the infbmration. 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 relating to building construction uthorize representatives of Cupertino to enter the above -identified property for inspection purposes.
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_ New SFD or Multifamily &Lle-llings: Apply for demolition permit for
etstm� buildursDemolition permit is required prior to Issuance of building
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f`olm ifany Hazardous Materials are being used as paft of this project.
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Copy oPlamrin A� ro\a1 Letter or Meeting with Plann'n r'or to
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submittal of Building Permit application.
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CU#TI<NO ,
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(o-cupertino.org
PERMIT CANNOT BE FINALED JUNTIL THIS CERTIFICATE HAS'BEEN
COMPLETED, SIGNED AND 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 sleepffig sleepingroom
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:{( �, 'ii j" Permit No. 9
t
Specify Number of Alarms: # Smoke Alarms: �1 # Carbon Monoxide Detectors:
1 have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
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Signature.................................................................................................................Date: P
....................................................................................... ...........................................
Contractor Name:
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Signature .................. ....Lic.# .... Date: f
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Smoke and CO form.doc revised 09127116
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